How Engaged in Legal Planning for Incapacity and Death Are Canadians? A Mixed-Methods Survey.

Background: This study aimed to measure the level of involvement of Canadians in preparing for incapacity and death and to explore facilitators and barriers. Method: The authors used an online survey based on the social cognitive theory and the Stages of Change model. Result: One-hundred and forty-eight participants took part. The main facilitators were avoiding burdening others and reducing conflicts. Some respondents thought legal planning did not apply to young and healthy people. Some did not trust lawyers. Conclusion: The authors suggest that more people would trust lawyers if they knew the limits of legal documents and if they worked with medical experts.

Integrated likelihood for phylogenomics under a no-common-mechanism model.

BACKGROUND: Multi-locus species phylogeny inference is based on models of sequence evolution on gene trees as well as models of gene tree evolution within the branches of species phylogenies. Almost all statistical methods for this inference task assume a common mechanism across all loci as captured by a single value of each branch length of the species phylogeny. RESULTS: In this paper, we pursue a "no common mechanism" (NCM) model, where every gene tree evolves according to its own parameters of the species phylogeny. Based on this model, we derive an analytically integrated likelihood of both species trees and networks given the gene trees of multiple loci under an NCM model. We demonstrate the performance of inference under this integrated likelihood on both simulated and biological data. CONCLUSIONS: The model presented here will afford opportunities for exploring connections among various criteria for estimating species phylogenies from multiple, independent loci. Furthermore, further development of this model could potentially result in more efficient methods for searching the space of species phylogenies by focusing solely on the topology of the phylogeny.

Prevalence of enduring power of attorney and barriers towards it in community geriatric population in Counties Manukau Health.

AIM: Enduring power of attorney (EPA) is a simple and easy-to-set-up legal document which protects the wishes of the donor, as well as preventing significant psychological and social cost for the patient and their family when long-term residential care needs to be arranged due to the patient's increasing care requirements. It also reduces the significant cost in hospital beds days for the district health board involved while awaiting the Protection of Personal and Property Rights order. However, the prevalence of EPA is low in the geriatric population who arguably need it the most. This study aims to identify the barriers in obtaining an EPA in this population. METHODS: Using a cross-sectional design, 100 individuals seen in community geriatric clinics or home visits in Counties Manukau Health between June to September 2015 were surveyed. RESULTS: There was no significant difference in prevalence of EPA between those with cognitive impairment and those without (40.4% and 35% respectively with difference in proportion 5% (95% CI: -14% to 24%, p 0.61)). New Zealand Europeans were more likely than other ethnic groups to have EPA (63.5% vs 10.4%, with difference in proportion of 53% (95% CI: 37% to 69%, p<0.001)). Forty-three participants without EPA gave lack of information as their reason for not having obtained one. The majority of those without EPA (49 participants) felt that their doctor or lawyer would be the best person to convey such information to them, as opposed to mass media such as TV or internet. CONCLUSION: EPA has not been widely acknowledged as an important aspect of health and legal planning by the participants of this survey, predominantly due to the lack of knowledge in the general public and financial barriers. Increased efforts to educate and support uptake could have positive personal and social outcomes.

Last wills and testaments in a large sample of suicide notes: implications for testamentary capacity.

BACKGROUND: The leaving of a will prior to death by suicide is a relatively unexplored area. AIMS: To determine the frequency and details of will content in suicide notes. METHOD: Coroner records for 1565 deaths by suicide in Toronto (2003-2009) were reviewed for (a) will content and (b) the presence of depression, psychotic illness, dementia and intoxication prior to death. RESULTS: In total, 59 (20.7%) of 285 available suicide notes were found to have will content. Of those who left a will, 43 (72.9%) were reported to have a major mood or psychotic disorder, but none had dementia. Fifteen of 19 toxicology samples showed alcohol, sedative hypnotic/benzodiazepine, opioid and/or recreational drugs were present. CONCLUSIONS: A substantial minority of suicide notes may also include testamentary intent. The observed high rate of mental illness and substance use around the time of death has important clinical implications for understanding the mindset of people who die by suicide and hence also legal implications regarding testamentary capacity.

End-of-life planning activities: an integrated process.

This study examined end-of-life planning and whether common characteristics predicted completion of these decisions. Participants in the Nebraska End-of-Life Survey were asked whether they had heard about or completed five plans: a health care power of attorney agreement, a living will, a last will and testament, funeral or burial preplanning, and organ and tissue donation. Logistic regression was used to identify predictors of these outcomes. Predictors of completing end-of-life plans, including funeral and burial preplanning, included older age, higher household income, and higher religiosity. This suggests that all of these decisions may be part of an integrated planning process at the end of life. Further, results from this study indicate that the role of religiosity, found in this study to predict both financial and health care planning, warrants further exploration.

The social stratification of older adults' preparations for end-of-life health care.

I use data from the Wisconsin Longitudinal Study (n = 4,971) to evaluate the extent to which socioeconomic status affects three health-related (living will, durable power of attorney for health care, and discussions) and one financial (will) component of end-of-life planning. Net worth is positively associated with all four types of planning, after demographic, health, and psychological characteristics are controlled. Low rates of health-related planning among persons with low or negative assets are largely accounted for by the fact that they are less likely to execute a will, an action that triggers health-related preparations. Rates of health-related planning alone are higher among recently hospitalized persons, whereas financial planning only is more commonly done by homeowners and those with richer assets. The results suggest that economically advantaged persons engage in end-of-life planning as a two-pronged strategy entailing financial and health-related preparations. Implications for health policy, practice, and theory are discussed.

Respuesta de los autores. Comentarios acerca del documento de voluntades anticipadas / Author's reply. Comments on living wills

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Risk-reducing legal documents: controlling personal health and financial resources.

Every adult can eliminate the risk of losing control of personal health decisions and financial resources by having a last will and testament, health proxy, power of attorney, and living trust. Yet evidence suggests that less than a majority of adult Americans have these documents. We surveyed 900 adult Americans (25 plus years old) to determine what factors predict the possession of these risk-reducing documents. In total, 46% had a living will and testament, 32% a durable power of attorney, 30% a health proxy, and 18% a living trust. Events that prompt people with wealth to secure these documents, such as increasing age, getting married, having children, and experiencing a life-threatening event were the strongest predictors of having a will. These were also among the strongest predictors of having a health proxy, along with a personal history of being proactive, and a family history that fostered trust of attorneys. Affluence, age, and education were the strongest predictors of having a living trust, and the strongest correlate of having a durable power of attorney was having faced a life-threatening event, positive experiences with attorneys, and higher educational achievement.

Inheritance and intergenerational wealth transmission in eighteenth-century Ottoman Kastamonu: an empirical investigation.

This article investigates the relationship between inheritance and wealth in the context of eighteenth-century Ottoman Kastamonu. Based on the estate inventories of the deceased (sing. tereke) as recorded in Kastamonu court records (sicils), the article introduces a variety of quantitative techniques to measure the impact of Islamic inheritance practices on wealth accumulation across subsequent generations and to understand how it influenced wealth mobility among various socioeconomic groups. The estimations provided in this article suggest that while the inheritance practice in Kastamonu caused wealth fragmentation, the process also contributed to the durability of economic divisions within the provincial Ottoman society.

Custody plans among parents living with human immunodeficiency virus infection.

OBJECTIVES: To describe and to examine predictors of making custody plans by parents living with the human immunodeficiency virus (HIV) infection. INTERVENTIONS: The custody plans of 296 parents living with HIV for 708 children were examined over 5 years, with at least 85% reassessed annually. RESULTS: Over time, increasing numbers of parents living with HIV made custody plans for all of their children (23.8%-52.8%), typically with extended family members. However, parents change plans frequently, and 44.8% of parents living with HIV died without custody plans. Custody planning was less likely in families with only adolescent children, when parents had a partner, or when parents were depressed. Parents' disclosure of HIV status, physical health status, substance use, and ethnicity were unrelated to making custody plans. CONCLUSION: Custody planning is a slow and unstable process in families affected by HIV.

Sharing the wealth: the effect of siblings on adults' wealth ownership.

Inequality in wealth has been well-documented, but its causes remain uncertain. Family processes in childhood are likely to shape adults' wealth accumulation, but these factors have attracted little attention. I argue that family size matters: children from larger families accumulate less wealth than do those from smaller families. Siblings dilute parents' finite financial resources and nonmaterial resources, such as time. This diminishment of resources reduces educational attainment, inter vivos transfers, and inheritance. Reduced educational attainment and transfers alter financial behavior; saving; and, ultimately, adults' wealth. I demonstrate that sibship size is associated with lower overall wealth in adulthood and that parents' resources and education, respondent's education, financial transfers, and financial behavior all mitigate the effect of siblings. Sibship size also reduces the likelihood of receiving a trust account or an inheritance and decreases home- and stock ownership. The findings provide important insights into early family processes that shape wealth accumulation and inequality.

A study of different types of suicide notes.

A study of suicide notes in West Berlin revealed that those leaving instructions in their notes were younger, more often Catholic and having problems with work, loneliness and addiction. Those including wills and testaments were older, more likely to be female and widowed/divorced, and more likely to have recently experienced the death of a partner.