Dying Just Got a Whole Lot Harder
Doulas, space burials; resomation; green burials with wicker caskets and corpse location-monitoring devices; diamonds colored by funeral ashes: Death’s vocabulary is expanding. New—and old—ways of dealing with dying and death are emerging in this century.
Traditional funeral patterns and religious ceremonies are still in vogue. But a range of new choices is enabling a new consciousness that gives people more control over their final days and death in ways not possible in the past.
More choices around life’s last processes enable people to be more introspective about personal values and spiritual feelings as well as aesthetics and practical matters. The decisions can be confounding.
Conferences on dying and death have become annual events for health and civic organizations, such as the San Francisco Jewish Community Center (JCCSF). More intimate “death cafés” are another new trend. They’re available annually at the JCCSF, every third Tuesday at the North Beach Library, and once a month at the Zen Hospice in Hayes Valley.
These cafés, originating from the “café mortel” movement that emerged in Switzerland and France around 2000, are facilitated forums in a confidential setting where people feel free to talk philosophically and practically about death.
“Both my Mama and my dog were having health problems and in danger of dying and I could talk about them both without anyone judging me,” said Dany Vallerand, who attended a death café at the JCCSF. "Thinking more about death made me accept that death is part of life. Death is normal. And, I have pre-paid on cremation services which gives me peace of mind since I have no siblings and my parents have passed,” Vallerand added.
When exploring one’s feelings around dying and death, it helps to understand the history of life’s final chapter.
Up until the Civil War, both death and disposition of remains were straightforward. If people died at home, families washed the body, prepared it for viewing, held a religious service, and buried it in a plain pine box or a shroud in the local cemetery. A simple headstone marked the grave.
The use of embalming fluid grew out of Civil War circumstances. A temporary preservative was needed to send dead Union soldiers from the sweltering South to their families in the North. As the 20th Century progressed, more people died in hospitals than at home. Death also began to recede from public consciousness as funeral parlors took over duties once handled at home.
Death became a business. The push of post-World War II consumerism turned burials into symbols of status, greatly increasing the price of funerals. In mid-century, with median annual income just $5,600, families were cajoled into paying upwards of $1,000 for a funeral.
Cost consideration has boosted the popularity of cremation. Today, cremation costs range between $1,500 and $3,000, while a traditional burial rings in between $7,000 and $10,000, according to The National Funeral Directors Association (NFDA). And in 2016, cremations accounted for 50.2 percent of funerals, up from 47.9 percent in 2015. The Association estimates that by 2035, the rate of cremation will reach 78.8 percent.
These days increasingly fewer Americans live and die in the same place, which also makes cremation a desirable option. Furthermore, people are placing less importance on religion in funerals, according to the NFDA; however, whether cremations are religious or secular, visitation, viewing, and memorial services are also possible (usually as add-on costs).
A growing trend is to substitute a “life well celebrated” event, where mourners can express individualized feelings. Such events can be held in a crematorium setting or at locations as diverse as a bar, a beach, or a sports arena.
Disposal of Ashes
A big decision for those considering cremation is what to do with the ashes. According to the NFDA, 46 percent of ashes are buried in a cemetery or interred in a columbarium, 39 percent are returned to family ownership, and 10 percent are scattered someplace other than a cemetery; the remaining five percent are not claimed. State laws dictate where ashes can be legally scattered. In most cases, ashes may be scattered in national parks with a permit or at sea at least three nautical miles from shore.
As cost-effective and convenient as cremation is, it has a big downside. A growing body of research finds that the cremation process produces carbon dioxide, which exacerbates climate change; it produces sulfur dioxide and nitrogen oxide, which contribute to the formation of acid rain; and it emits dioxin, a very potent toxin. Mercury fillings in teeth cause the average crematorium to release many pounds of mercury into the air annually.
Traditional burial also has a negative impact on the environment. Caskets, casket linings and vaults for traditional burial put land-destroying chemicals in the ground; these include embalming fluid, steel, copper, bronze and reinforced concrete. In addition, hardwood from endangered forests is used.
The green burial movement in the U.S. offers a non-toxic choice. In a green burial, the corpus is buried with no embalming fluid, in a shroud or eco-friendly casket, on designated land with a small rock or planted tree to mark the grave. A GPS signaling device is used so flora and fauna don’t obscure the grave.
Although green cemeteries in the U.S. are far-and-few between, a 19th century cemetery in Mill Valley has set aside part of its land for green burials, in which land restoration and preservation are paramount. It also offers traditional cremation with equipment it claims produces less of an environmental hazard.
Green burial at the Mill Valley cemetery can exceed the cost of traditional burial. The burial site and upkeep of the gravesite cost $7,370 to $9,900, depending on location. There is an additional charge of $2,250 for opening and closing of the grave.
Although green burial offers the advantages of being non-toxic and preserving habitat and biodiversity, it is, along with traditional burials, using up increasingly scarce land. In her forthcoming book, Be a Tree; the Natural Burial Guide for Turning Yourself into a Forest, C.A. Beal says that green cemeteries in England are considering the possibility of reusing a grave once full decomposition has occurred.
So, what’s a body to do?
A law allowing another more eco-friendly means of corpse disposal than cremation or traditional burial has just passed both houses of the California Legislature. With the governor’s signature, alkaline hydrolysis will go into effect on July 1, 2020. Also known as “water cremation” or “resomation,” the cost would be about the same as cremation. The process uses electricity, which can come from renewables or carbon-free sources, according to the Bay Area Consumers Association. Alkaline hydrolysis vents nothing into the air; dental amalgams and other metals in the body do not dissolve, but remain intact and can be reclaimed and recycled at the end of the process.
Alkaline hydrolysis involves the use of a high-pH (alkaline) solution to dissolve the soft parts of the body, leaving behind only bones, which will be crushed and returned to the family in the same way as cremation ashes.
Although old-time home funerals are rare, they do exist. California has no law requiring that a licensed funeral director be involved in making or carrying out funeral arrangements. But because things could go awry with a dead body, The National Home Funeral Alliance offers information, guidance, resources, and links to home-friendly funeral directors.
Another decision for people to make in the complicated steps toward an afterlife is whether to donate their organs or even their whole body to science or medicine. “I decided to donate my brain to UCSF,” Mary Hunt, a San Francisco senior, told me. “After participating in a research project there, I thought donating my brain could help further knowledge of brain injury.”
In 2005, California launched an online organ, eye and tissue donor registry with a confidential database. The Donate Life California Organ and Tissue Donate Registry also manages the donation wishes of people who check the “YES!” box on their driver licenses. More information can be obtained through The Bay Area Funeral Consumers Association, which is the local affiliate of the national nonprofit Funeral Consumers Alliance, which is dedicated to protecting the right to choose meaningful, dignified, and affordable health care.
Perhaps the most difficult decision of all—whether to facilitate your own death—was made possible in 2016, with California’s legalization of Physician Assisted Dying (PAD). California is the fifth state to allow the procedure. PAD laws across states are similar: Patients must have a life expectancy of six months or less as certified by two physicians, and must be able to self-administer oral drugs at a lethal dose. Of course, if PAD is not an option, to hasten the end of life, patients can voluntarily stop eating and drinking water, stop treatment or not start treatment, or elect palliative sedation.
End of Life Services
To assist the dying, the Medicare Hospice Benefit was established in 1983 to provide access to quality end-of-life care. The term “hospice,” from the same linguistic root as “hospitality,” can be traced back to medieval times when it referred to a place of shelter and rest for weary or ill travelers. The first modern hospice was established in England in 1974, by the physician Dame Cicely Saunders, who worked with the terminally ill for 26 years. Today, through Medicare or Medicaid, hospices help the dying through a team of professionals, who provide compassionate and expert medical care, pain management, and emotional and spiritual support expressly tailored to patient needs and wishes.
Even though the majority of patients receive hospice care in their homes (per a 2014 survey by The National Hospice and Palliative Care Organization), hospice care is also available in nursing homes, residential facilities, hospice inpatient facilities, and acute care hospitals.
For those who have the resources, death doulas—meaning “women who serve” in ancient Greek—can provide more in-depth discussions than hospice workers may have the time or inclination for. Doulas can also provide, for example, round-the-clock companionship.
There are so many loose ends at the end of a person’s life. Bodies and ashes aren’t the only remains to be disposed of. There’s also a lifetime of acquisitions. In a new book called The Gentle Art of Swedish Death Cleaning, author Margareta Magnusson, a Swedish artist who describes herself as somewhere between ages 80 and 100, makes a case for “dostadning,” a hybrid of the words for death and cleaning. Magnusson addresses the benefits of giving things to family and friends while one is still alive.
Esther Torres, before a serious operation, told me she cleaned out her San Francisco apartment in a major way. “I didn’t want my parents to have to face so much clutter. And, now that I’m well, I’m enjoying the lightness.”
And, don’t forget about Spot. If a dog is accompanying one into older age, she can think about enrolling him in the San Francisco SPCA Sido program. Named for a dog slated to die according to her owner’s will, the SPCA helped pass legislation more than 30 years ago to ban will-decreed pet deaths and require that pets will be lovingly cared for if they outlive their guardians.
Thinking over all options for end-of-life helps one make important decisions for his or her advance health care directive, says attorney Deborah L. Fox, who presented a seminar on “Getting Your Ducks in a Row before You Go” at the JCCSF conference. Also called a living will or medical directive, an advance health care directive is a legal document specifying the health-care actions to be taken if illness or incapacity renders a person unable to make such decisions.
Still, important as it is to dispose of ones assets thoughtfully, as Harriet Beecher Stowe said, “The bitterest tears shed over graves are for words left unsaid and deeds left undone.”
About Jan Robbins
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