For any family, end-of-life planning involves preparing legal documents, making healthcare decisions, and documenting preferences for disposition, memorialization, and financial matters. For LGBTQIA+ individuals and families, planning often requires additional considerations to ensure identity, relationships, and chosen family are recognized and respected throughout the end-of-life process.
While progress has been made, disparities still exist within healthcare, legal, and institutional systems. Thoughtful planning can help protect your wishes and provide peace of mind for the people you love.
Earlier this year, we worked with a family whose experience highlighted why these conversations are so important.
Mara* was a beloved transgender woman who died unexpectedly. Mara's mother belonged to a religious community that did not recognize transgender identities. After years of estrangement, Mara's inner circle worried that her mother could be identified as next of kin and gain authority over decisions that might not reflect Mara's identity, relationships, or wishes.
In this challenging case, Mara's mother could not be reached. While this reduced the likelihood that decisions would be made contrary to Mara's wishes, it also disrupted the normal decision-making process and created uncertainty during an already difficult time. As timelines advanced, Mara's community was left navigating legal and logistical challenges while trying to honor the person they loved.
The following sections explore common challenges LGBTQIA+ individuals may face during medical emergencies, funeral planning, and estate administration, and the steps that can help protect their wishes.
In the event of emergency or hospitalization, these are challenges that LGBTQIA+ face at higher rates than the general population:
Advance Health Care Directives are legal documents that let you state your medical wishes in advance and designate someone to make healthcare decisions for you if you're unable to communicate them yourself.
An Advance Health Care Directive is a legal document that allows you to:
A healthcare agent can:
You can also document preferences with things such as:
Without an Advance Health Care Directive, healthcare providers generally turn to next of kin as defined by state law. That person may not be the individual you would choose to speak on your behalf, or uphold your wishes.
Once your directive is completed:
Braeden Cohen, CEO and co-founder of LifeSource, recommends notarizing Advance Health Care Directives whenever possible. "Getting it notarized is the most protective way to complete an Advance Health Care Directive. You can even find 24-hour notary services. Simply letting people know what you want is not going to guarantee that you get what you want."
Chase, funeral director and cofounder at LifeSource, who has worked in funeral service for 14 years, says he encounters approximately one case a year where a lack of documentation creates complications for an LGBTQIA+ family
"People don't understand that once you get to the hospital setting, the rules completely and utterly change." Good intentions and verbal understandings do not carry weight once medical and legal systems become involved, so he recommends keeping a digital copy of your directive readily accessible so it can be provided quickly in an emergency.
The person making healthcare decisions before death is not necessarily the same person who has legal authority over final disposition after death.
In most cases, documents that authorize someone to act on your behalf while you are alive, such as a Medical Power of Attorney or Advance Health Care Directive, expire upon death. In California, a health agent named on an Advanced Healthcare Directive has legal rights to make decisions on final disposition.
A prearranged funeral plan can help ensure your wishes are clearly documented and followed. Chase emphasizes the value of preplanning, "We (LifeSource) follow the pre-need to a T. The only time there are issues is when there are inaccuracies in the documentation."
As with medical care and funeral planning, if not documented, property and assets may fall to next of kin be default. Not having a will may create challenges around:
Chase reminds families that these documents can and should be updated as circumstances change.
"You can always override older documents with new documentation. Be sure to update names and dates. As long as the new documents are properly executed, they will supersede older versions."
End-of-life planning is an opportunity to ensure your identity, relationships, values, and wishes are respected. For LGBTQIA+ individuals and families, thoughtful planning can help protect chosen family, reduce conflict, and provide clarity during some of life's most difficult moments.
The best time to create these documents is before they are needed.
