On my father’s 75th birthday, he announced some news: He no longer intended to learn Spanish. He told me that for most of his life he imagined he would one day speak the language fluently, but this year, at this new age and vantage point, he was giving up that goal.
He seemed a little melancholy about it but mostly relieved that he no longer had this piñata of shame hanging over his head.
Best of all, he adopted a mental heuristic for this goal-no-longer that I believe has liberating potential for everyone: Learning Spanish, he told me, was now an item on his “chuck-it list.” (Full disclosure: My dad’s name for the list is a little saltier).
Bucket lists can be a fun, inspirational tool — they encourage us to chase new experiences, such as learning chess or going on an African safari. But let’s face it: They can also be oppressive, irritating reminders that you can’t afford that $3,000 flight to Johannesburg.
As a philosopher of well-being, I can tell you that philosophers tend to divide into three camps on the subject: hedonists, who think well-being is all about good feelings; objectivists, who believe we live well when we achieve things with value transcending the individual; and desire satisfactionists, who think well-being means fulfilling your own goals.
I am in the third camp. I like that this approach respects individual differences and explains why there are so many different good lives. But it also has a serious flaw: Focusing on pursuing our goals often leaves us running on a treadmill of desire and frustration.
The solution to this problem lies in choosing which goals to pursue. The mere pursuit of a goal won’t promote your well-being — you have to be selective. This is where the chuck-it list comes into play.
Are you the kind of person who is going to be on your deathbed regretting that you missed your chance to ride in a hot-air balloon, like Dorothy in “The Wizard of Oz”? Then do it! But when I really thought about that long-held fantasy, I let it go pretty easily, along with parasailing and completing a “century” (a 100-mile bike ride). I felt liberated when I moved these activities to my chuck-it list. It freed me to think about what I actually want to do — which is, turns out, shorter bike rides and flying only in the safety of a commercial airplane.
Of course, building the chuck-it list can be difficult. In his book “Four Thousand Weeks,” Oliver Burkeman reminds us of the old time-management trick of thinking of your goals as rocks that you have to fit into the glass jar of your life. The advice is to put in the big rocks (important goals) first because otherwise you’ll fill your jar with little, unimportant pebbles and won’t be able to fit in the big ones later.
Burkeman dislikes this advice: He points out that the metaphor presupposes that we can squeeze in all the big rocks if we start with them, which might not be true. I agree. Sometimes, it’s a big rock that we have to move to the chuck-it list.
Discarding goals that we really care about is difficult; failing to complete them can elicit sadness or regret. For my father, the relief of letting go of speaking fluent Spanish came tinged with sadness because he saw learning a foreign language as valuable. When you move things to your chuck-it list because you can’t physically do them anymore (e.g., a marathon), there’s also likely to be a layer of disappointment about aging and the reminder of mortality. The same can be said about goals on a bucket list made impossible by financial constraints or time limitations: They force us to come to terms with circumstances beyond our control.
So what should we do about these negative feelings?
My neighbor, a retired pianist and choir director, told me she took learning certain difficult musical compositions off her bucket list. She described the resulting feeling as “sweet loss” — sweet because she can still listen to those beloved pieces, loss because she’s not going to be the one playing them.
Accepting this wisdom requires a shift in perspective. Bucket lists tie the value of our dreams to our value as individuals. Once we cut that tie, we can still appreciate the value of our abandoned goals by finding pleasure in the achievements of others.
Shifting away from a self-centered perspective can help giving up goals feel a bit less bitter. And really, what is the alternative? Keep everything on your bucket list and try to stuff all the rocks into the jar? This inevitably leads to disappointment and frustration. It might also lead to missing out on enjoying what wasn’t on your bucket list — things brought to you by serendipity that you couldn’t plan for, or things you’ve been taking for granted.
This is why I believe your chuck-it list is just as important as your bucket list. As you age, you grow into a different person with new priorities; your goals should evolve, too. Give yourself permission to remove those items you’ll probably never get to. And most important: Don’t feel so bad about it.
Author Amy Ettinger, center, with her husband Dan White and their daughter Julianna White at Disneyland in March.
by Amy Ettinger
Last month, I found out I have Stage 4 uterine leiomyosarcoma, a rare and aggressive cancer. Doctors say I may have just a few months to live. Treatment could buy me a little extra time, but not much. My disease is advanced and incurable. My prognosis has left me shocked, sad, angry and confused. I wake up some mornings raging at the universe, feeling betrayed by my own body, counting the years and the milestones I expected to enjoy with my family.
I am leaving behind a husband and 14-year-old daughter I adore, and a writing and teaching career I’ve worked so hard to build. I’ve been doing a lot of thinking about my life, and in addition to the horror, a surprising feeling has taken hold: I am dying at age 49 without any regrets about the way I’ve lived my life.
I learned that lasting love is about finding someone who will show up for you
In my teen years, I fell hard for a boy who broke my heart, not just once, but half a dozen times. It was an obsessive first crush, the kind that made me stop eating and sleeping. He broke up with me and we got back together many times in high school.
The feeling was addictive, although it made me miserable. Even after I graduated, I could not get him out of my head. His story ended tragically — he took his own life at age 21. His death was heartbreaking, but my fraught relationship with him, and the traumatic aftermath, taught me what I ultimately wanted in love — safety, support, fun and adventure.
I needed a partner who would help me feel good about myself, someone steady, reliable, and free from all that romantic drama.
A few years later, I met my future husband, who was insecure and grappling with his own worries. Dan was smart, bookish, funny and kind. His love for me was constant and never in question. He was a writer, but instead of being competitive with me, he supported my career. Dan and I have been together 25 years, never having broken up or even separated, even for a day.
I pursued my dream career with passion
“No one can make a career out of writing.” It was a statement I heard from almost everyone I knew, from teachers to parents to concerned friends. I was told I would face a life of rejection and begging for late paychecks.
But I knew I could not survive waking up each day to the morning commute and heading to a 9-to-5 office job under fluorescent lights. I like to be in charge of my own life and schedule.
When I wanted to write a reported history about ice cream in America, some people laughed.
“I can see it as a magazine story, not as a book,” one agent wrote me.
And yet I went on to land a contract with Penguin Random House to travel the country, eating ice cream, gathering research, interviewing Jerry from Ben & Jerry’s, and riding around on the back of an ice cream truck through the streets of Bensonhurst, N.Y. The book contract was lucrative, and the publication of “Sweet Spot: An Ice Cream Binge Through America” opened up opportunities I never expected, like being on NPR and teaching creative nonfiction writing.
>In the last few years, I have been able to mentor and coach dozens of promising writers. In return, these students, with their sincerity and soaring ambitions, helped revitalize my own writing, reminding me why I went into this business in the first place.
I have never had a bucket list; instead I said ‘yes’ to life
I’ve always tried to say yes to the voice that tells me I should go out and do something now, even when that decision seems wildly impractical. A few years ago, with very little planning, my family and I got in a car and drove 600 milesto a goat farm in central Oregon, where we camped out for four days to watch a solar eclipse. I once jetted off to Germany on two days’ notice, spending a week exploring Dresden and hiking through the Black Forest.
“Money always comes back, but if you miss out on an experience, the opportunity may never come back.” This has been my mantra since I met Dan. Even when our bank account was low on funds, we decided to move to New York City to pursue our writing dreams. It was ridiculously hard at first, but it worked out because we gave ourselves no other choice.
I’m a good saver but things like retirement accounts were never important to me. When given a choice between taking a family trip to Kauai or squirreling money into a 401(k), I always chose to head for the islands.
I found people in my life who can accept me as I am
I don’t try to hide who I am or apologize for it. I am a bit of a hermit. I am sure I have hurt people’s feelings with my behavior from time to time by ducking out of parties early or choosing not to go to Happy Hour. I have spent very little time worrying about it. I think it’s more important to find people who get me and accept me than want to change me. I have done my best to avoid people who come at me with unreasonable expectations. And because I don’t have to spend any time covering up my real self, my friendships are genuine. Since my diagnosis, I’ve had a chance to tell my friends how much I love them. They’ve told me that, too, and I deeply feel it.
I live where I want even though the numbers never add up
I love spending time in the redwoods and by the ocean. Just a few months ago, I was walking four miles a day along the sweeping ocean coastline at West Cliff Drive where I could see surfers and otters frolicking, and humpback whales lunge-feeding just off the shoreline. This became my everyday routine.
My favorite spots are within a 10-minute drive of my house, and most are still accessible even as my energy continues to drop off as the cancer spreads through my body.
The flip side of this dream life is the cost. My family and I live in one of the most unaffordable places in America.
Dan and I have talked dozens of times about uprooting, but my friends and our writing community are in Santa Cruz, and my daughter loves her friends and her school, so my husband and I have chosen to stay. My family will never own a house — at least not in my lifetime — but at least I am dying around people who love me and are bringing me meals when I need them. These are people who are willing to show up for me no matter what. And I know they will show up for my husband and daughter, even after I am gone.
The end of my life is coming much too soon, and my diagnosis can at times feel too difficult to bear. But I’ve learned that life is all about a series of moments, and I plan to spend as much remaining time as I can savoring each one, surrounded by the beauty of nature and my family and friends. Thankfully, this is the way I’ve always tried to live my life.
Reality knocked me for a loop one evening when my father-in-law called from his home in another state and asked for help. This kind of request was very uncharacteristic for him. We responded immediately and drove to his home. After much conversation and many questions from both sides, we eventually came to the hard truth. His cancer had progressed and, to my mind, was most likely terminal. I dug in and started contacting his doctors, trying to sort out his health issues and prognosis. This took most of a day. I came to realize he was seeing nine physicians! He was in a desperate state of denial. The oncologist repeated that he had been very open and clear with my father-in-law about the cancer and its spread.
My father-in-law had been readmitted to the hospital with a very determined but misguided surgeon. My father-in-law thought the surgery proposed by the surgeon would be a cure. It wouldn’t be, and I had the unenviable task of discussing end-of-life matters with the patient, something the surgeon should have been upfront about.
Hospice came to the hospital to discuss the care they could offer him at his home. He elected to enter into hospice, and we took him home. At this point, he was feeling fairly well, and he had a glorious two weeks with friends and family coming for visits from many miles away. Meanwhile, I quickly discovered I was in unfamiliar territory when it came to his care. It was increasingly difficult for me to care for someone I loved and had a close familial bond with. The amounts of medication he was allowed, the hard decisions I had to make… all were uncomfortably entwined with the closeness of being family. He asked for teaching regarding his health and prognosis, and we spent hours discussing end-of-life matters and the decisions to be made. Even though family was in touch, they were in their stages of denial. I became the liaison for the family’s questions, as well.
Uncharacteristically for me, I was struck with uncertainty, processing my grief while maintaining my professional duties. I relied heavily on the hospice nurses as they made their daily visits. The type of care I gave him, the large doses of medications that kept him comfortable… all were different when compared to my decades of working to save lives and titrating medications for patients who would, with the care given, most likely live to go home and resume their lives. I found myself relying on the hospice nurse, asking questions like, “Are you sure it’s ok to give him that large a dose of painkillers?” She worked with me, explaining how different this type of nursing was compared to the care given to save the lives of my usual hospitalized post-surgical, cardiac, neuro, psyche, burn, chronic respiratory, and emergency patients.
There were different, more intense emotions involved in caring for this terminally ill, beloved family member. I second-guessed myself in areas where I normally was quite confident. The advice that most helped guide me through the nights of caring for him was given to me by the hospice nurse. She repeated to me several times, “This is different from the nursing you are used to. You medicate this patient for his comfort… whatever it takes. You cannot overdose him. I repeat, you cannot overdose him.” So I learned a new skill. I learned to titrate medication for his comfort, to give him what he needed, without second-guessing myself. I kept him comfortable but functional.
And one night, he collapsed as he left the bathroom. He had no perceptible heartbeat. He had no perceptible breathing. After 15 minutes, he sat up and started talking! It blew my mind. Once he was settled back in bed, I teased him about him having left us to visit his favorite brother and his much-loved mother, both deceased. He suddenly looked at me with complete seriousness and said, “How did you know where I was?” He was thoughtful for the next few hours, then quietly said, “I’m ready. I’m ready to go, and I’m not afraid. I’ve done everything I needed to.” Three days later, he left us. That time there was no resurrection.
Start with music that matches your frame of mind and slowly shift to more soothing themes. A suggested playlist can serve as a guide.
By Raymond Leone
Music can have a profound effect on us. It can improve our physical and mental health by helping to reduce blood pressure, alleviatestressand lead to a release of dopamine, a neurotransmitter that affects our mood and sense of happiness, research shows.
As a music therapist working in a hospital, I use music to help reduce anxiety in patients. A review of 19 randomized controlled trials showed “an overall decrease in self-reported anxiety” among healthy individuals after listening to music, and a study I participated in found that a music therapy session resulted in positive outcomes for some patients.
I start with music that matches the patient’s frame of mind and slowly shift to more soothing themes. I find that their mood and affect will often follow. It’s called entrainment. We “entrain” to the music and follow along, both mentally and physically.
Listening or singing along to meaningful songs can also help people feel better.
I worked with a woman in her 40s who had been diagnosed with cancer. She was distressed because of the diagnosis, but there seemed to be another reason for her sadness that she could not put into words.
>We spoke about music and her favorite meaningful songs. She mentioned that she loved listening to Fleetwood Mac, especially the song “Landslide.” I played and sang it for her. She cried and when the song concluded, she said, “I know why I’m so distressed. I’m worried about my children.”
The song, which features the words, “even children get older,” helped her to identify her concerns. We were then able to converse about her children and start to work on a plan for how she would tell them.
Music can speak for us
Sometimes, when we are gripped by panic and anxiety, we may not have the words to describe how we are feeling. Then, a song comes on the radio or our playlist, and it hits us: “That is exactly how I’m feeling!”
Music — whether the dark, minor essence of Beethoven or the down-tempo sparseness of Lucinda Williams — can speak for us, especially when we are feeling anxious or depressed. Susan Cain explores feelings of longing and melancholy in her book, “Bittersweet: How Sorrow and Longing Make Us Whole.” She theorizes that acknowledging and accepting these feelings make us whole and are comforting.
She references music as a way to help us navigate and own these feelings and says there’s power and a unique beauty in sad or melancholic music.“A moon-lit sonata can be therapeutic for people experiencing loss or depression; it can help us to accept negative emotions rather than ignoring or repressing them; it can show us that we’re not alone in our sorrows,” she writes.
Music is subjective
There are many articles with headlines such as “10 best songs to help you relax, according to science” or “30 songs to soothe you when you are anxious.”
What if you don’t like most or any of those songs?
One of the great things about music is that it is subjective and how we use it is personal, too. We can explore ways to use music, all kinds of music, to help us in our lives when we need it. There are times, particularly after an emotional day at work, when heavy rock music relaxes me. The sounds and aural atmosphere match my inner feelings and angst at that moment. It’s a release.
How I use music to help my patients
I generally use live music, improvised mainly on the guitar, to help people with pain and anxiety in a clinical setting. Live music helps me meet the patient where they are. I can then gradually change and manipulate the music to help bring them along to a more relaxed place. Sometimes, the patients fall asleep at the end of the music.
I have developed my music therapy technique over years of practice. These are the steps:
The initiated soundscape is empathic; it reflects what the patient may be going through or feeling inside. The music is “entraining” to their inner psyche of the moment.
The music may initially include some tension and dissonance.
Then the music starts guiding them toward a new, more relaxed place. It has some release from the tension and more soothing and harmonic themes.
It moves toward more resolve and grounding and focuses on aesthetics or beauty.
Many times, the music concludes, having moved toward one chord — a simple two-note mantra.
How you can use music when you are anxious
When you are feeling anxious, instead of finding some “relaxing” music, put together a personal playlist and let the music or the song sequence guide you.
Start with a song or piece of music that matches your current mood. The initial song or songs can have a little more intensity, some tension and dissonance or melancholy. Then each ensuing song can gradually, one step at a time, help bring you along toward a more relaxed place.
Use music that you like. Maybe it’s Norah Jones or 80s pop or classic jazz or Mozart.
Here is a sample playlist with some instrumental guitar music, starting with a bit more intensity and then moving toward comfort and relaxation:
“Prelude” — Alex de Grassi
“Fusion of the Five Elements” — Michael Hedges
“Megalopolis” — Rodrigo y Gabriela
“The 2nd Law” — Michael Hedges
“Sleeping Lady” — Alex de Grassi
“The Sprinter” — Isato Nakagawa
“Prelude in D Minor” — Acoustic Alchemy
“Saint Agnes and the Burning Train” — Sting
“A Child’s Song” — Will Ackerman
“In This Moment” — Ken Verheecke
“The Rain Is Pouring” — Alex de Grassi
“For the Asking” — Will Ackerman
“The Water Garden” — Alex de Grassi
“The Bricklayer’s Beautiful Daughter” — Will Ackerman
“Golden Slumbers” — Erik Söderlind
Music can meet us where we are — perhaps anxious, depressed or low — and help take us to where we want to be — calm and relaxed. Pick what moves you and make music work for you.
Many of us say that if we have to die, we’d like to die comfortably in our home. Luckily, hospice—a Medicare-covered model of gentle, holistic end-of-life care—is ready to help with that goal.
Maybe.
by Laura Kelly
At age 78, my divorced father was diagnosed with Stage 4 colon cancer. He later admitted that he’d skipped getting any colonoscopies. He was a savvy healthcare researcher and, via drug trials, controlled the spread of his cancer for four long years. Then came the day his doctor said, “There are no more treatments left, Larry. Call your kids and sign up for hospice. Today.”
If you’re hazy about what hospice is, as my family was, check out Medicare’s hospice page that details the conditions that qualify you for hospice care and what costs Medicare will cover. You might also check out a 2023 New York Times article that sheds light on how hospice functions today. The industry has traveled far from its grassroots, volunteer origins of 40 years ago.
By the time I was flying from New York to Michigan to “help out,” my busy brother David had made the executive decision to move my father from his cluttered condo to David’s larger family home across town. My brother’s wife, 9-year-old daughter and three large dogs were no doubt a bit flummoxed when David deposited my hospice-unready father into the ground-floor master bedroom. But my father and everyone else were united in wanting the proverbial “good death” in the comfort of a home, even if it wasn’t his.
What happened during that home hospice experience surprised me. After it was over, I compared notes with friends. It seems that what my family went through might not be typical. Still, it could be a portent of what’s to come as the baby boomer bulge meets the realities of understaffed hospice care. Here are five takeaways if you’re ever considering home hospice for a loved one—or yourself.
1. Research hospice options before you need them
As my father and family found out, the very end is much too late to think about hospice—both for taking advantage of hospice’s full psychosocial benefits and for finding out what you’re getting into.
The hospice provider, which had been suggested to my father by his doctor’s office, turned out to be severely overstretched. We had only four short visits from a hospice nurse—a different person each time—during the 11 fraught days of my father’s end-of-life passage. It was also impossible to get the hospice doctor on the phone to answer our ongoing questions. Even so, we could never find the time to research and switch to another organization.
Since events can overtake you at the end of life, spend an hour today learning which hospice providers operate in your area. AARP keeps an excellent updated page with facts about hospice, including questions to ask when you interview organizations. Your future self will thank you.
2. Know what equipment and services to ask for
Beyond the electric hospital bed, rolling bedside table and plastic commode that the hospice group delivered, my brother’s home was not equipped for a dying person. Side note: At the intake meeting where we met with hospice nurse No. 1 and a social worker, we all agreed that the bed was much too short for my 6’4″ father. He requested a replacement, but one never arrived. We should have kept asking.
We quickly found ourselves making daily runs to a nearby Target for more towels, more large and small pillows for propping up, more pajamas, cooling patches, ice packs, a small table fan that my father could angle, sheets, blankets, sippy cups and dry-mouth swabs, plus an intercom because my father’s voice weakened too much to call for us in another room. My credit card got a workout.
3. Be prepared to hire help
As much as we tried to make my father comfortable, it seemed impossible. He was plagued by restlessness and couldn’t sleep or be convinced to stay in bed. Someone had to be near him around the clock to prevent a fall in his weakened state.
After six sleepless nights, we called the hospice phone line yet again with questions about the situation, and a nurse on the line finally filled us in on “terminal agitation,” a not-uncommon occurrence at end of life for cancer patients, even though no one in our family had heard of it. She told us that this kind of metabolic restlessness was worse than pain because it could not be soothed by painkillers. “Call us again if you need to,” she wrapped up.
By then, we realized that our home hospice team was mostly voices on the phone, not the on-site caretakers we’d expected. A concerned long-distance relative emailed me: “Get yourself some nighttime help so you can sleep.”
I had no idea how to find good health aides at short notice, but it turned out that “good” wasn’t the issue. We just needed someone to sit near my sleepless father, so we caretakers could get some rest. I also needed time to coordinate events outside of hospice, such as lining up a funeral home to call when my father died. In the end, I pretty much handed over my credit card to three different aide services to help us patch together 24/7 coverage until the end.
Will you need expensive additional aides for home hospice? Maybe, so be prepared by getting the names of aide services and interviewing them at the beginning of the hospice process, so they’re just a phone call away if needed.
4. Someone needs to be in charge
Continuity of care was a big problem for us and my father. There was a revolving stream of new hospice personnel and eight different aides, along with a churn of visits from nearby relatives and phone calls from folks farther afield. Meanwhile, every day brought changes and challenges as the end of life approached.
It took me far too long to realize that neither my father nor the home hospice team were running the show; I was. In unfortunate timing, during these hospice days, my brother had been pulled away to manage an ongoing crisis at his company. Still, every night, David remained on call to help me or an aide. He was the only one who could support my tall father as he restlessly moved from bed to nearby chair to commode.
Needless to say, my brother was exhausted. After another of these nights, I emailed my two sisters what came to be known as “the bossy note,” telling them exactly what was needed from them beyond the occasional visits bearing baked goods. It was all-hands-on-deck time.
I suggest that upon hospice enrollment or before, everyone should agree on a point person. This coordinator would have the overview of the home hospice situation, be given the latitude to set the ground rules and make decisions, and be allowed to delegate whatever to whomever, as needed.
5. Hospice at home may mean a nonprofessional will be in charge of medications
One of the hallmarks of hospice is the comfort care provided. On the first day, as I followed the intake hospice nurse on her way out the door with my list of anxious questions, she stopped me by handing over what she called a “comfort box.”
I pried open the white cardboard box and saw a confusing array of vials, syringes and suppositories. I thrust the box back toward her. “This is all for you to use, right?”
“No, they’re for you,” she said. “If your father needs them, you can call us. Put the box in the refrigerator where you can find it fast.” Then she left.
I immediately regretted that I didn’t ask her to go over each and every medication and how to use it, recording her explanation using my cellphone.
Later on, when I hired the aide services to help us through the final days and nights, I found out the aides weren’t allowed by their companies to prepare the needed antianxiety and sedative medications, and they could only give them to the patient when directed by someone in charge, meaning me. If I wasn’t awake to direct them, my father wouldn’t get his comfort meds.
As my shaking hands prepared morphine syringes and crushed Ativan pills in the middle of the night, I thought, “I would never expect or want someone like me to do this for me.”
My advice: When you’re doing those early interviews with prospective home hospice providers, ask who will actually dispense the medications. Maybe you’ll find out the home hospice nurses will be there to do it. But in our case, they weren’t.
My father died on Oct. 25, 2015, after his 11 days of home hospice care.
Was it the good death my dad had hoped for? I’ve never shared this with my siblings, but I don’t entirely think it was. My father had always prided himself on being the problem solver, not the problem maker. While we tried to hide our distress, he couldn’t help but notice how unprepared his kids were to supervise this 24/7 medical undertaking.
One late night, as I lay awake on the king bed beside my restless father in his little hospital bed, he told me he was sorry about “all the trouble I’m causing,” as he put it.
“I didn’t imagine it would go like this,” he said quietly. “No help. No sleep. Not knowing what’s coming next. Thank you for everything you’re doing.”
I reached over and touched his hand. “Dad, I am so grateful to be here helping you through this after all you’ve done for us. Please don’t apologize. You’re no trouble at all.”
Later, I heard friends’ stories of their supported and peaceful experiences in dedicated hospice facilities. There, they could quietly share smiles and good memories, listen to music, even be served meals. A facility can perhaps more easily arrange quality-of-life options for the patient, such as expert bathing and therapeutic massages with oils. Most important, a facility would presumably be staffed with professionals who could administer the proper palliative medication. A place that’s designed and intended for end-of-life care clearly has some advantages.
If, however, you’re with the majority who would prefer using hospice in a familiar home setting, look into what’s entailed well ahead of time. Ensure that family or friends are willing and able to coordinate all the activities and decisions. Have a credit card ready for all the purchases and extra help you may need. And don’t make hopeful assumptions, as I did. Be proactive and ask the necessary questions, so you or your loved one gets the quality end-of-life care all of us deserve.
Many Americans report that their relationships with loved ones continue past death in some way, according to a recent Pew Research Center survey.
Around half of U.S. adults (53%) say they’ve ever been visited by a dead family member in a dream or some other form. And substantial shares say they’ve had interactions with dead relatives in the past 12 months:
34% have “felt the presence” of a dead relative
28% have told a dead relative about their life
15% have had a dead family member communicate with them
In total, 44% of Americans report having at least one of these three experiences in the past year.
Women are more likely than men to say they have had these kinds of interactions with dead family members. And people who are moderately religious are more likely than others – including those who are highly religious and those who are not religious – to have experienced these things.
The survey was conducted March 27-April 2, 2023, among 5,079 adults on the Center’s American Trends Panel. It included Americans of all religious backgrounds, including Jews, Muslims, Buddhists and Hindus. But there are not enough respondents from these smaller groups to report on their answers separately.
While the survey asked whether people have had interactions with dead relatives, it did not ask for explanations. We don’t know whether people view these experiences as mysterious or supernatural, or whether they see them as having natural or scientific causes, or some of both.
For example, the survey did not ask what respondents meant when they said they had been visited in a dream by a dead relative. Some might have meant that relatives were trying to send them messages or information from beyond the grave. Others might have had something more commonplace in mind, such as having dreamt about a favorite memory of a family member.
Experiences with being visited by a dead relative
Overall, 46% of Americans report that they’ve been visited by a dead family member in a dream, while 31% report having been visited by dead relatives in some other form.
Roughly two-thirds of Catholics (66%) and members of the historically Black Protestant tradition (67%) have ever experienced a visit from a deceased family member in some form. Evangelical Protestants are far less likely to say the same (42%).
Roughly half (48%) of Americans who are religiously unaffiliated – atheists, agnostics, and those who report their religion is “nothing in particular” – say they have ever been visited by a dead relative in a dream or other form. However, those who describe their religion as nothing in particular are much more likely to say they have ever been visited by a deceased loved one (58%) than are agnostics (34%) and atheists (26%).
Recent contact with deceased relatives
When asked about recent experiences – things that have happened in the last 12 months – 34% of Americans say they have felt the presence of a dead family member and 28% say they have told dead family members about events in their life. Fewer respondents (15%) say a deceased family member has communicated with them in the past year.
Women are more likely than men to say they had at least one of these three experiences in the last year (53% vs. 35%). For example, women are more likely than men to say they recently have felt the presence of a dead family member (41% vs. 27%).
When it comes to religion, about half or more of Catholics (58%), members of the historically Black Protestant tradition (56%) and mainline Protestants (52%) say they have had at least one of these three experiences in the last year – significantly more than the 35% of evangelical Protestants who say the same.
Relatively few atheist (15%) or agnostic (25%) adults report any of these experiences over the last 12 months. In contrast, roughly half (48%) of those who say their religion is nothing in particular reported one of these experiences.
These experiences also differ by Americans’ religious commitment, as measured by a scale that includes indicators of religious service attendance, prayer frequency and self-assessments of religion’s importance in one’s life.
Americans with medium levels of religious commitment are more likely than those with either higher or lower levels of religious commitment to say they’ve felt the presence of a family member who is dead, told a dead family member about events in their life, and felt a dead relative communicate with them in the past year.
Summing up this pattern in another way: People who are moderately religious seem to be more likely than other Americans to have these experiences. This is partly because some of the most traditionally religious groups – such as evangelical Protestants – as well as some of the least religious parts of the population – such as atheists and agnostics – are less likely to report having interactions with deceased family members.
— Our funeral practices have a high carbon footprint. Becca Warner explores how she could plan her own more environmentally-friendly burial.
By Becca Warner
Not many of us like talking about death. It’s dark, and sad, and prone to throwing us into an existential spiral. But the uncomfortable truth is that, as someone who cares about the environment, I realised I needed to stop ignoring the reality of it. Once we’re gone, our bodies need somewhere to go – and the ways that we typically burn or bury bodies in the West come at a scary environmental cost.
Most people in the UK (where I’m from) are cremated when they die, and burning bodies isn’t good for the planet. The stats make wince-worthy reading. A typical cremation in the UK is gas-powered, and is estimated to produce 126kg (278lb) CO2 equivalent emissions (CO2e) – about the same as driving from Brighton to Edinburgh. In the US, the average is even higher, at 208kg (459lb) CO2e. It’s perhaps not the most carbon-intensive thing we’ll do in our lives – but when the majority of people in many countries opt to go up in smoke when they die, those emissions quickly add up.
What is CO2e?
CO2 equivalent, or CO2e, is the metric used to quantify the emissions from various greenhouse gases on the basis of their capacity to warm the atmosphere – their global warming potential.
Burying a body isn’t much better. In some countries, the grave is lined with concrete, a carbon intensive material, and the body housed in a resource-heavy wood or steel coffin. Highly toxic embalming fluid, such as formaldehyde, is often used, which leaches into the soil alongside heavy metals that harm ecosystems and pollute the water table. And the coffin alone can be responsible for as much as 46kg (101lb) CO2e, depending on the combination of materials used.
I spend my days attempting to tread lightly on the planet – recycling cereal boxes, taking the bus, choosing tofu over steak. The idea that my death will necessitate one final, poisonous act is hard to stomach. I am resolved to find a more sustainable option. (Listen to the Climate Question’s episode exploring whether we can have a climate-friendly death).
In traditional burials, graves are lined with concrete, a carbon-intensive material, and bodies are embalmed in toxic fluids which can leach into the soil
My first port of call is the Natural Death Centre, a charity based in the UK. I pick up the phone and am pleased to find Rosie Inman-Cook on the other end of the line – a chatty, no-nonsense type who is quick to warn me about the dubiousness of many alternative deathcare practices. “There are always companies jumping on the bandwagon, seeing a cash cow, inventing stuff. There’s a lot of coffin producers and funeral packages that will sell you a ‘green thing’ and plant a tree. You have to be careful.”
Her warning brings to mind some “eco urns” I’ve read about. Some are biodegradable, so that buried ashes can be mixed with soil and grow into a tree; others combine ashes with cement so they can form part of an artificial coral reef. These options offer a kind of eco-novelty: what’s a more fitting end for an ocean lover than to rest among the reefs or for a forest fanatic to “transform” into a tree after their death? The only problem is that however sustainable the urn, the ashes deposited in it are the product of carbon-intensive cremation.
So can I avoid my body becoming a billowing cloud of black smoke in the first place?
Inman-Cook’s remit is natural burials. This involves burying a body without any barriers to decomposition – no embalming fluids, no plastic liners or metal caskets. All of this means zero CO2 emissions, according to a recent analysis conducted by UK sustainability certification company Planet Mark. The body is buried in a relatively shallow grave, which might be someone’s garden, or, more often, a natural burial site.
Some natural burial sites allow graves to be marked with stones or other simple markers; others are stricter and don’t allow any markings at all. These are woodlands or other wildlife-rich places, often managed in a way that actively supports conservation. “It’s [about] creating green spaces for wildlife, nice places for people to visit, planting new woodland at the same time – and it’s a positive legacy,” Inman-Cook says.
But what of the not-so-natural materials that make their way into the human body – pharmaceuticals, microplastics, heavy metals? They surely don’t belong in the ground. One solution might come in the form of a coffin made of fungi. The Loop Living Cocoon claims to be the world’s first living coffin. It is made of a native, non-invasive species of mushroom mycelium, which is also used to create insulation panels, packaging and furniture. I speak to its inventor, Bob Hendrikx.
“The best thing that we can do is die in the forest and just lay there,” he says. “But one of the problems we’re facing is soil degradation – the quality of the soil is getting poorer and poorer, especially in funeral sites, because there’s a lot of pollution there. The human body is [also] getting more polluting.” Microplastics, for example, have now been found in human blood.
Natural burials are growing in popularity. It involves burying a body without any barriers to decomposition – no embalming fluids, plastic liners or metal caskets
Mycelium has the power to increase soil health and absorb heavy metals that would otherwise leach into groundwater. Some fungi species have been found to break down microplastics, and future research could uncover ways to harness this for human burials.
But based on current research, the real impact of today’s mushroom coffins is difficult to know. I ask Rima Trofimovaite, author of Planet Mark’s report, what the likely benefits of a mushroom coffin are. She says that there is limited data on whether human bodies pollute the ground following a natural burial in a shallow grave. But she says that it is likely that most pollutants are “sorted out at the right level with the right organisms” when only a few feet underground, no extra fungi needed. “I think an option like this is still important,” she says. “We know that natural burial is the least emitting, but not everyone likes being wrapped up in a cotton shroud. People might prefer a mushroom coffin because it has a shape.”
However ecologically sound a natural burial – with or without fungi – might be, land remains precious. In cities in particular, green space for natural woodland burials is at a premium. It was this that prompted young architecture student Katrina Spade to investigate what could be done to make burials in cities less wasteful. Her solution is a logical one: to compost the body in a hexagonal steel vessel, reducing it to a nutrient-dense soil that the family can lay onto their garden.
Sustainabilty on a Shoestring
We currently live in an unsustainable world. While the biggest gains in the fight to curb climate change will come from the decisions made by governments and industries, we can all play our part. In Sustainability on a Shoestring, BBC Future explores how each of us can contribute as individuals to reducing carbon emissions by living more sustainably, without breaking the bank.
Spade launched Recompose, the world’s first human composting facility, in Seattle in 2020. Washington was the first US state legalise human composting the same year, and the practice is now legal in seven US states. Other human composting facilities have sprung up in Colorado and Washington.
Recompose has so far composted around 300 bodies. The process happens over the course of five to seven weeks. Lying in its specialised vessel, the body is surrounded by wood chips, alfalfa and straw. The air is carefully monitored and controlled, to make it a comfortable home for the microbes that help speed up the body’s decomposition. The remains are eventually removed, having transformed into two wheelbarrows-worth of compost. The bones and teeth – which don’t decompose – are removed, broken down mechanically, and added to the compost. Any implants, pacemakers or artificial joints are recycled whenever possible, says Spade.
With no need for energy-intense burning, human composting has a far smaller carbon footprint than cremation. In a lifecycle assessment conducted by Leiden University and Delft University of Technology, using data provided by Recompose, the climate impact of composting a body was found to be a fraction of that of cremation: 28kg (62lb) of CO2e compared to 208kg (459lb) CO2e in the US. When I ask Spade about the production of methane – a particularly harmful greenhouse gas that is released when organic matter rots – she explains that the vessels are aerated to ensure there’s plenty of oxygen. This prevents the anaerobic process that causes rotting, she says.
Turning a human body into soil also reminds us that “we’re not adjacent to nature, we’re part of nature,” Spade says. This shift in our relationship to the natural world is an environmental benefit that’s hard to quantify but is “critical to the plight of the planet”, she says.
Turning a human body into soil reminds us that “we’re not adjacent to nature, we’re part of nature,” says Katrina Spade, founder of Recompose
Can anyone be composted? I ask Spade this question as I want to know if I’d “qualify” to meet the same end as a banana peel. The answer is, broadly, yes – but not if I’ve died of Ebola, a prion disease (a rare type of transmissible brain disease), or tuberculosis, as these pathogens have not been shown to be broken down by composting, says Spade.
As she describes the process, it strikes me that clothes would presumably not be welcome in the composting vessel. Instead, the remains are shrouded in linen, and families who choose to hold a ceremony can cover them with organic wood chips, straw, flowers, even shredded love letters.
“In one case, a family brought red bell peppers and purple onions that had just ripened in their loved one’s garden – it was so beautiful,” Spade recalls. The body enters a “threshold vessel”, where the Recompose team takes over. They remove the linen shroud but not the flowers and vegetables. I quietly hope that my family would really go for it here. I picture baskets of pine cones, mounds of mushrooms, maybe some of my beloved house plants.
This is all feeling very earthy – but there is another low-carbon option that centres around a different element: water. “Water cremation” (also known as “aquamation”, “alkaline hydrolysis” or “resomation”) is an alternative to traditional cremation, and was the method of choice for Archbishop Desmond Tutu, who helped end apartheid in South Africa. It is another altogether gentler and cleaner affair than cremation, producing just 20kg (44lb) CO2e. “That’s a big difference,” Trofimovaite says. “You slash massive amounts of emissions with resomation compared to flame cremation.”
Approximately 1,500 litres (330 gallons) of water is mixed with potassium hydroxide, and heated to 150C (302°F). In just four hours, the human body is reduced to sterile liquid. More than 20,000 people have been water cremated over the last 12 years, mostly in the US. The UK’s largest funeral provider, Co-op Funeralcare, recently announced that it will introduce the practice later this year.
The speed of water cremation makes it a great budget option. The Co-op anticipate the cost to be comparable to flame cremation – around £1,200 ($1,500) with basic support but no funeral service. Natural burials can be a similar price, but costs are often much higher, depending on the individual burial site. Composting is a lot more pricey at $7,000 (£5,500) – slightly more than the average standard UK burial, which costs £4,794 ($6,107).
I speak to Sandy Sullivan, founder of Resomation – a company that sells water cremation equipment to funeral homes across North America, Ireland and the UK (and plans to in the Netherlands, New Zealand and Australia in the next year). He is patient when I say I’m picturing the process as a kind of melting, and that I’m not sure how I feel about that.
“This is what you end up with,” he says, holding up a large, clear bag filled with a bright white powder. “This is flour, by the way,” he adds quickly. The point is that the final product is dry, ash-like. The flour is a likeness of what is returned to the family, and it comprises only the bones, which have been mechanically crushed (as they are following flame cremation). The soft tissue of the body is broken down in the water and disappears down the pipes to the water treatment plant.
Flame cremations are among the most carbon-intensive funeral rites
Sullivan’s bag of flour represents the physical takeaway that is so important to many families. It demonstrates what Julie Rugg, director of the University of York’s Cemetery Research Group in the UK, says is central to so much of our thinking about funeral practices.
“In the face of death, we seek consolation. And it’s been really interesting seeing how there’s been a conflict, in some cases, between what is sustainable and what people find consoling,” she says. Bags of bone ash and compost go some way towards overcoming this by offering us something tangible, an anchor for our grief.
As I consider the various options I’ve learned about – melting, mulching, mycellium – I find my thoughts returning to my first conversation with Inman-Cook. I am taken with the simplicity of natural burial, the absence of any bell, whistle, vessel or chamber. I’m pleased to learn that, based on all she has learned during her scientific analysis, Trofimovaite has reached the same conclusion. “I would try to do it as natural as possible,” she tells me. “Natural burials are the most appealing.” But an unmarked natural burial is a perfect example of the conflict Rugg has identified.
Carbon Count
“Somebody says they love the idea of being buried in this beautiful meadow, but they can’t put anything down on the grave,” she says. Rugg describes “guerilla gardening” taking place at one natural burial site, by a family member intent on surreptitiously marking their loved one’s grave with distinctive clovers. “What we’ve got to arrive at is a system which allows us to feel that our loss is special. We’ve got to think about sustainability at scale that still offers consolation.”
The answer, it seems to me, could lie in reimagining what “special” can mean. As Rugg says, in a typical memorial garden “you can’t move for plaques everywhere. We resist the dead disappearing, and actually we find that less consoling than we might think.”
I come away from the conversation with a clear sense that, assuming I’ve avoided going up in a puff of smoke, one of the most helpful things I can do is to refuse to lay claim to any single patch of land at all. I hope my family could find consolation in the knowledge that I’d be happier becoming one with a whole landscape. Why be a tree when I can become a forest?
