Category: Cultural Expressions

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What the Greeks teach us about suicide

— The great tragedians’ writings on suffering, stigma and survival can help guide our own struggles with assisted dying.

Lucas Cranach the Elder, The Suicide of Lucretia, painting, circa 1525

By Rowan Williams

A leading broadsheet marked Good Friday this year with an article about the need to overcome the “taboo” surrounding physician-assisted dying. It seemed a rather odd way not only of celebrating the day, but of referring to a topic that has had its fair share of uninhibited public discussion in the past two to three decades; but the writer was, I suppose, trying to distance the issue from the stigma that still hangs around the word “suicide”. Edith Hall, in this remarkable, brave and compassionate book, evidently shares something of this concern, seeking to disentangle the idea of “euthanasia for someone facing an inevitable and agonising death” and “temporary and intermittent urges” to end one’s life. The great moral weight of the book’s argument is the conviction that suicide as we normally think about it is an act that inflicts drastic damage on survivors. Anyone contemplating deliberately ending their life needs to be alert to that damage – a damage that can have transgenerational consequences impossible to quantify.

Transgenerational trauma is at the heart of the book. Hall presents us with a tragic family history, both her great-grandfather and her grandmother having taken their own lives, leaving her mother with a crushing burden of guilt and bewilderment, expressed in years of emotional repression or confusion and self-harming habits. As Hall writes, no one was paying much attention in the mid-20th century to the needs of suicide’s “survivors” – children, siblings, friends, carers. People were largely left to work out their own strategies, and these strategies, often involving some level of denial, had their own lethal effects: Hall’s last but one chapter, “The Author’s Tale”, describes her own harrowing struggle over many years with suicidal depression, and the crucial role that consideration of the violence her suicide might inflict played for her.

This is where her classical studies prove significant. Hall is one of the most prolific and insightful commentators in English on Greek tragedy, and in Facing Down the Furies she draws out an aspect of this literature that not many have highlighted. In her view, what is strikingly distinct in the tragedies of Aeschylus, Sophocles and Euripides when they deal with suicide (and with other forms of untimely and violent death) is their readiness to imagine the reactions of survivors – parents, spouses, children, whole households – so that the unnaturalness of the act is not blunted or romanticised. “You’ve destroyed more than just yourself,” says Theseus, lamenting his dead wife Phaedra in Euripides’s Hippolytus. And, with perhaps even more poignancy, the same author’s Suppliant Women depicts a father resolving on suicide after his daughter has killed herself.

In a way, this unsparing recognition of suffering is the other side of what is laid out so poignantly in a very different drama, the Philoctetes of Sophocles, where extreme physical anguish is compounded by the lack of any observer: “He [Philoctetes] desperately needs to have his suffering acknowledged,” as Hall writes. Part of the function of tragic writing is the securing of witness: the telling or showing of suffering does not ease pain but at least breaks down the terrible isolation of the sufferer. Perhaps – so tragic literature suggests – the fact of witness preserves the glimmer of hope that unmitigatedly terrible experience can be “meaningful”, at least to the extent that it is accompanied by compassionate acknowledgement.

So for Hall, the tragedians were her “witnesses”; they offered words and images to let her know that the crushing inheritance of family catastrophe and the blinding loneliness of suicidal depression had been seen, thought, spoken. Her book is written to pass on that perception and to tell us, when we face the pressure of unrelieved unhappiness or meaninglessness, that our lives are always bound with those of others, and so are not simply a property for us as individuals to dispose of.

Digesting all this, we may come to understand more clearly the reactions that help to perpetuate the stigma surrounding the issue. There is sheer anger: how could they do this to me, to us? There is condemnation, religious or otherwise: this is a sinful rejection of the gift of life. There is passivity, collusive passivity: it’s their decision, it’s a matter of freedom. The anger has to be dealt with by the sort of patient narration that Hall undertakes so sensitively in her extended memoirs of her family (providing, incidentally, a vivid snapshot of Scottish civic and cultural life from the mid-19th to the mid-20th century). Condemnation abandons this patient quarrying for understanding and will get us nowhere. Collusive passivity simply fails to register the depth of destructive impact; at worst it spills over into the cheapened existentialist dramatising of suicide as the ultimate expression of sovereign autonomy (Dostoevsky has some things to say about that).

There is a textbook oversimplification that associates ancient Stoicism with a view resembling this, and it has found avatars in more modern discussions. Hall reminds us that in its most familiar form (in Pliny, or Marcus Aurelius’s Meditations, say) it is bound up with a distinctive culture of “noble” liberty, independence, honour and reputation, which is not quite what the earlier and more pragmatic Stoics actually suggest. She also notes that in later writers (David Hume is a good example) it is typically favoured by wealthy, male, single thinkers, people who are not that interested in the effects of their actions on others because they do not live in a particularly interdependent framework of relations.

She notes that religious attitudes to suicide have played a large part in establishing the stigma around it. Biblical prohibitions against the taking of human life were read as implicitly forbidding taking one’s own. Just as the killing of a family member is in some sense a worse offence than killing a professed enemy, so suicide deserves special opprobrium because it is the violent ending of the life that is closest to you – your own.

Hall does not go into the full detail of St Augustine’s treatment of the question in his City of God, but it has some resonance with her summary of the Roman cult of “noble” suicide. Augustine is discussing the fact that some women (especially nuns) raped during the Sack of Rome in 410 took their own lives, and he compares it with the well-known Roman legend of the suicide of Lucretia after being raped by Tarquin. He gives very short shrift to the idea of suicide for the sake of honour, and says firmly that the victim of sexual violence is not to think of herself as guilty, nor is anyone else to treat them as culpable. Lucretia is for him an example of what he analyses at length in City of God, the Roman obsession with status and reputation at the expense of internal moral clarity. He recognises the depth of shame that is felt by survivors of rape, but warns against assimilating it to guilt. By contemporary standards, he pays no real attention to the abiding trauma of physical violation, the burden of self-disgust and so on; his treatment of the question is one that does not give much space to the subject’s point of view. But he does at least counter the idea that internalising the blame that a patriarchal society projects is a good thing.

Hall, I suspect, is not a great aficionado of Augustine, but there is some common ground here. Dealing with suicidal thought or temptation involves restoring a sense of being positively involved with the lives of others – the feeling that people are “invested” in your life, and that killing yourself is an injury to them. But for that to happen, the culture you live in also needs to demonstrate that investment. For the survivor of rape or any other form of abuse, for the demonised sexual minority, for those left behind in
the bloodthirsty competitiveness of some academic hothouses or online networks, what makes a difference is not only an individually positive attitude but the assurance of – once again – being witnessed, being taken seriously, being treated as though your well-being were intrinsic to that of others. Policies around – for example – student mental health (something that Hall, a professor at Durham University, and this reviewer both have some experience with) are not only about survival tactics for individuals but about creating cultures that challenge shaming and affirm what I’ve called investment. And this book is triumphant proof that teaching and writing about the humanities is a vitally necessary dimension of such culture creation. Anyone who has ears to hear, let them hear.

Hall writes with lucidity and directness, and her treatment of the classical texts is consistently insightful. There are one or two forgivable bumps in the road here and there. The reference to an intriguing apocryphal story of St Peter confronted by a suicidal woman is a bit garbled in the notes, assimilating two ancient works attributed to the same author that happen to be printed together in the same volume. Also, the citation of two texts from Hebrew Scripture as a “Jewish proscription of suicide” is rather misleading: one of these texts is an instance of the general prohibition against murder which the rabbinical commentators took as including the prohibition of suicide; the other bears no obvious relation to the topic and may be a faulty transcription. Jewish scholars have generally allowed that there is no direct condemnation of suicide in the Torah, and certain dramatic acts of individual and collective suicide when faced with persecution or massacre (from the death of King Saul or the mass suicide of the defenders of Masada against the Romans) have been regarded by the commentators as pardonable, even sometimes as admirable. We might see here an implied argument (whether we accept it or not) that in a way complements Hall’s main concern: in these instances, a survivor of mass violence would be left exposed to the worst fate imaginable, so that collective suicide could appear a more merciful and moral possibility.

But that is not Hall’s main focus. What we have is a moving reflection on how the sense of anchorage in the lives and needs of others is central to keeping us alive, especially when not much else appears to be doing so. In one way, the phrase quoted above about “intermittent and temporary urges” does less than justice to the intensity of suicidal ideation grounded in traumatic loss, obsessive guilt, or extreme and unbroken depression. Some would say that it is more like the steady presence of a death sentence, with only the timing being uncertain: not a matter of unbearable physical agony but a mental hopelessness that makes a liveable future just as unimaginable. Indeed, the case for physician-assisted dying often appeals to just that sense of an unimaginable future, whether or not accompanied by excruciating physical pain. This is not a book about temporary bouts of darkness, but about the long and winding road of internal terror or emptiness that leads to the final decision for death; about the deep roots in family history as well as individual suffering that push in that direction.

Which is why I hope we hear more from Edith Hall about how her reflections bear on the question of “assisted” suicide – reservations about which are not all rooted in some variety of irrational dogmatism (religious believers in fact disagree on this as on a good many other ethical questions). As the pressure for legal change mounts – a petition led by Esther Rantzen recently triggered a debate in parliament – there is also a heightened awareness that how and by whom decisions are to be made if there is new legal provision are not straightforward, precisely because of the complex mutual “investments” involved where a dying person and their families and friends are concerned. There are reassuring and not-so-reassuring stories; there is a nagging uncertainty in some minds about how a new policy would work in terms of resourcing for palliative care, the use of funds, the pressures on an overloaded healthcare system and so on.

Hall is right to want to resist assimilating all forms of “willed” death to the desperate, isolated, heartbreaking and hurtful instances at the centre of her narrative. But as we go on grappling with these questions we need not the breaking of an imaginary taboo, perhaps not even just the disappearance of a tradition of stigma, but more of the granular, sensitive, honest recording that this book offers, and more of the deep resource of the imagination represented by the great tragedians she so eloquently brings alive for us.

Facing Down the Furies: Suicide, the Ancient Greeks, and Me
Edith Hall
Yale, 256pp, £18.99

Complete Article ↪HERE↩!

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Hospice remains a blind spot for Medicare Advantage

By Maya Goldman

As Medicare Advantage grows bigger and bigger, there’s one area the industry and regulators haven’t figured out how to make work yet: hospice.

Why it matters: The end-of-life care option is the only Medicare service that can’t be offered in the private-run alternative, which now covers over half of enrollees.

  • Medicare is winding down an experiment — years earlier than expected — that let some Medicare Advantage plans offer a hospice benefit, citing operational challenges and limited interest from insurers and hospices.

Catch up quick: Usually, when a Medicare Advantage beneficiary decides to enter hospice after receiving a terminal diagnosis, traditional Medicare pays for this care while they remain enrolled in their private plan.

  • That could make navigating insurance “very, very clunky” for hospice patients, especially when they have health care needs unrelated to their terminal illness, said Lynne Sexten, CEO of Agrace Hospice.
  • And this affects a lot of people. Nearly half of the 1.7 million Medicare Advantage beneficiaries who died in 2022 used hospice services, according to the Medicare Payment Advisory Commission (MedPAC).
  • Experts say the roots of this awkward arrangement likely goes back about 40 years, when private Medicare first became a permanent offering. At the time, traditional Medicare had just started covering hospice, so officials had limited data on how much it cost.

What they did: Medicare’s Innovation Center began an experiment in 2021 that allowed Medicare plans to contract directly with hospice providers.

  • It aimed to test whether that could make end-of-life care transitions more seamless for Medicare Advantage patients while reducing costs and improving care quality.
  • Participating health plans also covered palliative care and transitional care, where patients continued curative treatments like dialysis or chemotherapy temporarily during their hospice stay.

The Innovation Center announced abruptly in March that it would end the program in December, a year after officials said it would run through 2030.

  • The news came after two major insurers — UnitedHealth Group and Elevance — pulled out of the model. Only 13 insurers participated this year.
  • Hospices largely cheered the decision. Lower reimbursement rates, delayed payment from insurers and burdensome quality reporting made the experiment difficult for hospices that chose to contract with insurers, an independent evaluation of the program found.
  • The Centers for Medicare and Medicaid Services stressed that its decision to end the experiment doesn’t mean it failed, and the agency in a statement to Axios said it will continue to evaluate results.

Many insurers also faced a learning curve on how to work with hospice for their Medicare enrollees. Hospice is delivered and paid for differently than other Medicare benefits.

  • The experiment tried to do too much too fast, said Kevin Kappel, vice president at SCAN Health Plan, a nonprofit insurer that joined Medicare’s hospice experiment last year.
  • “I think people underestimated how complex it was to do. … We’ve learned a lot,” Kappel said.

Yes, but: Hospices and insurers said they still need to figure out how to make care more seamless for Medicare Advantage beneficiaries.

  • “This is by no means the end of the story for end-of-life care providers and MA plans,” said Ethan McChesney, policy director at the National Partnership for Healthcare and Hospice Innovation.
  • It’s been a full decade since MedPAC, the congressional advisory committee, recommended including hospice in Medicare Advantage, warning that excluding it “fragments care accountability and financial responsibility for MA enrollees who elect hospice.”

What we’re watching: Industry leaders say hospice doesn’t necessarily have to become part of Medicare Advantage to improve care integration, or at least not right away.

  • Ohio’s Hospice, a nonprofit provider that participated in the Medicare experiment, said it will continue working with Medicare plans to extend palliative care and symptom management to more patients, CEO Kent Anderson said.
  • While Anderson said some peers worry about the growth of Medicare Advantage, “the longer we sit outside the managed care world, the less relevant we’ll become.”

Complete Article ↪HERE↩!

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All that remains

— From liquid cremation to mushroom suits, why more people are opting out of burial

Cemeteries are overcrowded and damage the environment. Where’s your body going to go now?

By Mary Elizabeth Williams

There are an awful lot of tombstones in my neighborhood in October. They bear names like “Noah Scape” and “Izzy Dead.” They pop up regularly this time of year, and disappear again in November. And with each passing Halloween, they less resemble some familiar authentic counterpart as they do a vestige of a bygone tradition.

“By 2035, a stunning 80% of us will be opting for cremation.”

Here in the U.S., fewer and fewer of us are choosing to spend our afterlife six feet under. Since 2015, cremation has surpassed traditional burial as the preferred choice for our remains, and the National Funeral Directors Association (NFDA) estimates that by 2035, a stunning 80% of us will be opting for cremation.

A big driving factor, of course, is cost — caskets are expensive, cemetery plots are expensive and graveside maintenance is expensive. In my state, New York, funeral and burial fees can run between $8,000 and $12,000. And that’s just the basics. Jack Mitchell, president of the National Funeral Directors Association, talked to Marketplace earlier this year about the “man hours to prepare for a viewing with embalming and dressing and cosmetics, and then to have staff there to oversee when a visitation was going on.”

Another factor is the peripatetic nature of modern life. “It’s a very transient world we live in today,” Mike Nicodemus, the vice president of cremation services for the NFDA told CNN back in 2020. My in-laws rest side by side in a leafy plot not far from the home they used to share. But for many of us, a final resting place presupposes that one has had a final living place. And given that the average American moves around eleven times in a lifetime, where we end up is likely far from where we started.

Then there’s the unignorable limitation of space. In the U.K., a quarter of town council-owned cemeteries will likely be at capacity within the next decade. In America, urban centers are already facing a similar shortage of spaces, with historic cemeteries like Green-Wood and Arlington nearing capacity. (You thought it was hard finding a place to live in the city? Try finding one when you’re dead.) My mother’s ashes are tucked in a corner of a Catholic cemetery and mausoleum one state over. Her parents and deceased siblings are buried in an entirely different area — there was no room left for her there by the time she died.

You thought it was hard finding a place to live in the city? Try finding one when you’re dead.

But while cremation is an increasingly popular and seemingly more environmentally friendly choice — especially if you opt for a biodegradable container — there are downsides. Marc Bisson, managing director at Catholic Cemeteries in Canada, says, “Both traditional burials and cremation have pros and cons when it comes to the environment. While cremation avoids leaving large coffins and remains in the ground, which can be potentially harmful, it still emits large amounts of pollutants and utilizes fossil fuels to power the furnace.”

Bisson notes an increasing number of alternatives for what to do with one’s body once it’s shuffled off the mortal coil. “Some new processes are emerging as potentially more sustainable options for cremation, including liquid cremation or aquamation,” he says, explaining the process. “Through using alkaline hydrolysis, organic body compounds can be dissolved, leaving only bone, which can then be cremated to ash for your urn. The hydrolysis liquid is safe for water disposal, and this process helps limit the use of traditional cremation incinerators.”

He adds that for those who want a more traditional experience but with a sustainable twist, there are still more choices. “Different elements go into a green burial,” he says, “including a biodegradable casket and tombstone, a natural fiber shroud, a shallow grave to accelerate biodegradation, and opting for overall smaller headstones. Additionally, if you are being kept in a casket over burying cremated remains, you can choose not to use chemical embalming, which helps to avoid polluting the ground when decomposition takes place.”
Artist and inventor Jae Rhim Lee created a stir with her proposal for an “Infinity Burial System,” a spores-laden shroud that essentially composts the body.

But so-called green burials come with their own set of drawbacks. While the process is legal, the industry around it remains largely unregulated. Earlier this month, “at least” 189 decaying bodies were discovered in a Colorado funeral home called Return to Nature. The business had offered cremation services and “green” burials without the use of embalming fluids. The company had suffered recent business losses and had been operating with an expired license. It is expected to take several weeks to identify the decedents.

One of the more intriguing new developments in remains management is the so-called mushroom suit. Over a decade ago, artist and inventor Jae Rhim Lee created a stir — and a viral TED Talk — with her proposal for an “Infinity Burial System,” a spores-laden shroud that essentially composts the body. Luke Perry chose this plan before his death in 2019, though there are questions regarding its effectiveness.

And for those who prefer the water to the woods, sea burials are another option, though the Environmental Protection Agency keeps an understandably tight rein on exactly what parts of the country they can occur, and how far out the body must be released.

My friend Fawn Fitter has written about her plans for a sustainable afterlife at the University of Tennessee in Knoxville Forensic Anthropology Center. At the “Body Farm,” students learn how to extract critical information from decomposing bodies for identification and criminal investigations. “What I really want,” she wrote at the time, “is to be as useful as possible for as long as possible.”

My own hope is to follow a similar purposeful intention. Several years ago, I visited my doctor in the lab where he’d worked for years developing cancer immunotherapies. A former patient had arrived that morning, this time in a zippered bag, to make one final contribution to research. As a fellow long-term clinical trial patient, I can’t imagine a more fitting place for me to wind up eventually, too.

For a host of practical reasons, the cemetery appears to be a dying proposition. But as evidenced by a multitude of atmospheric seasonal decorations, there is still nothing quite like a graveyard for drama. After all, there aren’t too many great cinematic scenes involving urns — and even fewer that aren’t comedic. A solemn gathering in front of a headstone, in contrast, has the weight of significance. But that may be less about any literal dead body in the ground than it is about our human need for memorial.

“Traditional burial practices are being reimagined.”

“As perspectives in our society continue to evolve, many traditional burial practices are being reimagined,” says Elreacy Dock, a Las Vegas thanatologist and death educator. Historically, cemeteries have served as a place of remembrance and reflection. Many of the 19th-century cemeteries were intended to be spaces for peaceful recreation and lingering during visitations of loved ones, so these locations showcased lush landscapes that featured willow trees, flowerbeds and lakes.”

She notes that “Although this approach to cemetery design is less popular in the 21st century,” there are still ways of incorporating tradition into modern death rituals. “It would be most comparable to conservation and green burial cemeteries,” she says, “which emphasize maintaining natural landscapes without disrupting the environment or surrounding habitats.” She speculates, “The future of death beyond burial may shift to digital memorials, virtual tributes and interactive platforms that enable bereaved individuals to honor their loved ones without the limits of physical space.”

We think of death as an event. It’s not. It’s a process, one that continues long after the last mourner leaves the funeral. We break down, we burn or liquefy, we become part of the earth or the air or the water. And understanding and making choices about what becomes of our corporeal remnants matters, not for us but for those who loved us and for the planet we were briefly alive on. “The way we choose to memorialize our loved ones will also significantly change over time,” says Dock. “However, what will not change is the essence of remembrance.”

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“The hardest part is seeing them deteriorate having got to know them”

— A Q&A on supporting people at end of life in care homes

With more and more people expected to die in care homes over the coming years, it’s more important than ever the professionals working there get the practical and emotional support they need to provide excellent end of life care.

By Dr Julie Watson

When we think about what it means to die at home, it can be easy to jump to one idea of what this looks like. That is, a rented or owned flat, house or other dwelling. But for a growing number of people, ‘home’ at the end of life means the communal setting of a care home.

Right now, 20.5 % of all deaths and 34.6% of deaths of people over 85   happen in care homes. The number of people over 85 is set to increase by 90% by 2048, meaning this figure is only going to rise. The median length of stay in a care home is now 15 months, which means deep relationships form between staff and those in their care.

Good palliative care focuses on quality of life, and also accepts dying as a natural process. It’s vital people working in care homes get the support they need – both practical and emotional – in order to be able to give people in their care the best end of life experience possible.

I spoke to Senior Carer, Loren Hunt, who’s worked in a care home for several years, about what this looks like for her.

Q: First things first, could you describe a typical day?

We help the residents to get up, get dressed and start their day, have breakfast and then see what activities they’d like to do. Throughout the day, we help them with things like going to the toilet and if they need assistance with eating and drinking. We check their general well-being, make sure they’re comfortable and safe.

In the evening, we help them get into their pyjamas, washed and ready for bed. It’s personal care, but also a lot of general life support and making sure they’re happy and comfortable.

As a Senior Carer, I’m responsible for delegating tasks to the team as well as caring for people directly.

Q: What’s the best thing about working in a care home?

My favourite part of my job is just getting to know the residents and building that friendship and connection with them. I enjoy helping people to get the most out of life… Having a dance and being silly, making them happy. Trying to get them to participate in things. I think there’s a perception that if you go into a care home, you just sit in a chair all day and that’s that. But it’s not like that really.

Some of the people we care for have had such interesting lives. We’ve got so many residents who have done a lot of travelling and lived abroad and have wonderful stories. So it’s really nice just having chats about that with them as well.

Q: What’s the most challenging part?

We’re taught to not get too connected to the people in our care so that we don’t get upset when they do pass away. But when you do see people deteriorating and then getting to that point in life where they’re reaching the end, I think that’s the hardest part.

It can take months and months, or it can be really, really quick. But as soon as you realise it’s coming, it’s sad. And of course, when they do ultimately pass away, it is upsetting because as much as you’re advised not to get too emotionally attached, you can’t help it really.

I feel like you wouldn’t be doing your job as well as you could if you didn’t get connected to the people you care for.

Q: What are the challenges of caring for someone who’s approaching the end of their life?

If you’ve known someone for a while, it can be hard to adjust to their new needs because you get so used to them being able and not needing as much support. You have a routine together, so when it suddenly changes you have to adapt and think: ‘Ok, how can I now best support this resident now?’

And it is a lot of learning to do, and there may not be much time. It would definitely be helpful for more training on that side of things. It’s the area where I personally feel the least knowledgeable. Because it’s so different from person to person, and there is no set of rules which say: ‘OK, when this happens, you do this’, because everyone is different.

Q: Could you give an example?

One area which is often spoken about is eating and drinking at the end of life. There’s this perception that as soon as someone’s palliative, they don’t need to eat proper food anymore. That fluids should be thickened, or food should just be things like ice cream and yoghurt.

But that’s not necessarily true for everyone. For some people it might be, but others might manage to eat and drink fine until the very last stages. Or they might just want a taste of their favourite food. There’s nothing to say that if they want a taste of salmon or a roast potato, they can’t have that. They might not have a lot, but it means they’re still able to have that pleasure.

I think carers are often scared, thinking ‘what if I give them this piece of potato and they choke?’ so it feels safest to default to the ‘safest’ option. To have some help with confidence so that, for example, if someone does ask for a bite to eat, you can use your judgement and understand how to make it as safe as possible.

Q: Do you experience the very end of someone’s life very often?

Yes, people will quite often die in the care home so that’s something I’ve experienced quite a lot. There have been a few instances where people have suddenly become really unwell and been taken to hospital and died there.

It’s not as nice when you don’t really know what happened. You don’t know if their death was nice or not because they weren’t at home. And from what we hear, I don’t think it’s usually as peaceful as it is when they die in the care home, in their home.

Q: What does giving someone a good death mean to you?

I think what really separates the really nice death experiences that I’ve had from the not so nice ones is just being able to have that personal element to it. When you’re able to do all you can to make sure they’re happy and comfortable in their last moments.

An expected death makes it a lot easier to make sure it’s a nice one. But even when it’s unexpected, I think it’s about the resident having everything they need in place, such as their medications – so they remain peaceful and not too distressed.

It’s also having people they know around them. It makes a huge difference when staff who’ve known the residents for years can be with them as they die, and can put like their favourite music on or sit and just have a chat about things if they’re still able to talk. We’re quite lucky that we have quite a low staff turnover. A lot of our staff have been there for 10 years or more.

A not so nice death would be obviously if they didn’t have all their medication in place to support them, because I think the worst thing is when a resident gets really distressed and there’s nothing you can do about it. But also, if they’ve never met the person who’s with them, and if they didn’t know their likes and preferences. If they weren’t able to sit and have a chat with them and support them in their weakest moments.

Thinking about that person as a human being who needs connection, just as we are all human and seek and build those relationships. It’s very special to be there when someone’s dying, but when you feel uncertain, unsure or like something’s not right for them, it can be very hard.

Complete Article ↪HERE↩!

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Reclaiming the D-Word

— In planning for end of life, we first need to be able to talk about it.

We all know we’re going to die, but it’s one of the few human experiences we don’t like talking about. How can we change that?

By

Death—it’s a reality of life that on a certain level we know will come for us all, but one that in our modern world we have managed to push to the peripheries. The average lifespan for a Canadian in 2020 was a hair shy of 82 years – over 84 years for women and around 80 for men. This means we are living on average a quarter century longer than we did a hundred years ago, a fact we tend to forget about when we think about the institutions established in this country in generations past.

This coupled with the fact that multigenerational households are increasingly rare in this country means that for a great many Canadians, death is a remote concept that only rears its head upon the passing of parents, which increasingly takes place in the latter half of people’s lives. More than ever before, it has become easy to simply not talk about death and, when we’re forced to, do so in hushed tones and with euphemisms like ‘pass away’.

The upshot of this is that of Canadians under the age of 35, less than a quarter have a will and less than ten percent have drawn up powers of attorney. This is a precarious position to be in. Despite life expectancies being longer than ever, people still die all the time and at every age. Without these important legal documents in place, family members’ grief can easily be exacerbated by legal hurdles and interpersonal conflict.

Planning for end of life, however, requires braving the subject of death, something that feels unnatural to many of us. Sometimes it takes an unexpected, sudden death in the family or in one’s inner circle to bring the subject to the forefront.

A (Sort of) Cautionary Tale

Tania Jacobs’ story is a prime example of how the unimaginable can occur in an instant and a lesson in the importance of communication within families. A Calgary-based registered psychologist and mother of two children, aged ten and twelve, Tania lost her husband Trevor when she was 37. A sudden illness – invasive Group A Streptococcal disease – took him from initially calling in sick from work on a Friday to dying on a dialysis machine in hospital two days later.

So unusual were the circumstances of her husband’s death that, even within a young widows’ group she joined after her loss, she felt like something of an outsider.

“Within the group, about a third of the women had lost a partner to cancer, another third to suicide and other mental health-related deaths, and a further third to heart attacks, car accidents, and other relatively common occurrences,” she notes.

“And then there was me in this very narrow band of those who lost someone to freak illness. My experience represented a tiny minority within this group.”

Had her family dynamic been different, Tania could have ended up a cautionary tale. While she and her husband had had brief conversations about not wanting to be hooked up to a machine at end of life, there was no will or enduring power of attorney in place, and her husband’s finances were not particularly well organized. For example, he had an RRSP that was set up in his childhood with his sister as beneficiary, something he had not changed in adulthood.

“I was very lucky that there was no fighting among family members,” she asserts.

“I’ve heard plenty of stories where this is not the case. In my situation, my husband’s parents and siblings were completely on board with me being the sole beneficiary. In the case of my sister-in-law, when I contacted her about the RRSP, she immediately transferred the beneficiary status over to me. That said, it would have been smoother and easier had we had all those documents in place.”

She also benefited from the fact that her stepfather had been the personal representative of the will for both of his parents and was able to guide her through the estate process. A referral from a lawyer friend of hers to an estate specialist also meant she was able to navigate this process smoothly despite being, in her own words, a “grieving zombie who was barely able to function” and not having a will in place.

In the aftermath of her husband’s death, Tania got all her personal affairs in order, including a will, personal directive, and enduring power of attorney. Furthermore, she notes that many of the people in her inner circle did the same thing shortly thereafter.

“I know a lot of our friends took us as a cautionary tale and went and got this stuff sorted out,” says Tania.

“Many of our friends were like, wow, we don’t have a will! We don’t have any of that stuff in place either. As for my mom, who is a really organized human being who certainly had those documents in place, [she] took this as a sign that she needed to update everything. It’s like there was a ripple effect involving people in my life, where everyone took this as a sign to take some sort of action.”

She also intends to broach the subject with her own children.

“Now that my kids are moving towards adolescence, I see us having conversations about this stuff. They’ve already been through a lot in terms of grief counselling and whatnot, so they’re very familiar with death. Of course, I don’t want to scare them or get them worked up about the possibility of their mother dying, but it’s coming to be that time. Even explaining to them what this conversation was about, saying that I would be talking about daddy’s death and the preparation people need to do around that, was perhaps the beginning of that conversation.”

A Death-Adjacent Life

For Tania Jacobs, death was a remote concept until it struck her family out of the blue. For fellow Calgarian Marie Carlson, however, it’s been a reality of life for a long time and one with which she has become ever more comfortable. Marie is a retired former health policy specialist with Alberta Health Services with a background in medical sociology. She is now an energetic volunteer at Calgary’s Dulcina Hospice, the largest hospice facility in Canada west of Montreal, where she interacts daily with residents in the final months of life.

Marie’s introduction to death came early with the loss of her brother at age 31 to colon cancer when she was only 15. Her brother’s death led her to pursue a partial degree in theological studies in addition to her sociology degree and to dive into the subject of death and dying. Her interest in the subject stayed with her over the course of her career and influenced her decision to become a hospice volunteer following her retirement.

“I’ve always wanted to do this work,” says Marie of her volunteer role.

“Back when my brother died there wasn’t palliative care like we know today, and I’ve always wanted to help people live as well as possible at the end of their lives.”

In her volunteer work, Marie finds herself up close and personal with death daily. She notes that in her work, as well as in life, she does not shy away from the d-word that so many people replace with euphemisms like ‘pass away’. In the hospice setting, the word ‘death’ is standard parlance.

Given her longstanding acquaintance and interest in end of life, it’s hardly surprising that Marie takes her own end-of-life planning very seriously.

“I’d say I’m pretty prepared for death,” she explains.

“I’m very aware of my own mortality and I continue to get ready for end of life. I’ve done all my paperwork—my will, my personal directive, and my enduring power of attorney, and I encourage others to do the same. I’m also doing my ‘death cleaning’ right now. I’m of Swedish descent, and the Swedes have a tradition that they call ‘death cleaning’, where you clean out all your junk before you die. It’s a way of getting things in order so that there’s less work to pass on to your family when the time comes. I don’t want to wait until I’m too old, so I’m doing it now.”

Her relationship with death has also impacted her relationships with family and friends and the emotional presence she brings to her interactions.

“I’ve experienced a lot of deaths over the years,” she notes.

“My brother died. My parents are dead. My niece is dead. I’ve had a cat and a dog die. Some of my friends have died. I have a sister who is 87 and her health is starting to fail. We don’t get to this stage in our life and not experience death. Knowing what a difference companionship can make to a dying person and their family has affected how I engage with others. I think about my brother, who was only 32. His death really impressed upon me how important it is to just be there, to just be open and be present. It makes me mindful to spend quality time with the people I care about.”

Meanwhile, Marie continues to be positively impacted by her interactions with hospice residents and the palpable joy many of them exude at end of life.

“I’d say my biggest surprise working in a hospice setting has been the amount of laughter and joy you encounter. I know that probably sounds weird. There’s a lot of black humour that I hadn’t expected. Sometimes people say, ‘Gee, that must be a really depressing place to work. How could you go in there?’ But the amount of laughter that we have with our residents, families, hospice staff and other volunteers is unbelievable. Obviously, not every day is like that, but it’s like a little epiphany how beautiful this experience can be.”

“With hospice care, it’s essential to have a strong volunteer program with skilled and compassionate coordination, such as we have at Dulcina,” she further adds. “It’s the entire package of programs and volunteer support that enables us to do this valuable work.”

Talking About Death

Death—it’s a topic of conversation that never killed anyone, but one that many cultures avoid as though it did. Fortunately, a death positivity movement has begun to take shape in recent years, a movement that promises to take the stigma out of the subject and create a climate more conducive to end-of-life planning.

One of the most visible drivers of death positivity has been the growing worldwide phenomenon of Death Cafes. Founded by Jon Underwood and Sue Barsky Reid in the UK in 2011, the Death Cafe movement has since gone global, with gatherings now having been held in more than 80 countries. Death Cafes are get-togethers typically held in libraries, places of worship, and other public venues as well as actual cafes. They provide a safe space to talk about death and dying, which, in Underwood’s view, “helps people make the most of their (finite) lives.”

Death Cafes can also serve as a venue for talking about the importance of end-of-life planning. In Alberta, Covenant Health’s Palliative Institute has been promoting Death Cafe as such a venue, providing resources for current and aspiring Death Cafe facilitators while also producing publications related to advance care planning and end-of-life-related legal documentation for distribution at these events. One publication is My Wishes Alberta, a workbook that serves as a gentle introduction to end-of-life planning, encouraging readers to reflect on their most salient values and identify their wishes for if and when they succumb to a serious illness.

In the cases of Tania and Marie, it took an untimely death in the family to trigger inner reflection and outer conversations about death. This in turn leads to legal documents being put in place to ensure their own end of life will be as pain-free for family members as possible. The death positivity movement seeks to destigmatize the subject of death and create a culture wherein people don’t have to experience the unimaginable to ready themselves for the inevitable.

Complete Article ↪HERE↩!

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Dust to dust

— Green burials — no embalming, rapid decomposition — are gaining ground… and giving back to it, too

By AV Kitching

Adriano Valentin was passionate about the natural world. An animal lover, he believed in taking care of the planet and all the creatures who live on it.

He drove an electric car. He composted his waste. He faithfully recycled, and tried his best to reuse and repurpose household items.

When Valentin, 80, was diagnosed with a terminal form of pancreatic cancer, he reached for a newspaper cutting his wife Jane Dick, 71, had snipped and tucked into a bookshelf. The article mentioned Quinn Hunter, a local funeral director offering natural burials with minimal environmental impact.

Jane Dick says participating in a green burial of her husband, Adriano Valentin, ‘was very intimate. It was also healing.’ (Supplied)
Jane Dick says participating in a green burial of her husband, Adriano Valentin, ‘was very intimate. It was also healing.’

“When he found out he was terminal, he pulled the cutting out, gave it to me and said, ‘Let’s talk to her,’” Dick says.

Valentin wanted his burial to be an extension of who he was as a person.

“A natural burial appealed to him because we are always trying to live lighter on the earth. We’re not saints, by any stretch of the imagination, but we believe that small things add up and that you have to set a good example. The green burial was just another way,” Dick says.

A green burial harkens back to the oldest form of interment, where a deceased person is simply placed in the ground, without any chemicals, preservatives or adornments, and covered with soil.

After death the body is washed, then wrapped in a simple shroud. It is then placed in a biodegradable shroud or casket, in a grave dug 1.7 metres (5-1/2 feet) deep; closer to the surface to ensure it is more bioavailable to fungi, plants and animals.

There are no headstones or footstones to mark the grave. Instead, the land above it is kept natural, seeded with native plants and flowers.

It’s a return to the old ways, says Richard Rosin, funeral director and president of the Green Burial Society of Canada.

Five principles of green burial

1. No Embalming

Bodies are prepared for green burial without the use of embalming. Decomposition is nature’s way of recycling a body, without need for intervention by us. A body that is not embalmed can still be prepared in a dignified way for burial and viewing. This is made possible with refrigeration and the use of environmentally sensitive soaps, lotions and disinfectants.

1. No Embalming

Bodies are prepared for green burial without the use of embalming. Decomposition is nature’s way of recycling a body, without need for intervention by us. A body that is not embalmed can still be prepared in a dignified way for burial and viewing. This is made possible with refrigeration and the use of environmentally sensitive soaps, lotions and disinfectants.

2. Direct Earth Burial

The unembalmed body is wrapped in a shroud made of natural, biodegradable fibres and then buried directly in the grave. Alternatively, the shrouded remains can be placed into a casket or alternative form of container, where the casket or similar container is also made of sustainable and fully biodegradable materials. In an ideal circumstance the shrouds and/or casket will be locally sourced, as close as possible to the deceased’s place of death and burial. For green burial, no outside grave liner or protective vault is used. The body in a shroud or casket is buried directly in the ground.

3. Ecological Restoration and Conservation

Once a green burial has taken place, the surface of the grave is allowed to settle before being restored with locally indigenous species of grasses, flowering groundcovers, shrubs and trees. Preferably grave restoration is achieved by using a plant palette and plan that has been designed to integrate the area seamlessly into the surrounding landscape and ecosystem. Key components of green burial are protecting and preserving burial grounds. Covenants, protective easements and other enforceable guarantees made by the green burial cemetery operator will ensure that the site will never be repurposed and that the ecosystem that evolves there will be protected.

4. Simple Memorialization

For green burial, memorialization should be simple and visually appropriate to the site. Communal memorialization — simple, basic inscriptions on naturally sourced materials — is preferred. Alternatively, small, hand-crafted, individual monuments may also be used, but these should be made of natural, preferably locally sourced materials. Ultimately it is the green burial site as whole that becomes a living memorial to the persons interred there.

5. Optimized Land Use

A well-planned green burial cemetery (or cemetery section) will optimize the land it occupies. Design elements will include minimal infrastructure, such as temporary roads that can be removed and converted into interment lots, operationally pragmatic grave dimensions, and section lot plans that maximize interment capacity. The reuse of graves is a highly sustainable practice that optimizes land use in a green burial (or any) cemetery. Common in many places, grave reuse is currently available only at a few cemeteries in Canada. Where full-body interment is not practical or possible, space within a green burial area may be designated for the interment of cremated remains.

For more information go to greenburialcanada.ca.

— Green Burial Society of Canada

In the last three years Rosin has conducted 22 green funerals in Manitoba and has pre-planned eight.

A staunch advocate of green burials, Rosin believes once we are dead, we are meant to return to the earth in as natural a way as possible so our composting bodies become an energy source for the planet.

As our body decays, it nourishes the earth, the nutrients within sustaining plants and other wildlife.

Embalming a body with formaldehyde — one key difference between green and traditional burials — slows down the process of decay. The embalming chemical can leach into the groundwater and pollute it.

Another difference is the receptacles used to contain the body. In a green burial, the container holding the body is made from biodegradable materials, which are easily sourced from local makers. They are often also more reasonably priced.

In a conventional burial, bodies are often interred in elaborate wooden caskets with metal handles. Some people are buried in caskets made of steel, bronze or copper. There is also the choice of having a grave liner, made from concrete or plastic, into which the casket is placed.

“There are better ways and solutions for end-of-life care in a way that goes back to the basics of what we are used to,” Rosin says. “We are energy when we are dead. That’s what we are and that’s what we ought to be. We are supposed to go back into the system.”

However, as someone who runs a full-service funeral company that offers different options to bereaved families, Rosin, who has been in the industry for nearly 40 years, fully supports families in whatever decisions they make.

“We are energy when we are dead. That’s what we are and that’s what we ought to be. We are supposed to go back into the system.”
– Richard Rosin

“I don’t inflict my solutions if people already have one,” he says. “It’s a hard enough time emotionally; people who are grieving certainly don’t need somebody telling them what to do.”

Most of us avoid thinking about death and what happens to our bodies when we die. Giving it thought forces us to confront our own mortality. We have become adept at ignoring the nature of our existence; death is something we are all marching toward.

Death is both one of the most ordinary and most extraordinary events in life, second only to birth.

Owing to our discomfort, an entire industry has grown up around death that provides a sanitized, clinical approach to the very human, sometimes messy and painful nature of dying.

This industry provides a buffer between those who have died and the ones left behind.

“We hand out large amounts of money for companies to deal with our deceased. Preserved with chemicals, ensconced in wooden or metal boxes, our dead lie there as if they are only asleep,” says Trish Penner of Green Cemetery Project Winnipeg.

“We have amazing people in this world related to the death-care industry, related to funerals, related to cemeteries, but then there are also those doing this as big business, profiteering off death. There are both.”

Trish Penner, who is leading the Green Cemetery Project in Winnipeg, says a green burial site ‘allows the natural ecosystem, including plants and animals, to make this space their own.’ (Ruth Bonneville / Free Press)
Trish Penner, who is leading the Green Cemetery Project in Winnipeg, says a green burial site ‘allows the natural ecosystem, including plants and animals, to make this space their own.’

Cultural traditions, religious beliefs and values intersect when it comes to deciding what to do with a person after they are dead.

Budget is another pressing issue.

With spiralling burial costs — Rosin estimates it can cost anything from $8,000 to $10,000 for a conventional burial — around 75 per cent of Canadians choose to be cremated. In Manitoba a simple, or direct, cremation can be anything from $1,000 to $3,600.

“Yes, it will be cheaper to do a cremation,” Penner agrees. “A green burial is not the cheapest option, but often most environmentally friendly options aren’t.”

But our mindset is shifting. People are becoming more willing to engage in conversation about green burials and its ecological benefits.

Let’s talk about death

Trish Penner has organized a conference on May 4 for those interested in learning more about Green Burial Project Winnipeg, and exploring some of the legal, social, emotional and health-care aspects of preparing for death.

Reclaiming Death — A Community Conversation is an opportunity to think and talk about death in community with others.

Trish Penner has organized a conference on May 4 for those interested in learning more about Green Burial Project Winnipeg, and exploring some of the legal, social, emotional and health-care aspects of preparing for death.

Reclaiming Death — A Community Conversation is an opportunity to think and talk about death in community with others.

“I am hopeful that this conference will nudge people to talking about death before there is a life-threatening diagnosis,” Penner says. “People are very vulnerable when someone they love is dying or has died. With having important conversations earlier in life, it empowers us. We want to know that we are making decisions for our people as they would have wanted if they were able to make their own choices. We want to have the important conversations about what we mean to each other before that time has passed.”

The day will be broken into two halves. The morning session will be about preparing for death. There will also be an optional meditation on death, just prior to the day’s events. At lunch people can seat themselves at tables that are open to discussing death care or at tables where attendees are not ready to talk about death at this time.

The afternoon will explore whether we could be doing death care differently, whether there are ways we could be involved in the care of our loved ones around the time of their death and afterwards. There will home-funeral and green-burial advocates talking about what options are currently available, a presentation on wills and power of attorney, a talk by a palliative care nurse and a panel discussion on preparing for death.

Pre-registration is required.

For in-person attendance

Cost: $60 (includes lunch)

Location: 150 Bayridge Ave.

For remote Zoom attendance: $30 per link.

Please contact Trish Penner at trishpenner@hotmail.com or go to greencemeterywinnipeg.ca to register.

When she first started the Green Cemetery Project Winnipeg, there were only two registered green cemeteries in Canada. Today there are 14, scattered across British Columbia, Alberta, Ontario and Nova Scotia.

For Penner, it’s all about changing how we view cemeteries — not as a manicured field full of headstones, but a place where nature can thrive.

“The one point that people sometimes make is they don’t want to have a gravesite dedicated to them indefinitely, and that the land could find another purpose,” she says. “I think with a green burial, some of that is addressed, in that for our site, we are not planning to have grave markers, like a headstone, at each site. Instead we will be creating a wild, natural space that allows the natural ecosystem, including plants and animals, to make this space their own.”

She anticipates there will be paths with benches for resting and sitting areas for reflection.

Penner is currently testing a piece of land 50 kilometres outside Winnipeg to see if it will be suitable for the cemetery she has in mind. She and her team have been looking for land for nearly three years and while they are eager to start the process, there are still a number of hurdles in their way.

“We have to find something that would work in terms of RM bylaws, support of residents in the area for this project, proximity to Winnipeg, water table or flooding in the area throughout all seasons, and characteristics about the land that would complicate digging graves, such as tree roots or bedrock, and it falling within our budget capabilities,” she says.

Penner plans on basing her grave options on the City of Winnipeg’s price structure, which falls in the range of $2,350 to $2,950. There will be additional costs, such as the opening and closing of the grave, and the possibility of a group memorial marker, which allows the family of the deceased to place a plaque on a dedicated wall.

“But you don’t have to buy a grave liner, you don’t have to buy a grave vault, we won’t have the option of large headstones and footstones,” she explains of the site, which would allow burial in shrouds or biodegradable caskets. “Even the casket will not be as expensive, because you won’t be using embellished and stained wood boxes.”

In Brookside Cemetery, among the oldest and largest garden cemeteries in Western Canada, plans are afoot for a dedicated green burial site.

This spring, the city’s naturalist services branch, working with cemeteries administrator Brett Shenback, is naturalizing a small piece of land at the municipal cemetery, which is a National Historic Site.

Previously a conventional lawn, it will be replaced with Prairie grasses. Shenback hopes the native grasses will be well-established by 2025 and that soon after the cemetery will be able to offer green burials in that specific area.

Brett Shenback, cemeteries administrator, at the space that will become the green burial site at Brookside cemetary. (Mikaela MacKenzie / Free Press)
Brett Shenback, cemeteries administrator, at the space that will become the green burial site at Brookside cemetary.

The pilot project is a way of testing the waters; if there is more demand for these kinds of burials, the city will look at expanding its green burial sites in the future.

“Edmonton and Calgary have established a green burial section in their municipal cemeteries and they have been really popular,” Shenback says.

“There is a growing segment of the population who live their lives mindful of the environment. They want a green burial that aligns with their personal values … I am seeing more of this interest today than I did five years ago.”

Brookside currently offers a hybrid solution for those who would like to be buried in as natural a way as possible.

Municipalities coming on-board the green burial idea are moving in the right direction, Rosin says. While those working within the funeral industry are able to provide for everything else, they cannot offer cemetery space.

“The cemetery industry has to realign their thinking and the city doing it is a huge start,” he say. “They have a very strong municipal responsibility to the environment. Other cemeteries will be able to see that cemeteries are not just headstones; there are opportunities to do other things with a green cemetery.”

On 8 March, Adriano Valentin was buried.

In the hours after he died Valentin’s body was washed by his sister-in-law and niece, and he was dressed in clean clothes before being picked up by the funeral home.

At the funeral home, Valentin’s body was refrigerated. Before burial he was wrapped in a shroud and placed on a biodegradable tray before being driven in a hearse to his final resting place.

“Because his body was on a tray, those of us in attendance were pallbearers. We all carried him to the grave. Some people would find that difficult, but for me it was comforting. Because I was accompanying him, I found it very pure and beautiful,” Valentin’s wife Jane Dick says.

“There was no casket, there was no box — I was saying goodbye to a person. For me, being involved in those small ways with his burial was very intimate. It was also healing.

“I lost the greatest love of my life, but it was comforting to have that intimate goodbye.”

Complete Article ↪HERE↩!

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Preparing for the Unthinkable

— A Brief Guide to Digital Legacy Planning

By Adam Engst

The sudden death of our friend and Take Control author Charles Edge emphasized how terrible things can happen to anyone at any time (see “Take Control Author Charles Edge Dies,” 22 April 2024). Those later on in life are usually more aware of their mortality and plan for it, but for younger people, it’s hard to contemplate the possibility of incapacitation or death, whether due to an accident or just bad luck.

I don’t know what Charles may or may not have done in this regard, although he wrote about the topic three days before he died from a cerebral aneurysm. Since then, Tonya and I have been thinking more about what would happen if one of us were to be incapacitated or die. We both know a lot about the other’s digital setup, but is it enough? We’ve come up with a list of items that we need to share with the other so they could take over, and we hope it’s useful for you, too.

The most comprehensive reference for this sort of planning is Joe Kissell’s ebook, Take Control of Your Digital Legacy. He wrote the first edition back in 2017 when we were still running Take Control, and he published a second edition in February 2024 that brings it up to date in myriad ways. If you want to do more than the basics—and I highly recommend that you do—read Take Control of Your Digital Legacy and put thought into the many aspects of your digital life that go beyond just allowing your spouse, partner, or child to get through the early days of not having you around.

Identify Your Trusted People

First, figure out who will need to take the reins when you’re incapacitated or dead—I’ll refer to that person as your steward. For those in a couple, one member will likely take the role of steward for the other, but if both die, there needs to be a backup.

You may also need other people in various roles: a healthcare proxy, someone with power of attorney, the executor of your will, the guardian of your minor children, or a trustee. I’m far from an expert on this topic (we’re about to update our woefully outdated will from 22 years ago), so get advice from a lawyer or estate planning professional.

Whoever you choose, talk to these people soon to make sure they’re willing to help and know what’s involved. Such discussions can be tremendously difficult, but just think how much more difficult it will be for them if they’re thrust into such a position without having had the talk. That’s doubly true if your preferred steward isn’t all that technically adept.

Create Digital Legacy Information

If you’re incapacitated or dead, your steward will need to work with healthcare professionals, organizations with which you do business, government agencies, and much more. To ease that process, I recommend building a set of digital legacy information they can turn to whenever some question or problem arises. For instance, they might need to share your health insurance information if you’re admitted to a hospital, notify family members they’ve never met, pay your mortgage, and more. From what I’ve heard from those who have gone through this, there’s always more.

Here are some items that I encourage you to assemble and ensure that your steward can access in the event of an emergency:

  • Login passwords/passcodes: It’s essential that your steward be able to get into your Mac, iPhone, and iPad to access other information, so make sure that they either know your login passwords and passcodes or can look them up in a secure location. Don’t assume that Face ID or Touch ID is sufficient—devices with biometric authentication still require their password or passcode regularly.
  • Password manager: I can’t emphasize strongly enough how important it is that you use a password manager for all your online accounts. By collecting everything in one place, a single master password gives your steward instant access. Although password-sharing setups like 1Password for Families and Apple’s Shared Family Group work well for everyday use, sharing the master password ensures your steward can access accounts that may not be shared.
  • Medical information: Your steward will likely need your health insurance information if you’re admitted to a hospital in an emergency situation. A short list of current medications, allergies, and surgical histories may also be helpful, especially if you have severe allergies to common medications or must take certain medications regularly.
  • Estate planning documents: An estate planning professional should help here, but your steward will likely need to access documents that specify your healthcare directives and power of attorney, along with your will, guardianship documents, trusts, and so on. Make sure to communicate the location—online or offline—of those documents.
  • Communication plan: A stressful aspect of someone dying is communicating their passing to family, friends, and community members. Develop a list of people who should be contacted quickly. They can then be asked to spread the word further to your relatives, employer or clients, friends, and community groups.
  • Financial affairs: Create a document that lists your bank accounts, investment accounts and assets, and insurance policies. For each, include an account number if appropriate, and either a link to the website (the login credentials should be in your password manager) or a description of the location of physical documents (“the bottom drawer of the wooden filing cabinet, in an Insurance Policies folder”). Add any notes that might help your steward, such as contact information for accountants or lawyers.
  • How to be me: Joe Kissell suggests this item in Take Control of Your Digital Legacy, and I think it’s brilliant. The goal is to create a document that briefly explains what you do—think of it as training someone to take over from you. It could include regular tasks, details about home or car maintenance, important financial tasks like paying property taxes, and notes on how to deal with your technology. If you are your household’s IT person, tech notes may need to include how the network is set up, how the home automation system works, how backups work, and how to reboot the router. Generating such a document from scratch might be challenging, but if you start one now and add tasks as you perform or remember them, it will become a valuable resource over time. You may want to organize it chronologically, listing key actions for each month.

One final note. Apple’s Legacy Contact system for sharing Apple data in the event of your death is worth setting up because it ensures your account won’t be deleted for 3 years, but as long as you trust your steward sufficiently, providing full access gives more flexibility. Google provides an Inactive Account Manager you can configure to share select data with specific people if your account goes inactive, but that will take at least three months.

Other Decisions to Consider

My goal so far has been to lay out the information your steward will need to take care of you and manage your affairs in the immediate aftermath of your being incapacitated or dying. As horrible and stressful as that will be (but less so if you’ve left them good information), there’s vastly more work that comes from winding down your life. You can make it easier for them by thinking ahead and documenting your wishes in these areas:

  • Email: How do you want your steward to respond to incoming email messages from individuals, businesses, and mailing lists? What should happen to all your saved email in the long run?
  • Chat: How should your steward respond to incoming chats in Messages, WhatsApp, Facebook Messenger, and so on?
  • Social media: If you use social media, it’s a good idea to instruct your steward to post a final farewell so anyone looking you up will know what happened. Consider it an opportunity to have the last word. Some social media services allow accounts to be archived so they remain online but limit access, so if that’s desirable, let your steward know. Or just have them delete your accounts.
  • Photos and videos: Dealing with thousands—or tens of thousands—of photos and videos is going to be a ton of work for your family. If you have the time, create albums of photos and videos you’d like to share with specific family members.
  • Other data: It’s hard to know what additional documents you might have or what you want to have happen to them. If you have data that should be shared, be sure to leave some high-level instructions about what it is, where on your drive it can be found, and who should get it.

Again, this article is far from comprehensive—my goal is to help you start thinking about these issues. Take Control of Your Digital Legacy addresses additional topics and provides a great deal more advice. I also encourage those of you who have had to serve as stewards for a family member to share anything you learned from your experiences in the comments.

Complete Article ↪HERE↩!