Overview
We’re both obsessed with death and terrified to look at it.
We have trouble even fathoming our own mortality and that of our loved ones.
True crime fans can’t read or hear enough stories about it, we see it constantly on the news, it's in every movie, we slow down to look at car crashes, and yet people have trouble believing death will happen to THEM.
Funeral rites traditionally refer to the final disposition of a body after death, but there is so much more that goes into the end-of-life process.
Different beliefs shape the way we prepare for death, how we treat bodies, and the way we mourn. They also shape the way we live our entire lives.
Every culture and religion has its own way of thinking about, defining, and ritualizing death and burials. The ultimate goal of these traditions are to help people be more accepting and less afraid, while encouraging people to live their best lives (according to whatever power is defining that image).
Fortunately, with medical advances and people tending to live longer, more than ever people are preparing for death in advance.
Thanatology
Thanatology is the study of everything surrounding death, dying, and how people react to it: grief, bereavement, arrangements and processes for the physical body, and social attitudes that come with loss.
These cultural beliefs about death and how it should be handled can actually affect how afraid we are of death itself.
With much variety among cultures, I only touch on a few of them below but I have some great book recommendations in the references for those interested in learning more.
Significance to clients
“The great achievements of humanity were born out of the deadlines imposed by death”— Doughty, C. The Smoke Gets in Your Eyes
I’ve been up close and personal with Death herself many a time, and I’m still afraid. Can you blame me?
Dying is the scariest thing we all do. It’s the root of a lot of fear, anxiety, and phobias people experience.
But spoiler (I hardly know her): everyone at some point will die, and/or experience the death of a loved one. Loss is one of the most traumatic things that can happen and can affect us for a long time in a variety of ways.
We should be sensitive to the fact that cultures and religions differ in how they handle the dying process, and that many immigrant populations are forced to give up important cultural rites when they come to the U.S.
For example, Islamic custom is to wash and purify the body immediately after death, burying them as quickly as possible.
Embalming is against their religion, yet many U.S. states have regulations requiring ALL funeral directors to be trained as embalmers even if they don't plan to practice it. So if a Muslim person wanted to become a funeral director to serve their people the way they deserve, that individual would have to compromise their own religious beliefs just to be certified.
We need to be aware of those kinds of losses of religious freedoms that may affect our neighbors. They deserve to care for their dying and express their grief in line with their own beliefs.
Why are we afraid of death?
The Journal of Abnormal and Social Psychology published a 1961 paper describing the most common reasons people fear death:
- It would cause grief to loved ones
- Plans and projects would come to an end
- It may be painful
- No longer having new experiences
- No longer being able to care for dependents
- Afraid of what might happen if there’s life after death
- Afraid of what might happen to body after death
People do tend to become more accepting of their own death as we age, but damn… Look at that list. I’m stressed just looking at it from my chronically ill, yet relatively healthy, point of view.
Aging may mean developing more chronic diseases, seeing parents and loved ones die, and realizing we’re now the oldest generation. You may begin to feel your life’s work is coming to an end, or (the more distressing take) that there won’t be time to accomplish all you want to do.
This is when people often begin to prepare for end-of-life issues such as advanced healthcare directives and funeral arrangements.
Of course, we don’t want to feel like we’re burdening or causing pain to loved ones, and we’d prefer to avoid our own pain.
Ultimately, I think we also fear depending on someone to meet our needs, and not being able to meet them on our own.
Having to give up that control is scary, and has compounding implications for women, who have carry a disproportionate amount of the emotional care burden for their families.
For these reasons and more, preparing for end-of-life issues well in advance can help both the dying person and loved ones with some of this fear.
End-of-life issues
End-of-life issues involve management of the final phases of life, after-death disposition of the body, memorials, and asset distribution.
Patient self-determination act (1990) says patients have the right to
- Make their own healthcare decisions
- Accept or refuse treatment
- Make advance healthcare directives in case they become incapacitated
Preparing for this final scenario, or how someone does does not want their life to end, is especially helpful when both individuals and loved ones collaborate in the end-of-life process. This is true logistically and for the emotional processing of surviving loved ones.
Spending meaningful time with, and affirming feelings for, the dying can bring both parties peace, resolve unfinished business, and help with coping.
Failure or inability to express these last sentiments can result in feelings of guilt or bitterness in survivors.
While that may be true, I want to pause and note that this is making a big assumption that the relationship is relatively healthy and intact.
Those who are no contact, or have experienced abuse or other harm from the dying individual, should absolutely not feel obligated to forgive or communicate with them just because they’re on their death bed.
That’s an incredibly difficult and highly personal choice. If this is something you’re experiencing, I encourage you to reach out to a trusted loved one for support.
Death care options
Hospital
- Focused on prolonging life and curing disease, even at the risk of quality of life
Hospice
- View both clients and their loved ones as a unit
- Inpatient/outpatient
- Emphasizes pain management (palliative care), alleviation of fear, and dignity of client
- Based on controlling and relieving pain rather than trying to cure disease
- Often increases quality of life
Euthanasia
- Highly controversial
- Can be active or passive
- Active
- Persistent vegetative state or terminal illness
- Usually drug overdose
- Physician-assisted only currently legal in a few states
- Passive
- Withholding available treatment (ventilator, feeding tube, surgery, etc.)
After death options
- Burial
- Embalming
- Natural or “green”
- Cremation
- Donation of body or organs
- So many more
In the US, options have traditionally been limited to burial, embalming, cremation, or donation of body or organs
The average funeral in the US costs $7000-$10000 including things like body preparation, funeral, burial, and headstone.
It’s a pretty hands-off process in terms of mourners spending meaningful time preparing the body, which is actually unusual.
Natural/“green” burials have become more popular recently
Really there are SO many more options. All have pros and cons, and some would be considered more acceptable than others based on culture, location, and other factors.
Some things that may seem morbid or savage to us are completely normal in other cultures.
For example, a tribe in New Guinea cannibalizes their dead because they believe that makes their loved one apart of them forever.
The Zoroastrians of Iran believe a “clean death” involves exposing their dead to be eaten by vultures in a ritual they call a sky burial.
In Tana Toraja, Indonesia, they naturally mummifying their dead in their own homes and have huge festivals every year where they dress them up and hang out with them.
In turn, many other cultures, myself included, believe the way we handle bodies in the U.S. horrifying.
For example, in the US embalming is advertised as "sanitary", but it uses harsh chemicals that are terrible for the environment. It’s also a wildly grotesque process.
Burying the dead in caskets, in general, is seen as strange in other cultures because we preserve the bodies and then hide them away.
Many cultures also believe spending meaningful time with the body, like having loved ones wash it and prepare it for burial, or even just sit with it, can aid in coping.
Calls for reform in the death industry
Right now, we have to make a costly decision at a time of emotional and financial stress. We need to reform the industry in our society, introducing new practices that aren’t so focused on making money and include the family. — Doughty, C: From Here to Eternity
Stay informed + make family dinner weird by talking about it!
Checklist for making your end of life intentions known:
- Communicate with loved ones
- Create a living will and make sure loved ones know where to find it, along with other important documents.
- Advanced directives
- Healthcare power of attorney
- Loved one entrusted with healthcare if you’re unable
Whatever the end-of-life intentions are, encourage loved ones to make them known.
When we fail to explicitly state wishes, our preferences can’t be taken into account.
References
- Missouri Division of Professional Registration https://pr.mo.gov/embalmers-rules-statutes.asp
- Get Your Shit Together https://getyourshittogether.org/
- ACLU Giving Docs.
- Board of Embalmers & Funeral Directors. (n.d.). Statutes and Rules. https://pr.mo.gov/embalmers-rules-statutes.asp
- Diggory, J. C. and D. Z. "Values Destroyed by Death." The Journal of Abnormal and Social Psychology 63, no. 1(1961): 205-10.
- Doughty, C. (2016). Smoke gets in your eyes: and other lessons from the crematory.
- Doughty, C. and Blair, L. (2019). From here to eternity: travelling the world to find the good death. London: Weidenfeld & Nicolson.
- Kail, R. V., & Cavanaugh, J. C. (2019). Human development: a life-span view. Boston, MA: Cengage Learning.
- Roach, M. (2012). Stiff: the Curious Lives of Human Cadavers. London: Penguin.