I’m dead, now what?

This provocative title caught my eye at the local bookstore several years ago. It is a practical workbook that functions as both an organizer and end-of-life planner. My siblings (who share a similar dark and cynical sense of humor) appreciated it as a unique holiday gift during the pandemic.

The thought occurred to me that this type of planning does not always occur for psychologists in practice. Fewer than half of Americans have a will, according to several Gallup polls published in 2019 and 2016, respectively. I’m not aware of surveys of practicing mental health professionals on this topic but it could be a good dissertation topic for a graduate student! Bottom line: I suspect that there are many psychologist practitioners who are remiss on succession planning.

Death denial is pervasive. Cognitive scientists suggest we may be “hardwired” to believe in immortality. Deb Kelemen, professor of psychological and brain sciences at Boston University and developmental psychologist argued in an academic presentation that we are “natural eternalists who are naturally biased to believe in psychological immortality.”

Natalie Emmons, formerly a post-doctoral researcher at BU, and Dr. Kelemen have published research demonstrating that across cultures and religions, children are predisposed to believe that their emotions and desires existed prior to life.

Jesse Bering, an American psychologist at University of Otago, New Zealand and author of “The Belief Instinct: The Psychology of Souls, Destiny, and the Meaning of Life,” has described how our very cognitive architecture makes it near impossible for humans to conceive that our emotions, desires, and self will not exist in some form after death.

From a cognitive behavioral therapy perspective, it seems that people are prone to a core cognitive distortion about our own immortality. It reminds me of a particularly sardonic college friend who once accompanied me to the shopping mall. When the clerk asked, “How would you like to pay for that?” she replied, deadpan, “I’d rather not.”

Though we would all “rather not,” the fact remains, anyone at any age can be incapacitated or die from myriad causes.

As an example, stroke is the leading cause of long-term disability and the third leading cause of death in the U.S. More than one out of three people hospitalized for stroke are under the age of 65.

Psychologists are as likely as anyone else to become incapacitated or die during our careers. All mental health professionals, practitioners, and researchers should leave instructions that serve as a “professional will” to help our colleagues and loved ones handle our affairs if we die or become incapacitated while still active in our career.

It is not only common sense, but an ethical obligation for practitioners to plan for the possibility of service interruption because of death or disability. Section 3.12 of the American Psychological Association’s ethics code reads, “Unless otherwise covered by contract, psychologists make reasonable efforts to plan for facilitating services in the event that psychological services are interrupted by factors such as the psychologist’s illness, death, unavailability, relocation, retirement, or by the client’s/patient’s relocation or financial limitations.”

If such planning does not take place, then the responsibility for handling the details of a career interrupted by death or disability falls to colleagues or relatives and potentially leaves a less than positive legacy.

How will active and past clients be notified? Who will take responsibility for transfer and retention of patient records, according to state law? Depressingly, even death does not protect us from malpractice litigation! Your estate can still be sued. Those who have served as executors are aware that there are countless clinical, legal, and financial details to be sorted out after a person’s unexpected death or disability.

The American Psychological Association’s Practice Organization has created multiple helpful articles focused on succession planning, as well as how to create a professional will. Though the term “professional will” is used ubiquitously, I have read at least one opinion that the term may be inaccurate from a legal perspective given that wills are made for individual people rather than for their business practice or careers.

The process involves creating a succession planning document that identifies the person(s) who will serve as executor and provides them with the relevant information to carry out the wishes of the psychologist who has become disabled or died. Most electronic medical record applications request that a professional will be uploaded to provide instructions for how to handle records in the event of incapacitation.

I once knew a wife whose husband was not a psychologist but whose small business had similar requirements for dissolution. He died without a will, leaving her to cope without passwords, usernames, or key financial information and to determine whether thousands of files needed to be retained. She spent the better part of two years paying for storage space, sorting through paperwork, and spending sleepless nights in fear that she would be sued if she failed to handle her husband’s business affairs properly.

Ironically, his was not an unexpected death. He had learned that he had an end stage cancer more than 13 months before he died but like most of us, believed that he would have enough time to handle such matters.

People diagnosed with life threatening illness often fail to anticipate that they may suffer a complication and become too sick to function in their current role, prior to death. Lack of planning can similarly affect researchers and academics. Consider the world of academic research. Without written instructions, there is a great deal of discretionary decision making about how to handle projects, data, authorship, and research grants. Academic leaders and colleagues are more likely to feel prepared with a document outlining the specifics of an individual’s succession plan.

Active and former patients may be particularly affected by a practicing psychologist’s death or sudden disability. It is critical to identify a clinician who is suited to help clients make a successful transition to a new therapist. Often, the topic of making a will comes up when I am working with clients who are diagnosed with life threatening illnesses. I usually share the observation that I have never known anyone to not feel relieved at having made decisions and written instructions that will help others to handle their affairs after death.

Succession planning reduces emotional distress for those left behind. Margareta Magnussen, author of the 2017 book, “The Gentle Art of Swedish Death Cleaning,” developed a checklist with a section for important papers. The checklist suggests that you designate an area for important documents and files, be sure that key people know where to look, and periodically check to be sure that your will (in this case, your professional will) is up to date.

While we may be cognitively unable to imagine our own non-existence, it is easy to envision how much easier it would be for another person to handle our affairs with written instructions, versus without.