What Is Your Motivation – Making Funeral Arrangements Out Of Love And Not Fear

What is motivation?  Motivation is used to describe WHY someone does something. Of course, there are a mountain of studies and theories, but simply stated, there are many different forces that guide and direct us.  If you look towards literature and the arts, you can simplify it even further.  From the bible to John Lennon, it appears as if “there are two basic motivating forces: fear and love.”

Let’s put this into perspective and think about weight loss.  Many people start their weight loss journey at their doctor or loved one’s urging to cure or improve a medical condition, thus potentially saving their life.  They are motivated by fear – fear of dying, fear of winding up in the hospital, fear of something that only loosing weight will solve.  However, once they reach their weight loss goal or receive a clean bill of health from their doctor, their motivation to lose weight and stay healthy is removed and many times, they revert to their unhealthy habits and regain the weight.  What has been found is that although fear can be an excellent motivator, especially following a life-threatening event, it is too uncomfortable and emotionally draining for us to stay in that mindset for very long.

In other words, fear is not sustainable.

But what happens when, while during their weight loss journey, people discover things that they love? Perhaps they can run and play with their kids without gasping for breath or without pain.  Perhaps their skin clears up.  Perhaps they like how they look in the mirror. What happens when they fall in love with the results of their weight loss and improved health?  When people replace their fear driven motivation with love driven motivation, then they are better able to sustain their weight loss and health.

In my role as a funeral director, I have seen a world of difference when someone makes funeral arrangements out of love rather than fear.  Typically, those who are motivated by love plan in advance, include their family or even their friends in their decisions, and think globally instead of selfishly.  On the other hand, I have seen those motivated by fear regret their decisions or make decisions based on prior negative experiences without understanding that funerals have changed and that their loved ones need some sort of ritual to build that positive foundation for grief.

So how can you approach death with love? At its simplest, by being prepared.  By writing down your wishes.  By securing payment for your funeral by purchasing life insurance, prepaying your funeral, or setting aside assets designated for funeral expenses.

You can also approach death with love by understanding that you do not know what you do not know and seeking out knowledge to make informed decisions. Knowledge is power and sharing knowledge is empowering. Did you know that in the state of Texas you can be buried within 24 hours, but it can take 2-10 days to have the legal authority to perform a cremation?  Or that some cemeteries will allow you to be buried without a casket? Or that a power of attorney expires upon death so if you do not have an authorized agent of disposition and your spouse has dementia or your biological children do not get along that your disposition might be determined in court? Or that you can have a meaningful service that does not include a church or a funeral home or a major expense?  Or that cremated remains can be made into bullets, tattoos, jewelry, coral reefs, paintings, or go into outer space?  Incomplete information creates false expectations and negative experiences.  Understanding the ins and outs of what happens when someone dies will enable and empower you to make the right decisions at the right time.

Finally, you can also approach death with love by being creative in ones preplanning approach and utilizing me as a resource and guide in helping you plan your final moments with love, so that your loved ones won’t have too.

So, what is your motivation?  When it comes losing weight, finding a new job, getting married, having a medical procedure, or even planning for life’s eventualities – what is motivating you to make the choices you made or are about to make?  Without motivation you simply cannot achieve anything.  The next time you admire someone’s accomplishment, including your own, it makes more sense to ask WHY they did what they did instead of HOW because, when the why is clear, the how is easy.

Modified from a speech given by Jessamyn Putnam at the Women Empowering Women event at the Vineyard B&B at Lost Creek Ranch on November 5, 2019.  Copyright 2019 Jessamyn Putnam.

Jessamyn Putnam at the Women Empowering Women event, pictured bottom row, second from the right.

Putnam Celebrates Small Business Week

For more than 50 years the President of the United States issues a proclamation announcing National Small Business Week. This week recognizes the vital contributions of entrepreneurs and small business owners to the United States of America through award ceremonies, events, and competitions.

The Putnam family of Funeral Homes is one such small business that believes in growing and innovating with our clients, while also empowering our clients in their most vulnerable moments.  With 3 locations – Bertram Funeral Home in Bertram, Cremation Advocates by Putnam in Marble Falls, and Putnam Funeral Home and Crematory in Kingsland – we are situated to help burial and cremation families throughout the Highland Lakes, Central Texas, and beyond.  While the majority of our families come to us from Kingsland, Llano, Tow, Buchanan Dam, Burnet, Bertram, Oatmeal, Liberty Hill, Marble Falls, Meadowlakes, Horseshoe Bay, Spicewood, Lakeway, Cottonwood Shores, Granite Shoals, Highland Haven, Round Mountain, and Johnson City, we also serve families in Austin, San Antonio, Houston, Midland/Odessa, and outside of Texas from California to New York as well as internationally.

Being a family-owned small business allows us more flexibility than corporate funeral homes and crematories, and ensures that our dollars remain local.  In fact, we donate several thousand dollars a year to local schools, non-profits, and civic organizations.  And all of us are involved in the community, contributing around 2,000 volunteer hours in 2018.  We do not have shareholders that focus on immediate and consistent profits, which allows us to innovate and work with our client families to forge ongoing relationships and sustainable long-term growth.  We believe in supporting our community and are honored when our community supports us.

As a small business, we are also able to focus on what is best for our client families.  We have on-site refrigeration and an on-site crematory, which means that your loved one never leaves our care.  We do not contract out with cremation mills and we only cremate for our client families, which ensures the integrity of  our quality control and identification procedures.  As desired, we offer life stories and obituary writing services, have a certified celebrant on staff, have two grief therapy dogs in training, and coordinate with a variety of churches and local vendors to create a meaningful memorial or funeral service or celebration of life.  We assist with preplanning and have a variety of tools at our disposal, including a licensed insurance agent, to assist you in preparing, and controlling, what happens to you after death.  We sell monuments, urns, caskets, and jewelry, but we also stay alert to discourage emotional overspending.   We are a member of the invitation only trade association – Selected Independent Funeral Homes – as well as the National Funeral Directors Association, the Texas Funeral Directors Association, and many more, which provide us with a network of international funeral homes that enable us to assist you anywhere in the world.

Ultimately our goal is to work as guides and advocates to help you build a positive foundation for grief.  That is the beauty of being a small business and a family-owned funeral home and crematory.

 

Memorializing Mom for Mother’s Day

by Jenny Goldade of Frazer Consultants

With Mother’s Day coming up, it’s a time to honor moms and remember those no longer physically with us. It’s a tough time of year for those grieving the loss of their mom. That’s why we’ve come up with these mementos and traditions to pay tribute to mom this Mother’s Day.

Mother’s Day Mementos

A DIY memento is a perfect keepsake to honor and remember mom. From photo crafts to a shadowbox, there’s something for everyone that captures their mom’s personality.

Here are a few ideas to get started:

  • Make a photo memento such as memorial frame or scrapbook filled with photos of your mom and her adventures.
  • Put together a shadowbox filled with her favorite things such as clothes, jewelry, photos, and items related to her hobbies.
  • Decorate a jewelry box to keep all her jewelry safe in one place.
  • Personalize a vase with her name and other little decorations like gems or ribbon and put her favorite flowers inside.
  • Organize all her signature recipes into a personalized recipe book.

Family Traditions

Family members can come together during Mother’s Day to honor and remember her together. Whether it’s through visiting her favorite place or baking her favorite dish, there are many ways to pay tribute to mom.

Some ideas are:

  • Visit her grave site or ash scattering location and leave flowers.
  • Go to her favorite restaurant and go around the table and share a memory of her.
  • Plant flowers in a memorial garden in her honor.
  • Donate time to a community food pantry, animal shelter, children’s hospital, or another location.
  • Take a trip to her childhood home, school, or another special place.

Personal Rituals

When grieving your mom, it’s alright to have a tradition of your own to honor her. There are many possibilities, from writing a tribute to her or just taking the time to look through old photos.

Here are a few ideas to help find the perfect ritual to remember her by:

  • Take some time to yourself to remember her by just sitting in peace and quiet.
  • Look through old photo albums and scrapbooks.
  • Remember her by lighting a tribute candle in your home.
  • Write and dedicate a song or poem to her (you can share it, frame it, or keep it to yourself).
  • Keep a book of your memories with her and share them with your children or loved ones.

 

Healing Hearts

Putnam Funeral Home and Crematory, LLC, which includes Cremation Advocates by Putnam in Marble Falls and Bertram Funeral Home in Bertram, is happy to be a Healing Hearts sponsor for Camp Agape, a free summer program for children grieving the loss of a loved one.

Registration is now open for the 2019 camp, which is scheduled for July 8-11 at Camp Buckner Retreat Center in the Texas Hill Country. Children between the ages of 7 and 12 attend Camp Agape at no cost to their families. Register eligible children now at the Camp Agape website –www.CampAgapeTexas.org.

We cannot say enough good things about this organization. They are wholly committed to helping families that have experienced trauma from the loss of a loved one and we have personally witnessed how their efforts change children’s lives in the Highland Lakes area.

Most children come away from their Camp Agape experience able to process their grief and move past it. There are numerous examples of these children now serving in their organization as leaders and taking what they learned from their hardship and using their experience to grow and help others overcome death. This camp provides opportunities for experiences that can’t be found anywhere else. Many times, these children have not left their loved one’s side since the death occurred. This camp pulls them out into a “camp environment” to have fun, process their grief, learn to move forward, and also to realize they are not alone. The children see there are many other children going through what they are going through. In addition, they receive professional help from counselors and have buddy counselors that have walked the path they are walking.

After the camp is over, each child also has the opportunity to come to a Fall Retreat and process grief with their family and also meet other friend’s families. Many of the children that attend camp make life-long friendships with other children attending because they are able to bond at such an intimate level.

In addition to donating to this organization, we volunteer as well. It has been a wonderful experience.  Camp Agape will change the future of a child’s life… guaranteed.

To find out more about Putnam, Cremations, Burials, Preplanning, Celebrations of Life, Monuments, Grief and Aftercare, please visit www.CremationAdvocates.net or www.PutnamCares.com.

Premier Marble Falls Funeral Home and Cremation Advocates

Cremation Advocates by Putnam’s client families have only positive things to say about their experience arranging cremations, services, and celebrations with Putnam.  100% of our survey responses from 2018 say that they would recommend Cremation Advocates by Putnam to their friends and family members and they would use Cremation Advocates by Putnam for themselves or another family member.  98% of survey responses said that they believe that they received an incredible value for the price of services.  This was emphasized by comments from those who had recently attended or arranged services at other funeral homes.  These comments touched on the fact that our cremation package pricing was inclusive of everything needed for cremation and their were no hidden fees or surprises, that there were no high pressure sales, that our offices were contemporary and filled with natural sunlight and looked nothing like a funeral home, and that our staff is compassionate, understanding, patient and kind.  Client families found that we care about our families and will move heaven and earth to ensure that they are able to make meaning out of an emotional time.  Our client families also appreciated our active involvement in the community to include the incredible amount of volunteer hours our owners and staff pour into the Highland Lakes, as well as monies donated.

We at Cremation Advocates by Putnam appreciate our client families’ sincere and heartfelt responses.  We created our Marble Falls location to meet the changing needs and wants of our clients. We are honored to serve our client families and always pledge to be an advocate and walk our families through their moments of stress and uncertainty.  With clients coming to us to arrange cremations and (yes, even burials) from Horseshoe Bay, Spicewood, Marble Falls, Meadowlakes, Burnet, Bertram, Round Mountain, Johnson City, Fredericksburg, and Austin, it is clear that our cremation client families are sharing their positive experiences with others.

We are available 24 hours a day, 7 days a week by calling 830-798-8413.  Our office is opened Monday thru Friday (excluding holidays) from 9-4 and by appointment.  We ask that you call and schedule an appointment to ensure that we are available to give you the time you need.  We also own Bertram Funeral Home in Bertram (appointment only, 512-355-8201) and Putnam Funeral Home and Crematory, LLC in Kingsland, TX which is open 7 days a week from 8-5 and by appointment (325-388-0008).  More information can be found at www.CremationAdvocates.net and www.PutnamCares.com.

 

2019 Reader’s Choice and Locals Love Us Awards

The Putnam Family of Funeral Homes (Bertram Funeral Home in Bertram, Cremation Advocates by Putnam in Marble Falls, and Putnam Funeral Home and Crematory in Kingsland) continues to win the local awards for Best In Class. We do so by going above and beyond and because we understand that we have only one opportunity to make this right. Remember our billboard – #YODO? From writing the obituary to personalizing memorial folders and celebrations of life, to introducing grief therapy dogs in training, and offering different funeral home concepts (traditional, contemporary, and familial), and even offering different funeral planning products from final expense policies to prepaid funeral contracts, we do everything we can to advocate for you before, during, and after your time of loss and help you make meaning out of an emotional time. Every employee is also a community volunteer and Putnam supports several local causes and organizations as we believe that investing in our community keeps our community strong. It also enables us to build relationships to better serve you when you need us the most. We are local and family-owned with the ONLY on-site crematory in the Highland Lakes area. Not only do we Keep Your Loved Ones Close and provide Excellence in Remembrance, but Putnam also Cares!  We provide cremation and burial services, celebrations of life, and preplanning services to Horseshoe Bay, Spicewood, Lakeway, Austin, Liberty Hill, Temple, Bertram, Oatmeal, Burnet, Tow, Kingsland, Llano, Highland Haven, Granite Shoals, Cottonwood Shores, Marble Falls, Meadowlakes, Double Horn, Round Mountain, Johnson City, Blanco, Boerne, San Antonio, Fredericksburg and beyond.

Chris Putnam Earns PhD in Business Administration

Central Texas entrepreneur, leader, funeral home owner, and philanthropist Chris Putnam successfully defended his research dissertation, “A Leader’s Perspective to Retaining Millennial Workers:  A Qualitative Triangulation of Job Embeddedness Theory and Leader-Member Exchange,” to earn his PhD in Business Administration with a concentration in organizational leadership from Northcentral University on November 28, 2018.  Dr. Putnam also holds a MBA and BA in Business Administration from Ottawa University and a Diploma of Funeral Service from Commonwealth Institute of Funeral Service.

Dr. Putnam has spent the last ten years studying generational theory.  In choosing his dissertation topic, he explains that “Each generation has distinctive characteristics and expectations.  Baby boomers and generation Xers who have been in leadership roles for several decades have experienced the frequent turnover of the millennial generation.  Little to no research is available from the older generations’ perceptions of the younger generation, however, millennial perception is abundant.  I wanted to fill a research gap from a leader’s perspective as to why millennials “job hop” more frequently than other generations.  Moreover, as a small business owner, I find it essential to understand how to retain millennial workers.  According to the Small Business Administration, millennial turnover costs American small businesses $64 billion dollars annually.”

Dr. Putnam’s research participants included members of the baby boomer and generation x generations who were small business owners in Central Texas and employed millennials. He found these leaders expressing frustration over a perceived lack of work ethic. Given the lack of existing information, most of the leaders did not have a specific strategy to improve relationships and increase retention; and the strategies they did employee contrasted significantly with what little literature exists that pertains to supervision and mentoring across generations.

Based on his research and conclusions, Dr. Putnam believes that there is a huge misunderstanding and communication barrier between the various generations.  The millennial generation is a very ambitious and productive group that walks to the beat of its own drum.  The baby boomer generation is very similar, and much can be learned about its influence.  The size of both the baby boomer and the millennial generations is squeezing the smaller generation X and forcing its members to acclimate and adapt to both generations to be successful.  And for those generation Xers who have waited patiently for their baby boomer supervisors to pass them the torch, they will be sorely disappointed when it is the millennial who grabs it from them.

Dr. Putnam thanks his wife Jessamyn for supporting him through his doctoral experience.  The four-and-a-half-year journey was full of studying, teaching at Schreiner University and Central Texas Community College, and research engagements that came with emotional highs and lows.  He also thanks his children: Liam, Connor, and Anson for the missed evenings and weekends and life interruptions his goal caused.  Last by not least, he wants to recognize and thank his Putnam team: Jim Simmons, Eli Heatley, and Brittany Carrington, for picking up his slack and maintaining an extraordinary level of service at Putnam.  Dr. Putnam’s research broadened the theories of job embeddedness and leader-member exchange and he plans to apply his findings to the Putnam organization and teach other business and organizational leaders how to increase employee retention by using positive relationships and encouraging a work-life balance.

Dr. Putnam launched the Putnam brand with Putnam Funeral Home in Kingsland, Texas in 2000.  After adding in a crematory in 2006 that is now the only crematory in the Highland Lakes area, Dr. Putnam opened Cremation Advocates by Putnam in Marble Falls in 2017 as a contemporary and alternative approach to a funeral home and opened Bertram Funeral Home in 2018. Putnam Funeral Home and Crematory, LLC is located at 145 Texas Avenue in Kingsland, 325-388-0008, www.PutnamCares.com,; Cremation Advocates by Putnam is located at 206 Ave. H, Suite#204 in Marble Falls, 830-798-8413, www.CremationAdvocates.net; and Bertram Funeral Home is located at 1010 East TX-29 in Bertram, 512-355-8201, www.PutnamCares.com.  Putnam is a member of Selected Independent Funeral Homes, National Funeral Directors Association, the Cremation Association of North America, the International Cemetery, Cremation, and Funeral Association, National Association for Grieving Children, and Business Network International.

For more information or to request Dr. Putnam as a speaker, please email him at chris@putnamcares.com or call him at 325-388-0008.

Finding Hope During the Holidays

We published this video on our website last year and are reposting it due to all of the positive comments and gratitude we received.  If you or a loved one are struggling with grief this holiday season, then please take the time to watch this brief video in which Dr. Jason Troyer shares how to deal with “grief bursts,” planning time for remembering, and adjusting your traditions.

 

Find Hope During the Holidays with Dr. Jason Troyer from Jason Troyer on Vimeo.

 

Dr. Troyer has a PhD in Counseling Psychology from the University of Kansas.  He is also certified in Thanatology and a member of the Association for Death and Education Counseling.  He is a professor in East Tennessee and teaches on death and dying, abnormal psychology, counseling, and related topics.

Bertram Funeral Home and Cremations

Putnam Funeral Home and Crematory, LLC, announces its recent expansion into Bertram, Texas with the opening of Bertram Funeral Home at 1010 East TX-29. Bertram Funeral Home is dedicated to serving the residents of Bertram, Oatmeal, Liberty Hill, Burnet, and the surrounding areas. The goal of Bertram Funeral Home and Putnam is to invest in the community and provide exceptional and personalized service during a difficult time.

This familial funeral home concept not only provides space for services and visitations, but it also provides our Bertram families and neighbors with access to the Putnam private crematory.  Putnam owns the only crematory in the Highland Lakes area and reserves its use exclusively for Putnam client families to ensure the integrity of our quality control and identification procedures while providing our families with the peace of mind that their loved one never leaves our care.  Bertram Funeral Home also offers the services of the only area Certified Celebrant.  Putnam is dedicated to the ones you love, and our caring and knowledgeable staff is here to remove as much stress as possible from the funeral process and to help you build a positive foundation for grief.

The staff at Bertram Funeral Home strives to provide excellence in remembrance. Everyone deserves a funeral or memorial that expresses how special they are. We at Bertram Funeral Home are committed to commemorating and honoring each person who enters our care.

Please call us at 512-355-8201 to schedule a tour of our facilities.

Bertram Funeral Home is located at 1010 East TX-29 in Bertram, Putnam Funeral Home is located at 145 Texas Avenue in Kingsland, and Cremation Advocates by Putnam is located at 206 Ave. H, Suite#204 in Marble Falls.

Five Centuries of Death Certificates

Reprinted with permission from the October 18, 2018, edition of the Memorial Business Journal, a publication of the National Funeral Directors Association.  Written by Carol Milano.  Photo Credit:  By Simon Burchell – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=11393051

You could say death certificates were born in 1538 when the Anglican Church decided that births, marriages and deaths should be recorded in parish registers. Until that time, it was easiest to discover a death by absence; documents might refer to a man in the past tense, for example, or his name would no longer appear on lists of jurors or witnesses.

Even for the wealthy, the recording of death was relatively unimportant. When someone died, the last will and testament became authoritative, rather than any actual death record. In England, the British government displayed great interest in wills, possibly as a source of fines or land. Because civil courts had the final say in any disputed cases, references to the deceased and his property can be found easily.

Before 1538, deaths might have been noted in church service books, missals, Psalters, chanceries or heraldic records. For richer individuals, legal information related to a death could be found in probates, coroners’ records and postmortem inquisitions. The less affluent often died anonymously.  Throughout Europe, though, more records can be found about the very poor than about the rich. Since everyone had to be buried somewhere, local authorities often arranged with churches to bury the poor.

In the 16th century, under “poor laws,” churchwardens collected alms from a parish’s wealthier members and used the money to build poorhouses. The indigent, if buried in consecrated ground, received quick, anonymous burials, sometimes in mass graves to reduce expenses. Any churchyard burials were probably due to a priest’s kindness. In England, more early data exist on criminals than on law-abiding citizens, especially if they were hanged; there were court records of the trial and execution date.

The first American settlers applied British laws and customs to the recording of deaths. Before 1800, churches maintained burial records for congregants throughout the Colonies. Most early American death information is found only in church records.  Eventually, some Colonies required churches to report death events to civil authorities; some locations have both civil and church historic records. Several Colonies, mainly in New England, actually enacted laws requiring local governments to record and maintain death certificates.

By the 19th century, many British and European countries were maintaining death certificates at the national level. The United States, however, has never created a national registry and was slow to establish government mandates for death certificate regulation. Before 1880, only 14 states (and five cities) needed death certificate registration. Most states didn’t require it until after 1900. Because registration laws were passed at different times, today, states have different information requirements for death certificates.

USES FOR DEATH CERTIFICATES

Based on an international form adopted in 1948, then modified in the 1990s, the United States has three types of death certificates:

• Standard
• Medical or legal case
• Fetal or stillborn death.

The form usually lists the immediate cause of death, the conditions that led to it and any significantcant medical factors, such as diabetes. The manner of death is also recorded, with space for indicating that the cause of death could not be determined or the investigation is pending. “Pending” status permits time for further medical examination while allowing for a funeral.

Death certificates are also a vital public health tool. They help set public health goals and policies, identify emerging public health threats and determine which medical conditions will receive government funding. Public health departments review death certificates to find patterns that could pinpoint a problem. A cluster of cancers in one geographic area might help lead to the discovery of an unknown toxic site, for instance.

For centuries, death certificate mortality data have been the best, and sometimes only, source of information about life-threatening illnesses. In Italy, for example, death certificate analyses guide allocation of national healthcare system funds. One review of 44,000 death certificates revealed that in low-income communities, common causes of death included cirrhosis of the liver, childbirth complications, respiratory diseases and lung tumors. In more affluent areas, women had higher rates of breast cancer.

Survivors use signed death certificates to file life insurance claims, settle estates and seek death benefits. One is needed to obtain a burial or cremation permit, which is combined, in some locations, with a transportation permit.

ABUSES

In 1866, a scandal in New York City spurred the need to regulate death certificates. When the city’s independent Board of Health was formed, police investigating the office of the former city inspector found a supply of signed, unnumbered burial permits. The inspector had been selling them to murderers, who used them to “legally” bury their victims!

Sometimes, a death certificate is used to fake a person’s death for insurance fraud. This approach typically requires avoiding law enforcement officials and relatives of “the deceased.” In one mid-1990s scandal, official-looking fake death certificates could be purchased for anywhere from $500 to $1,000. American criminals have even used counterfeit death certificates from less developed countries.

Death certificates have also become a tool for identity theft. When a fake death certificate uses a living person’s name, officials may freeze that individual’s assets, cancel credit cards, revoke licenses and cause enormous difficulties.

Unfortunately, U.S. death certificates have a high rate of inaccuracy, which isn’t surprising since only about 12% of American physicians receive training in filling them out. Up to 29% of doctors make errors about the age of the deceased, cause of death and whether an autopsy was performed. Death certificates of minority group individuals are the most error-prone.

Which error is most common? It’s identifying the cause of death, which is different from the manner of death. Many physicians make the mistake of listing as the underlying cause the mechanism of death. “Cardiopulmonary arrest” is not meaningful as a cause of death; eventually, everyone’s heart and lungs stop. The mechanism is an alteration of physical state or biochemistry, and it does get tricky. For instance, “old age” and presbycardia (“old heart”) are considered valid causes of death. One cause of natural death is addiction, a disease. Chronic alcohol and substance abuse are considered natural manners of death. However, “acute intoxication” is regarded as an accident.

Sometimes, doctors misreport a  cause  in  order to protect a family’s reputation. They might list “pneumonia” for an AIDS death or “accidental” for a suicide. Even before the AIDS epidemic, socially undesirable causes of death were often misrepresented on death certificates. These include alcoholism, syphilis, homicide, suicide and alcoholic cirrhosis of the liver. This kind of misreporting is more common where autopsy reports become part of the public record. (Some states have eliminated cause of death from publicly recorded death certificates.)

DEATH CERTIFICATE DILEMMAS

Usually, the funeral director acquires the death certificate and other needed legal documents and itemizes their costs on the bill. If a body must be shipped to a non-English-speaking country, necessary translation costs may be added. According to one major-city medical examiner, Delta, the airline used most frequently for body transport, even awards frequent-flier miles for the passage.

Funeral directors fill in the required information on a death certificate, which includes method and site of body disposition, and sign the form. Then the physician responsible completes his or her sections of the certificate, such as immediate cause and manner of death, significant conditions, details about any injury and whether a medical examiner was notified. Death certificates then go to the local or state government office that issues a burial permit. The death certificate (or its information) is sent to the state’s bureau of vital statistics and on to the National Center for Health Statistics.

However, it’s sometimes difficult for funeral directors to obtain the needed physician signature. Modern facilities such as managed-care HMOs and multi-specialty clinics may make it difficult to identify and track down the right physician. And survivors can’t bury or cremate without the signature of either an MD or a medical examiner on a temporary death certificate. A physician can sign only if a death was natural. Medical examiners must sign for cases involving potential public health threats, police action or other unusual circumstances. They can list the cause as “pending” until tests determine what it was. Usually, disposition of remains need not wait for a final autopsy report, which can take weeks.

One key purpose of modern death certificates is to prevent cover-up for murder. This can be difficult because for a non-natural death, the certificate must be completed by a trained official who has significant flexibility in determining the need for a post- mortem exam. When a physician can’t sign a death certificate and give presumed cause, a forensic pathologist or medical examiner will do an autopsy if a case requires police investigation. Ultimately, the medical examiner’s opinion will be based on all available information: medical records, the treating physician’s report, circumstances of death, investigation at the death scene, any inspection by police or fire marshal and autopsy.

In homicide cases, the medical examiner need not identify proof of intent, but he or she does have   to determine whether suicide was the method of death. Identifying the circumstances of a case really can be as complicated as forensic crime shows on cable make it seem. A medical examiner might have to figure out if tobacco use contributed to a death; the case might have involved two homeless people fighting over a pack of cigarettes.

Deaths aboard ships are handled distinctively. In England, British captains register any crew member or passenger death in the ship’s log, recording information similar to requirements on a death certificate. When the ship arrives at a British port, the captain must report the death to harbor authorities, who then investigate the circumstances.

Occasionally, autopsy, pathology or forensic findings appear well after a death certificate has been completed. In many jurisdictions, if findings become available within three years of the death, the physician who signed the original certificate can complete an amended certificate.

Procedures were so much simpler just 500 years ago!