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9 years ago

Creating an end-of-life plan

9 years ago
Reprinted from Cuenca Hilife

By Wendy Jane Carrel

While conducting research on continuing care and Capture guest colend-of-life options for older adults in Ecuador, I have witnessed the unexpected deaths of many North American expats. Here are some of the lessons I’ve learned.

If you want to save your family and other loved ones considerable grief, it is important to understand what is involved when a foreigner dies in Ecuador, and to have a plan in place, just in case. This goes for 40-year-olds as well as 60- and 70-year-olds.
Wendy Jane Carrel

Wendy Jane Carrel

Even though the subject is one that many of us prefer to avoid, your family and friends back home will be grateful if you plan ahead. Understand that the rules governing the disposition of human remains in Ecuador are different from those in North America. The time and bureaucratic requirements required to negotiate the Ecuadorian system, post-death, is daunting. Think: different culture, different point of view, different procedures.

MATTERS TO CONSIDER

Are you living alone? If so, do you have friends who can follow through with your wishes if you die?

Do you have a physician available who can be called immediately and declare cause of death to obtain a death certificate so an autopsy can be avoided (unless foul play is suspected)?

EMUCE, Cuenca City CemeteryWhich funeral service or transporter will collect your body?

Do you want your organs donated? Do you want to donate your body to an Ecuadorian medical school?

Do you want to be cremated or buried?

Have you chosen a funeral service or crematorium to handle your remains?

Do you want your ashes or remains shipped home? Do you want your remains to stay in country?

Who will be in charge of your affairs in the immediate aftermath of your death? Who will deliver the legal documents with your wishes to the crematorium or funeral home, obtain the Ecuadorian government declaration of death with appropriate stamps from the Civil Registry and the Ministry of Foreign Affairs? Who will obtain the proper documents from the U.S. Embassy or U.S. Consulate if remains will be going home?

OBSERVATIONS ON CREMATION OR BURIAL

The Ecuadorian culture, being predominantly Catholic, does not have a preference for cremation. If you had chosen to live in Asia, cremation would be a relatively easy matter involving fewer steps, as cremation is common practice there. When death occurs, local practices will govern how quickly a cremation can take place.

Cremation in Ecuador usually requires the approval of three blood relatives. A spouse is not EMUCE, Cuenca City Cemeteryconsidered a blood relative, by the way, and although exceptions have been made, don’t count on one.

There can also be roadblocks to cremation in cases if out-of-wedlock children or out-of-country children claim inheritance, especially if you own property in Ecuador. According to Ecuador law and tradition, all children who can prove paternity are entitled to a part of your estate, another reason the government prefers burial. Cadavers can be exhumed and DNA tested.

Burial in Ecuador is easier than shipping a casket home and less expensive, with one exception. Many cemeteries offer purchase of plots for a set period of time, with the understanding that remains will be removed and buried elsewhere at the end of that period. Arrangements must be made, in advance, for this relocation of remains.

If you are American, and your wish is to have your ashes or remains sent home, there is another step to complete after all Ecuadorian death-related documents are obtained. If your body has been cremated, the person who performed the cremation must go to the American Embassy in Quito or to the U.S. Consulate in Guayaquil and sign an affidavit that he or she cremated you. Your estate or family must pay for travel and other expenses, which includes paying the person’s wages for the day, lodging (usually not necessary) and meals. (See U.S. Government 7 FAM 258 DOCUMENTS TO ACCOMPANY REMAINS; these regulations were updated January 18, 2013). If your body is cremated in Cuenca, Loja or Ibarra, understand the expense and effort needed to fulfill this requirement.

As for shipment of remains in a casket, a U.S. consular officer will work with you to ensure that the Ecuadorian funeral director and American funeral director are in communication to guarantee that preparation of remains complies with local, U.S. Department of State, and federal requirements. Also note: DHL, Federal Express, and embassy diplomatic pouches cannot be used to ship cremated remains out of the country.

What happens if you die in Ecuador, have no spouse, and next-of-kin or legal representatives cannot be contacted? Your body will probably be transported to a morgue or public hospital (Hospital Vicente Corral Moscoso in Cuenca, for example), or to the city cemetery, where it will be placed in a mausoleum wall for four years. If no one claims it, your body will then be cremated and the ashes placed in a communal grave.

MAKING LEGAL PREPARATIONS

If you live alone, it is advisable to find two friends who can contact family you may have, as well as follow through on your wishes. You will need a legal document with the names of the persons you choose to represent you incorporated into your declaration. If you are married, it is still wise to designate others than your spouse who can look after your wishes, as I mentioned earlier.

Create a Constancia or a Documentacion Juramentada for end-of-life arrangements with an attorney and have it notarized. This is not a do-it-yourself (DIY) proposition; you need an attorney to prepare the document. Also note that your Advanced Health Care Directive or your Five Wishes (legal in almost all U.S. states, see www.AgingwithDignity.org ) are not valid in Ecuador even if notarized, apostilled and translated into Spanish. The U.S. and Canada use common law, a system of English law. Ecuador is governed by civil law. Again, your North American documents will not be recognized. If you wish to be cremated, and do not want your organs donated, this is especially important. Your desires must be stated ahead of time in these documents even though organ donation preference is registered at the Civil Registry when you receive your cedula.

Give copies of your documents to the persons who will represent you. Carry a copy of the document with you when you travel in the country. I carry my document with a list of people to contact in case of the unforeseen. I feel blessed to have the document and people I trust. When I’m not traveling, I carry an ID contact card with the name of my physician of preference, one family member, and two trusted friends who live nearby.

Ecuador’s Ministry of Foreign Affairs is now considering a protocol for the demise of foreign nationals who wish to be cremated. When applying for the cedula, the national ID card you receive with residency, there would also be a place for you to check to request cremation, or that you wish to will your body to a medical school. There is currently a place to check that you do or do not want your organs donated but I have heard of cases in which organs were harvested due to clerical error.

Note: In Ecuador your organs are automatically donated unless legally stated otherwise. Again, create the legal document that can protect you. If the government creates such a protocol (expect a year or two for this to happen), there may be less of a need for a Constancia or Documentacion Juramentada but I would still advocate having one anyway. Ecuador recognizes and accept papers from attorneys and notaries that have official stamps on them.

CONCLUSION

Remember that Ecuadorian legal documents rule. If you plan to live in Ecuador, make certain to create end-of-life arrangements with a local attorney and notary.

Remember to appoint at least two people who can legally represent you.

Have an end-of-life conversation with loved ones or friends. A movement in North America and Europe has emerged over the last two years about creating end-of-life wishes. Assisted Living homes are hosting “death cafes”, where residents talk about what constitutes a “good” or “comfortable” death and sacred burial. How do you envision the process? How will your body be handled? A British Medical Journal study released in 2010 concluded that surviving family members and spouses experience “significantly less” anxiety, depression, and stress than those whose loved ones did not have advanced plans.

Avoiding the subject of death may not be in your best interests. Consider making your plans known now. Create an end-of-life plan wherever you reside. It will provide peace of mind and a measure of control over your preferences. At some point, each of us will make our transition.

Resources

AgingwithDignity.org, British Medical Journal study, International Society of Advance Care Planning & End of Life Care (ACPEL), U.S. government document regarding disposition of remains http://www.state.gov/documents/organization/86578.pdf

Wendy Jane Carrel, M.A., is a bi-lingual North American. She has spent over two years traveling province to province in Ecuador (as well as in Chile and Mexico) researching senior care options. In her home state of California she served as a Senior Center Director for a city, Head of Information and Outreach for a County Office on Aging, Administrator in Assisted Living (including Alzheimer’s care), and a non-profit communications and grants officer. She offers guidance for North Americans who wish assistance negotiating the Ecuadorian health system, senior care options countrywide, end-of-life care, and disposition of rem

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