This month started out with a remarkable advance directive on display: John McCain’s funeral, which he meticulously planned and choreographed. Bioethicists frequently recommend that patients and their families fill out advance directives to guide end of life care. But an important part of death and dying is the closure that comes with marking a death: burial and ritual. How typical is it for those at the end of life to plan their funerals? Well, funeral directives are becoming more common, and there are different state laws surrounding how much control you have over your funeral in every state. In the State of Arizona, laws surrounding self-directed funerals are very specific, and John McCain surely was familiar with them. In Arizona there are legal protections that ensure you can control your burial and and funeral proceedings. (See:

John McCain’s beautiful funeral was a unique example of how end of life wishes are not completed with one’s last breath; Senator McCain was able to speak to the country directly through surrogate voices that clearly knew his values, wishes and preferences.  Aside from his tragic illness and death from glioblastoma – passing on the 9thanniversary of Senator Ted Kennedy from the same illness – we knew that John McCain had moral distress over what he must have viewed as a growingly mean-spirited country and congress  that was becoming crippled. John McCain’s advance directive was intended to remind the country about moral community and moral leadership. Remarkably, he clarified in his arrangements that a sitting President of the United States was not invited, and not be allowed to speak on his behalf. Instead, he chose the last two Presidents of the United States, indicating that he does not recognize the sitting President in that same role. By doing so, John McCain gave the country something it hasn’t had in a long time: a day of silence from vitriol, and a day to remember what moral leaders supposed to look like. He openly shamed his Republican colleagues in Congress by forcing them to listen to voices of reason, but more importantly, to rejoin the moral community.

John McCain’s funeral can be used as an example in end of life discourse that crucial conversations and closure can still go on, and patients can still control what happens and what is said in their name. The “Who Will Come to my Funeral” scenarios that often occur when patients are confronted with life-threatening illnesses can also be about “Who should NOT Attend my funeral”.  Undoubtedly, Senator McCain envisioned that his passing would prompt a national mourning befitting of a Presidential Eulogy. Once he considered that, he took control of which Presidents would deliver his eulogies. In the end, it was his daughter who said it best: “John McCain was not defined by prison, by the navy, by the senate, by the Republican party or by any single one of the deeds in his absolutely extraordinary life. John McCain was defined by love.”

Based on the coverage and analysis of his funeral, it seems the country heard his voice loud and clear: