“The human brain learns from stories,” says Traverse City birth and death doula, Krista Cain. As she sits with a mug of hot herbal tea at Cuppa Joe in the Village at Grand Traverse Commons, she explains her own story and the not-so-strange duality of her business, Sweetwater Doula, this way: Everyone experiences birth and death. Whether you’re experiencing them directly or through someone close to you, they’re an inevitability. They’re both also mammoth experiences marked by extreme emotion, hospital visits, and ceremony. Each of these experiences, she says, is a wave that smacks our bodies and minds repeatedly back down into the fray. Each is exhausting. But, she asks, “Why not ride [that experience] and let it take you in the direction you want to go? I want my teaching to be a surfboard.”
A doula is not a medical practitioner. A person working as a doula is not a doctor or a midwife; he or, more commonly, she is a guide.
Doula is a Greek word that was appropriated in the ’80s to describe a female assistant,” says Cain, but the definition has since expanded to describe someone who helps others during intimate emotional and physical events. Becoming a doula isn’t something with a hard start or stop, like a medical degree or a teacher certification. It’s common life experiences. “Walking people through life is a softer line,” she says.
Cain’s own line toward becoming a doula wasn’t a direct one. She originally hails from Southern California. She has a background in education and worked as a high school math teacher before coming to Michigan. But when she and her husband, who grew up in Traverse City, moved to northern Michigan in 2011, Cain, who was pregnant at the time, had a jarring resolution: “I’m not here to teach math. I’m here to teach people.”
Her transition into teaching about birth and death began with a certification in the Lamaze technique, which she still teaches alongside her workshops in birth and death. As she taught, she began to see that there were some holes in her personal experience with birth: She had never attended a birth other than her own. Her training as a birth doula began from a desire to offer even deeper knowledge and empathy to her clients.
Likewise, another life experience led her to expand her business to include not only guidance in birth but also in death. In particular, experiencing the death of her young goddaughter showed her how helpful it is to approach death in whatever way makes most sense to the person experiencing it. Death is certain, yet always feels unexpected.
Cain began training as— what she calls — a “death doula” in 2016, with an organization based in California called Bridging Transitions. The mother of one of its founders lived on the Leelanau Peninsula before she passed away in 2016. Cain was able to participate and assist the family during this time. She learned about both the scientific and social nature of death and dying.
Funeral Director and owner of Life Story Funeral Home, Vaughn Seavolt, worked directly with Cain during the funeral for a family who wanted to participate in all aspects of their father’s death. He said he sees a lot of value for both the person passing and the loved ones left behind.
“Having a death doula participate made it very meaningful for the family,” says Seavolt, “I think that it’s very rewarding and very healthy for families who want to participate as much as they want to.”
Cain says birth and death are extremely social experiences, and a doula helps with the social needs and pressures surrounding these major life transitions.
“A doula is a person who is skilled to walk beside you — your family, your partner — to meet your needs as you go through these changes,” says Cain. She will help you and your family in whatever way you need, from deciding what sort of service you want (do you even want a service?) to finding a place in the refrigerator for all the casseroles you’ve received.
“It’s not all about green burials,” says Cain. “You can do this with a body preserved in formaldehyde. You can do this with someone who’s been cremated.” On her website, Cain talks about how the ceremony surrounding the death of a loved one can be exactly what you make of it. It can take place at a funeral home, the hospital, a loved one’s home — whatever makes most sense for your situation. It can have as much or as little religion as is right for you and your family and friends. “There are religious traditions that guide the day, and there are ways you can walk alongside those traditions to serve the needs of the people who are carrying them out,” says Cain.
Most importantly, she provides both information and validation for your personal choices. In birthing and dying, what is right for one person might not be right for another, and that’s OK, Cain says.
Explains on of Cain’s birth clients: “It is also refreshing to hear people talk openly and without judgment about ‘taboo’ topics like postpartum depression and mental health counseling, miscarriage and infertility.”
Cain is adamant about empowering her clients through education. “We have a right to know about this stuff,” she says, “[both the] transformative experience of it and the nuts and bolts.”
A quick internet search reveals that end-of-life doulas are on the rise. There are lots of names for it: “end-of-life transition guide” or even “midwife of the veil,” but Cain prefers to keep things simple and bypass the poetry.
“Right now I straight up say ‘Death Doula.’ The reason I say that is because it’s really reallyclear. I don’t want to have to be that blunt, but we’ve done such a good job at covering it up.”
She’s working to uncover these topics, though she recognizes that it takes a fair amount of bravery to approach them openly. Cain often hosts workshops in both life and death. Who are they for? “Anyone with a life span!” she says, laughing. “If you’ve got a life span, you might at some point want to consider thinking about these things.”
Matters of Life and Death
Want to learn more about Cain, her services, or upcoming workshops? Check out www.sweetwaterdoula.com.
Would you prefer to be cremated or buried in a casket? Washington might give residents an additional option if it becomes the first US state to legalize an unusual end-of-life practice — composting human remains.
“Recomposting” — which advertises as more environmentally friendly than traditional funeral practices — is a process where a human body is quickly decomposed using heat-loving microbes and beneficial bacteria.
The temperature is kept at 131 degrees Fahrenheit (55 Celsius) for 72 consecutive hours. The remains are then added into soil that can be used as mulch for trees, flowers and other plants.
Neither Sen. Pedersen or Recompose, the company that would be responsible for the actual composting of human bodies, responded to a request for comment.
“The transformation of human to soil happens inside our reusable, hexagonal recomposition vessels,” the Recompose website says. “When the process has finished, families will be able to take home some of the soil created, while gardens on-site will remind us that all of life is interconnected.”
During the recomposting process, bodies are screened for non-organic materials like metal teeth fillings, pacemakers and artificial limbs, which are recycled whenever possible.
While this may sound ideal to people wanting an environmental-friendly option to burial, not everyone can go through the recomposting process. Some pathogens (like the bacteria that causes anthrax) may be resistant to the composting process, so people with certain health conditions may be ineligible.
While recomposting has yet to be made legal in the US, “green burials” (bury human bodies without chemicals) are legal in all 50 states. Currently, recomposting a human body is legal in Sweden.
Death is our universal condition, and every culture has ways to deal with bereavement and loved ones’ remains. While these rites vary greatly, it is becoming apparent that many of the world’s traditional burial practices are unsustainable in the face of overpopulation and climate change. All the funerals I have attended have their roots in Christianity, and require that the deceased either be cremated, or buried in a coffin and vault. In America alone, it is estimated that every year traditional burials result in the deposit of: “20 million feet of wood, 4.3 million gallons of embalming fluids, 1.6 million tons of reinforced concrete, 17,000 tons of copper and bronze, and 64,500 tons of steel being.” (The New York Times)
It naturally follows that the toxins and heavy-duty materials used to embalm, preserve and contain bodies has a detrimental effect on the environment. While cremation was thought to be an ecologically sound alternative, the procedure actually causes high levels of carbon dioxide to be released into the atmosphere. In light of the somber findings of the UN Intergovernmental Panel on Climate Change’s (IPCC) report on climate change, it is clear that drastic steps are needed to prevent the environmental collapse. It is not only what we do during our lifetime that can affect change: innovative eco-burials are proving that we can reduce our carbon footprint even in death.
Funeral rituals vary greatly across the globe, from the New Orleans’ Jazz Funeral, which blends West African, French, and African-American traditions, to the Turning of the Bones in Madagascar, where relatives commemorate the diseased by dancing with their bodies. My personal favorite is the sky burial, a tradition that is prevalent in Tibet, amongst other cultures, and which involves depositing bodies at high elevations so that they may be consumed by vultures. Having attended only a handful of funerals in my lifetime—all of which were in Western cultures and did not include an open casket—the notion of seeing a dead body is completely foreign to me, not to mention the inevitable scavenging that follows a sky burial.
However gruesome the ritual may appear to the outsider, it stems from real environmental and spiritual practicalities. Indeed, in many parts of Tibet and Qinghai, a lack of timber and fuel made cremation impossible, just as the sturdy and rocky grounds prevented earth burials. Furthermore, the ritual is considered to be an act of charity on the part of the deceased, who makes a final offering to other sentient beings.
The notions of compassion and impermanence are essential to Vajrayana Buddhism, and sky burials are a reflection of these virtues. In fact, charnel grounds are also cited in the Early Buddhist canon; in the Satipatthana Sutta, the Buddha encourages his followers to reflect on impermanence by observing dead bodies undergo various stages of decomposition. Unfortunately, with the number of vultures diminishing every year, sky burials are becoming somewhat of a rarity.
With overpopulation rising, funeral practices around the world are facing similar difficulties. In Korea, for example, the lack of burial space has forced many families to dig up the remains of their ancestors and have them cremated. Add to this the imminent threat of climate change, and it is no wonder that funeral practices around the world have to adapt.
Fortunately, a number of people and organizations are coming up with innovative solutions to this problem. There are now several companies in Korea who specialize in transforming people’s cremated remains into colorful beads (this provides an alternative to the urn, which can appear eerie to some). Others have opted to have their remains turned into reef balls that are then placed in the ocean, creating a natural habitat for marine life.
For those who want to bypass cremation because of its negative effects on the atmosphere, there are now a number of green alternatives that promote the natural decomposition of bodies: allowing remains to seep directly into the earth and provide sustenance for the surrounding flora and fauna.
In order to be environmentally friendly, biodegradable materials are used to make cloths, shrouds and caskets; and artificial markers such as tombstones are replaced by naturally occurring flora, or a GPS system. According to the non-profit organization The Green Burial Council, going green also has its financial benefits, since eco-burials can significantly lower the cost of posthumous arrangements. For example, prices for a complete natural burial at Honey Creek Woodlands (Georgia) start at US$3,400 —approximately half the cost of a typical modern funeral.
For better or for worse, concerns over the future of our planet are forcing us to make changes to age-old traditions. It is perhaps for this reason that the Catholic Church, and many funeral industries, have embraced eco-burials; and in 2015, the Funeral and Memorial Information Council found that 64 percent of adults aged 40 and up would consider having a green burial. Linda Holzbaur, a member of the Greensprings Natural Cemetery board, explains that when she buried her two family members, everyone “chipped in” with digging the grave, making it a very personal experience for all involved. Artist Jae Rhim Lee, who devised a burial suit made of flesh-eating mushrooms, encourages the West to face death head on and address “the actual process and acceptance of decomposition.” (TedBlog)
In this way, natural burials not only help to protect our planet; they also provide us with an opportunity to rethink death and to incorporate lessons of compassion, interconnectedness, and impermanence into our rituals.
Like most people, Cortney Gusick never considered the prospect of purchasing a casket until she needed to select one for a family member. Eight years ago, her dad died from pancreatic cancer, and she was thrust into the death-care industry as a consumer. The most difficult part of making the funeral arrangements was finding the right casket. Gusick wanted something that reflected who her father was in his very full life: a Hawai‘i boy who cared about the environment and carried those values with him to Oregon, where he raised his three daughters. Ultimately, Gusick settled on a simple pine box from a small-scale, non-commercial business. “His body was going to biodegrade as it was designed to do, and it would provide some kind of nourishment for the earth,” Gusick says. She reasoned that the receptacle in which he was buried should do the same.
Common caskets are not earth-friendly. Nearly every model found in funeral home catalogs is manufactured with metal, paint, silicone, synthetic polyester fabric, and other non-biodegradable materials. That greener options aren’t readily available in the modern burial industry concerns Gusick, especially in a place like Hawaiʻi, where a reverance for one’s natural surroundings is part of daily life. After her dad’s death, she saw the metaphorical light at the end of the tunnel, and she came out the other side a casket builder. “This is what I want to offer for people,” she says. “For someone’s eco-legacy to be, ‘I did right by the earth.’”
Last year, Gusick started Pāhiki Eco-Caskets, a low-impact, environmentally sound casket manufacturer, in the backyard of her Mānoa Valley home. The venture was a 180-degree pivot from her ongoing job at the Silicone Valley-based company UserTesting as a test engineer in the amorphous world of software and mobile applications. “I had zero background,” Gusick admits. But the 37-year-old felt equipped for the intensely tactile field she was about to enter. “My dad taught his girls how to do everything, how to change our own tires, acid-strip a deck, lacquer the house’s wainscotings,” she says. She binged on online tutorials to gain a baseline knowledge of woodworking. “Between Dad and YouTube,” she says, “I felt like, ‘I got this.’”
Three months later, she teamed up with Logan Baggett, a friend she met in Oregon who had previously worked in Hawaiʻi’s solar industry, to help finesse Pāhiki’s offerings of 4- to 6-foot-long, 100 percent biodegradable caskets crafted from untreated, Hawaiʻi-grown wood. Soon after, the company attracted five investors and received a business loan from the Office of Hawaiian Affairs, which they used to buy hardwoods and build out inventory.
In Hawaiian, the word pāhiki means “to pass quietly, go lightly, touch gently,” a definition the duo strives to embody. Their caskets are made with reclaimed local albizia, monkeypod, mango, avocado, and Norfolk pine provided by Waimānalo Wood, a lumber mill that also houses their workshop. Pāhiki caskets range in price from $1,800 to $2,200 (less than the $2,400 median cost of a standard metal casket). In the circumstance that someone needs a keiki casket, Pāhiki provides it for a dollar.
Gusick considers every dimension of her industry. We’re trapped in a “death-denial culture,” especially in the United States, she says, which is obsessed with indefinitely preserving the deceased in ways that only benefit the living. For Gusick, the more grandiose style of caskets, which can cost upwards of $15,000, are more for the living than the dead. Those caskets “resemble pieces of high-end furniture that belong in this world, that belong in a house, and look like they’re meant to last over time,” she says. But the reality is they go into the ground, never to be seen again.
Pāhiki’s unobtrusive design aesthetic is in direct response to that. The final products—caskets that trade metal, paint, synthetic fabric, and lacquer for wood, non-toxic glue, muslin, and coconut-oil finishes—are crafted to allow the wood grain to shine in its most organic state. The caskets are stripped of sensational flourishes, but not of sentiment. Family members can opt to purchase the “collaborative option,” for which Gusick and Baggett affix biodegradable linen loops around the casket’s perimeter to hold flowers from funeral guests.
Pāhiki also has a keen interest in engaging with communities that have large Native Hawaiian populations on Oʻahu and neighbor islands. During community talk stories, Gusick presents information about Native Hawaiian burial rights and practices—which involve cremating a body in an imu, wrapping the bones in kapa cloth, and burying them in lauhala—and how to perform them legally. As a Native Hawaiian, Gusick feels especially called to apply a Hawaiian understanding of ʻāina to her work. “Hawaiians were the original environmental stewards,” she says. “I can rewind back through so many generations of people where this was always their charge, to take care of the land, and now I can do it in a way that’s modern.”
As long as humans are dying, the death-care industry, which sees profits in the billions of dollars, will remain open for business. Pāhiki’s niche market is a fractional percentage of that, but it is poised to grow as an aging population becomes more informed of greener burial methods. While Pāhiki’s prototypes are evolving, the emotional gravity of the caskets will always be the same. “Isn’t it so crazy that we’re responsible for this thing that is so intimate for a person we’ll never meet?” Gusick often thinks. “We’ll never get to look into their eyes, never get to shake and touch their hand. It’s this very special, unique thing that will only be crafted and given to them once.” It’s a heavy order, but Pāhiki hopes to treat it lightly.
People who work in the death-care industry bring the lessons they learn in the field into their daily lives in quiet but profound ways. Here is what Gusick and Baggett have learned from the dead about how to live better every day.
Be introspective “Most people should contemplate death; it shouldn’t be an afterthought,” Baggett says. “We know it’s coming, we know it’s part of life—it’s just a transition, in my eyes.” Thinking about death and removing its negative connotations can lead to a more present and purposeful approach to life.
Be clear about your wishes “Documentation is an act of love,” Gusick says. “Put it in writing and in thoughtful detail.” The way you live isn’t always enough to let loved ones know how you want to be buried.
Be nice “There are 20 million things I don’t know about a stranger, but there is one thing I can guarantee I know about them and that they know about me,” Gusick says. That is the inevitability of death. “In society, you can quickly and easily dehumanize another person in the way you talk about them off-handedly or the way you treat them, not thinking back to that completely timeless experience you know you share with that person. If you reverse-engineer that awareness when you interact with people, you can use it to make a kinder, more insightful connection with someone. Or, you know, just try to not be a jerk.”
When somebody dies in the Catholic tradition, people generally know what to do. There’s the saying of the Last Rites at a dying person’s bedside, the vigil for the deceased — also known as a wake — and, often, a formal Mass of Christian Burial.
In the Jewish tradition, there’s the practice of sitting shiva: the week-long mourning process during which the family of the deceased remains at home, and friends and relatives call on them to pay their respects.
In the Islamic tradition, the deceased’s body is ritually bathed and shrouded in white cloth before Muslims of the community gather to perform the Salat al-Janazah, the customary prayer for the dead.
But what happens when you die and you don’t follow any faith tradition?
When Iris Explosion — an entertainer and social worker who prefers to go by her stage name — was widowed unexpectedly at age 28, she and her friends had to create the memorial service for her husband, Jon, from scratch.
Explosion and her husband were not conventionally religious — she describes herself as a “lax Jew,” while her husband, a queer man interested in alchemy and other occult practices, often felt alienated from the born-again Christianity of his parents. The memorial service her friends created a few days after his death, she says, contained a blend of traditions and practices individual to Jon.
A Jewish friend recited the Mourners’ Kaddish. The group told stories — some reverential, some “bawdy” — that reflected all aspects of Jon’s personality. They played an orchestral rendition of the theme song to Legend of Zelda, Jon’s favorite video game. Friends from out of town dialed in on Skype to share their stores. Numerous friends gave Explosion rose quartz, a stone associated in some New Age and occult traditions with heart healing, as a gift.
The memorial service — as well as a second funeral service, which took place a few months later, and was similarly eclectic in style — focused on Jon’s personality and interests rather than being constrained by a specific set of traditions.
Explosion is just one person among the 24 percent of Americans who identify as religiously unaffiliated. For the religious “nones,” the issue of what happens when you die is an open question in more ways than one. According to a 2008 American Religious Identification Survey, the most recent year for which data is available, 29 percent of Americans do not anticipate having a religious funeral, for whatever reason, and given the steady increase in religious “nones” over the past decade, that number will likely only rise.
But what do secular funerals — or death rituals more broadly — look like? What can they provide that religious death rituals can’t? What are the challenges involved in putting them together?
And as secular funerals become increasingly individualistic, tailored to the preferences and needs of the deceased, rather than a given religious or spiritual tradition, what does that mean for the sense of community engendered by ritual?
Secular funerals are part of a wider “unbundling” of religion
It started with weddings.
Scholar and psychologist Philip Zuckerman, author of Living the Secular Life, suggested in a telephone interview that secular funerals are just the latest iteration of the secularization of major life stages overall.
Its genesis, he said, lies in the proliferation of secular weddings in America. In 2017, just 22 percent of American weddings took place in houses of worship, a nearly 20-point drop from 2009, according to data from the wedding website the Knot.
“The first thing we saw was zillions of people going online and registering with the Universal Life Church,” said Zuckerman, referring to an organization that virtually automatically ordains people over the Internet, “so they can perform their own weddings for friends and family, so they can still make it sacred but not under the auspices of religion.”
Different states have different laws about the extent to which Universal Life ordinations are legally valid for performing weddings. Funerals, however, have no such restrictions.
Zuckerman posits that among the people he’s interviewed for his book research, the desire to have a secular funeral isn’t just about not wanting to affirm the existence of a God or an afterlife that the deceased may or may not believe in. Rather, he says, it’s also about wanting to preserve a sense of the deceased’s individuality.
“They just don’t want fairy tales. They don’t want to be told, ‘So-and-so’s in a better place now,’ or, ‘So-and-so is now suckling the bosom of Jesus’ — they can find that talk annoying,” Zuckerman said. “We want to curate our own Facebook page. Why wouldn’t we want to curate our own funeral?”
More and more, Zuckerman said, he sees people choosing their own music and their own speeches that they want to be read after they die. “I think that is part of our growing individual and less of this care of tradition … more and more people want to feel the idiosyncrasies of the dead person and the specialness of the dead person.”
This attitude, he said, is particularly prevalent in the United States. “We all like to think in the United States that we’re special. Why wouldn’t we want our funerals to be special too?”
Certainly, for Iris Explosion, commemorating Jon’s life in a way that felt true to his personality and character was a priority. From sharing Jon’s favorite Spotify playlists with his friends to curate the music selection for the services to working in references to My Little Pony — a show Jon loved — Explosion and the couple’s friends created a memorial for Jon that fit his character.
By contrast, Explosion said, she declined to attend other memorial services, like one hosted by Jon’s family in his home state, that had a more Christian focus, instead circulating an email to attendees of that service asking them to donate to Planned Parenthood, which she felt better reflected her husband’s values.
Explosion’s experience dovetails with a phenomenon called religious “unbundling.” A term coined by Harvard Divinity School researchers Casper ter Kuile and Angie Thomas, who have covered how phenomena like CrossFit and Soulcycle function similarly to religions for their participants, “unbundling” refers to the way both the religiously unaffiliated and the religious alike are increasingly willing to pick and choose elements of spiritual traditions.
Someone might, for example, be a committed Christian but also practice Buddhist meditation or yoga, or be an atheist but attend Jewish family holidays and read tarot cards. In a pluralist landscape, in which people are used to gathering information and ideas from multiple sources (not least through the internet), a more individualized approach to religion and life rituals is all but inevitable.
As a culture, we still haven’t figured out what secular death rituals should look like
Even for those of traditional faiths, death is a phenomenon that defies easy answers. But for the religiously unaffiliated, processing and dealing with death and its aftermath can be an especially loaded task.
Brad Wolfe is trying to help them do that.
Wolfe is the founder of the week-long Reimagine End of Life festival. The singer-songwriter and author was inspired to work in the end-of-life space after watching a close college friend’s struggle with terminal cancer. The festival, which takes place in New York and San Francisco, partners with community centers and artists to curate a 300-strong series of events — from talks to workshops to performances to museum displays — dealing with the subject of death.
“Death is often the central coalescing element around which many religions are formed,” Wolfe told me in a phone interview. “As we’ve become more secular in some communities … there’s an increasing hunger for that space … to come together and explore this topic.”
The New York festival, which took place around Halloween, featured a range of explorations: a class on how to write your own obituary, doctors talking about dealing with their patients’ deaths, live musical performances exploring themes of loss and bereavement.
What connects each event is a sense of intentionally: that people are actively setting aside time and space to deal with a weighty topic.
Both Wolfe and Zuckerman identify similar elements of what that “coming together” looks like. Ideally, both say, it involves elements of ritual, community gathering, and a sense of meaning: How do we conceptualize a person’s death as part of a bigger picture?
Wolfe suggested that we might be better off looking at this “coming together” not as a nonreligious event but as an expansion of the definition of what religion means. At least two Reimagine events are, fundamentally, immersive theater performances. In one, participants are invited into a phone booth to have conversations they wish they’d had with somebody who has died.
In another, participants role-play members of a fictional bereavement support group. Speaking about these events, Wolfe argued that the lines between art, ritual, religion, and performance are deeply blurred.
“The boundaries between art and religion are more porous when it becomes a practice explored with intention,” he said. What matters is the sense of significance shared by participants: “Having a practice, a shared system, allows us to connect in ways that give us a sense of comfort and something we know we can turn to.”
The idea or combining artistic creation and end-of-life ritual is far from new to Janie Rakow, president of the International End of Life Doula Association. As a “death doula,” Rakow works in hospices, helping those facing the end of their lives develop rituals and practices around their death. While she works with patients from a wide variety of religious backgrounds through the hospice, she tailors her work and approach to the individual in question.
One of the most important parts of the end-of-life process, she says, is the act of creation. She helps her patients develop what she calls “legacy projects”: individual artistic works, from a memory box to audio letters.
“Everyone has a legacy,” Rakow says. “So [I ask myself] what kind of legacy project could we possibly create with this person to really leave behind a sense of who they are or were?”
Next, she asks patients to help plan their own death — where they would like to be? What music they would like to be listening to?
“There may be some ritual work done around that,” she says, even if it’s “as simple as surrounding their bed, holding hands, saying a prayer or saying poetry, reading something to them, [or] lighting a candle.”
The point is to help dying people take an active, creative role in the story they leave behind.
Often, Rakow says, these rituals are tailored to individual passions. She gives the example of one man she worked with, who was dying from ALS, a degenerative neurological condition that prevented him from being able to move. With his wife, Rakow created a series of guided visualizations for the man, who loved hiking, “so we would bring him with his eyes closed on the most detailed and specific hike that we could from the very beginning to hiking all the way through.”
She’d walk him through ”smelling the forest and feeling himself walking up the hills and hearing the birds chirping and looking over at the crystal clear lake. And the more descriptive we could get, we were able to bring him back into his body that he wasn’t able to use through his mind.”
Secular rituals present their own set of challenges
One of the most difficult parts of creating secular death rituals is compensating for the lack of built-in community, or built-in structure, that often accompanies more established religious traditions.
Zuckerman pointed out that the secular bereaved don’t necessarily have a clear road map, or community support, to help them deal with the pragmatic aftermath of a death.
“One of the biggest problems for secular culture [is that] you have to cobble together and make it yourself. If you want your kid to have a bar mitzvah, it’s all taken care of. You want your kid to go through confirmation class in the Episcopal Church? Boom, they’re enrolled. If you want to do a secular version of that? Good luck. You’re on your own. You have to figure it out, explain it to people, rent the space, find people, figure out how to write up your own program. … It’s a lot of effort.”
The lack of intentional secular communities, Zuckerman said, only intensifies this problem. “With religious communities,” he said, “not only is the structure of the funeral in place, but there are going to be people who are going to immediately sign up to cook dinner for your family for a month and they’re going to deliver food to your doorstep and they’re going to help you get your kids to school and they’re going to do a lot for you. And when you’re secular, you don’t have those kinds of resources.”
For some secular Americans, the idea of having a “chosen family” — a close-knit network of friends — helps fill in the gap. Just as Friendsgiving has become a phenomenon among urban millennials, friendship networks more broadly have become an increasingly vital part of social cohesion, replacing both extended family structures and traditional organized religious communities.
That was certainly the case for Explosion. She cites her friends’ involvement in making the service possible at a time when she didn’t feel capable of planning herself. “I needed camaraderie and community,” she said, and I feel like I had it.”
At the same time, she says, she had less of a blueprint for how to cope with the next stages of grief after about six months.
“People go back to their own lives,” she said. “And it was hard to feel that sense of community. Without a church or synagogue to bind us together, it maybe felt like it dissipated. People missed their friend and their co-worker. But for me, it’s like, I miss my husband who lived with me, and it was hard to feel that sense of community after time had passed.”
The next step forward might be intentional secular communities
Explosion’s story points to a wider tension in the world of secular funerals and the creation of secular culture more broadly. On the one hand, the benefits of the “unbundled” religious landscape, for many secular Americans, lie in the opportunity to create truly new, individualistic rituals and experiences. We have the opportunity to curate our identities and public personae event after death, creating experiences that feel unique to us.
On the other hand, what risks getting lost in the process is precisely that feeling of collective identity that demands subsuming our individuality in a wider whole. Religious rituals and language, from Catholic ceremonial liturgy to the Salat al-Janazah, may not feel fully and uniquely “us,” but they nevertheless define and orient a wider community and give us a sense of shared values.
The 19th-century sociologist Émile Durkheim saw religion primarily as a shared construction of identity; in his seminal 1912 work The Elementary Forms of Religious Life, he wrote, “The most barbarous and the most fantastic rites and the strangest myths translate some human need, some aspect of life, either individual or social.”
As more and more Americans leave organized religion, the next question is whether, and how, many of them will gather together, and how an increasingly individualistic conception of identity can be reconciled with the real, human need for group belonging. As secular funerals and death rituals become the new standard, we may see some of these rituals become more group-centric.
For Explosion, for example, the process of grieving led her to an unexpected new ritual. During her husband’s life, she said, she often played a video game called Destiny with him, looking up the location of objects hidden in-game and giving him hints to find them. While she never particularly got into the game, she said, she enjoyed playing it with him. After his death, she started watching YouTube videos of people playing the game, or its sequel, to remember the time they’d shared. Then she decided to buy the game’s sequel to play it herself.
“I’ve been playing this game I wouldn’t have played if he hadn’t died. And it’s been meditative for me. Finding the little things, like doing these things we used to do, felt like a pilgrimage in a way,” she said.
Sometimes, Explosion communicates with other players in the game online. While she’s only told a few of them about her personal history with the game, she’s nevertheless found a community that can accompany her in a time of grief.
“When we do a big quest or a raid together, there’s always a moment for me of, you know, okay, he would have done this. He did this in the old game. Now it’s me kind of picking up this mantle.”
The secular funeral liturgies we see in the future may transition from being individualistic to being based on other nonreligious elements that bring a community together. They may involve the music of My Little Pony or the playing of video games.
Ultimately, they’ll represent two fundamental human needs. First, to make sense of a beloved’s death. And second — and just as importantly — to not do it alone.
With continual advances in modern medicine, we’re enjoying longer lives. As the population ages, and particularly as many people are living longer with cancers and chronic diseases, end-of-life care is adapting and changing.
People who are approaching the end of their lives will usually spend some or most of their time at home, requiring care and support to do so. Family members might not always be available to provide this care. When they are, the process can be rewarding, but it can also be challenging and complex, often leading to a severe emotional burden for the carer.
Gaps in our health and social care systems are starting to be filled by death doulas. But beyond providing practical support, families are increasingly seeking the services of death doulas to help navigate the experience of dying. Those nearing the end of their lives, too, may bring in a death doula to ensure they can die the way they want to.
We urgently need a conversation about death doulas and new models of care at the end of life. We are continuing to build an evidence base through research with the death doula community and via consultation with the health services that interface with death doulas.
Defining the death doula
We’ve seen a similar concept in midwifery, where birth doulas have long been providing social, emotional and practical support to help women through the process of childbirth. This has been shown to have positive outcomes for mothers and their babies.
Like birth doulas, death doulas’ roles and functions are non-medical; these can include advocating, supporting (spiritually and sometimes physically), guiding, and providing emotional support to the person and their family, mainly in the home.
We undertook a systematic review of the literature to find available evidence about the death doula role. We found little formal academic literature describing the role, their training, or contribution to individuals, families and the health system.
But what we do know is that each death doula enacts the role differently. They might spend time with the dying person, offering emotional and spiritual support, and sometimes providing physical care. They might support the family carers in the work they are doing. Some death doulas are only present in the last days of life, offering “vigiling” – sitting with the dying person so they are not alone.
Some doulas offer after-death rituals such as helping families prepare the body or keeping the deceased at home.
Some death doulas are paid by families who engage their services. Families have often found their chosen doula online or through word-of-mouth. Other death doulas work voluntarily, in a similar way to a hospice volunteer. But, because there are no formal structures or registers, we don’t know how many death doulas there are.
In Australia and elsewhere, palliative care nurses, social workers and those from the funeral industry work as death doulas. This seems to be a natural progression, but it’s a grey area: doulas are providing care, but are not registered or supervised.
There is little formal assessment to guide patient and family choice or to inform end-of-life care provided by professionals.
How can doula care be formalised?
Providing care in homes can be informal. It may be provided by families, friends, or community groups. Care can also be formally negotiated and provided by health services, aged care providers or private agencies.
It’s necessary to understand the implications of the death doula role. For example, they could become part of formal care arrangements such as home care packages or via private health insurance funding.
We also need to look at how these new roles are authorised to represent the dying person, as they are neither a family member nor a qualified health professional. It’s also important that they are appropriately trained and insured (if providing paid services).
There are personal, social and cost advantages in enabling care in the home for a dying person. For families, being able to support the person in a familiar environment can be a powerful motivator to engage a death doula to fill the gaps in care provision.
For the health system, care in the home is seen as positive. It can avoid unnecessary hospital use and help spread the costs of caring.
For the dying person who may prefer to die at home, it is a way of achieving this. Importantly, death doulas can improve the dying person’s ability to control their own care.
The death doula role may well incorporate some of the direct care provided by families and help them to navigate the complex needs and planning required at the end of life. If so, death doulas could represent an important opportunity to improve dying outcomes.
We need to ensure our community is informed, health service provision crosses both hospitals and homes, and that those providing care – regardless of setting – have skills and knowledge appropriate to their role.
B.C. College of Midwives and Pashta MaryMoon, 65, to litigate ‘death midwife’ title this week
By Liam Britten
In a sworn affidavit, Pashta MaryMoon says her passion for alternative holistic death care began when she was a seven-year-old girl watching a 1950s western movie.
She described watching a scene with a pioneer’s wife whose husband had died. The fictional woman, all alone, had no choice but to care for his body herself, prepare it for burial, inter it and then comfort their grieving children.
“Young as I was, and with the benefit of hindsight, this ‘hands-on’ approach struck me as making more sense than conventional funeral practices,” MaryMoon, now 65, wrote.
“I am a Death Midwife; Death Midwifery is my vocation and it is what I do.”
The problem with MaryMoon’s vocation, in the eyes of the B.C. College of Midwives, is its name.
The college, which is the legal body regulating and overseeing the practice of midwifery in B.C., has sent several cease and desist letters to MaryMoon since 2016 demanding she stop using the term “midwife” to describe her services.
Now, it is turning to B.C. Supreme Court to compel her to drop it in a two-day hearing this week.
Cites history back to ancient Egypt
According to the college of midwives, its birth-focused registrants provide a “continuity of care and support throughout the childbearing experience.”
Before birth, they provide physical exams and diagnostic tests; during birth they can conduct normal vaginal deliveries; and they also provide postpartum care after birth.
MaryMoon says death midwifery honours the philosophy and tradition of traditional midwives as someone who “attends to birth or death.”
In a document submitted to the court, her friend Mia Shinbrot outlined the services MaryMoon provides.
Before death, she helps the dying plan at-home funerals and work through their grief; during the death itself, she organizes death vigils; and after the person has died, she takes care of paperwork, helps with the funeral and provides grief support.
MaryMoon, in her affidavit, said the dual role of a midwife stretches back into ancient times and claims its roots go as far back as recorded history, as evidenced by ancient Egyptian gods like Isis or the Bird-Headed Snake Goddess, which she claims have aspects of both life and death in their natures.
College wants to avoid confusion
In an affidavit of her own, college of midwives registrar Louise Aerts argued it is important to keep the term midwife legally reserved for college-certified midwives to avoid confusing or misleading members of the public.
Aerts declined to comment further for this story, saying the matter is before the courts, but in her submission, she noted that other holistic death practitioners call themselves “death doulas” or end-of-life doulas.”
Douglas College even has an End-of-Life Doula certificate program.
But MaryMoon, in response to that, said the term “death midwife” is the only title that accurately encapsulates her services and approach. She believes there is no chance of confusing her work with that of a college-certified midwife.
“When people hear ‘death midwife’ or ‘death midwifery,’ they automatically assume a philosophy about it, in part, because they’re familiar with birth midwives,” MaryMoon said.
“There’s no other term in our culture right now that that the public recognizes.”
She believes that without the title, people facing death will not know that they can take a different approach to dying.
She will ask the B.C. Supreme Court for an exemption to restrictions on the midwife title on Nov. 29 and 30.