A growing number of South Korean women are training to be morticians, a field from which they had long been excluded, amid changing views on gender roles and a rising preference for women’s bodies to be handled by women.
With recent deaths of female celebrities and prominent figures, as well as growing scrutiny of sex crimes against women, gender sensitivity is changing the way families of the deceased bid farewell to their grandmothers, mothers and daughters.
“I felt uncomfortable when my classmates of a different sex touched my body, even when I was fully dressed,” said Park Se-jung, 19, who is in her second year of funeral directing studies. “I sure wouldn’t want them to touch, wash and dress my naked body even if I were dead. I am determined I should be the one bidding those women a proper farewell.”
The trend comes amid growing calls for crackdowns of sexual violence against women, including a rash of hidden-camera crimes, “revenge porn”, and online networks that blackmailed women and girls into sharing sexual and sometimes violent images of themselves.
In the early 2000s, about a third of mortician students in the country were women, but today they make up around 60% of the class, said Lee Jong-woo, a professor of embalming at Eulji University in Seongnam near Seoul.
“With Confucian ideology, death was considered a taboo in South Korea in the past, and had negative perceptions of whether women could handle such work, but the perception has been changing,” Lee said.
Funeral companies say they have been receiving more requests for female morticians.
“Most of the deaths of young people are suicides, and the families of the bereaved, especially if it was suicide and a woman, feel more comfortable if we handle the body,” said Park Bo-ram, a funeral director of seven years.
“I recall a teenaged student, an only child … had committed suicide,” Park said. “Washing and dressing the body, I saw many signs of self-injury on her thigh, but none of her family knew.”
Park recalls that the girl’s parents were immensely grateful, even in the midst of sadness, that a female mortician handled their daughter’s body.
South Korea’s suicide rate is the highest in the developed world: 24.6 deaths per 100,000 people in 2019, compared with an OECD average of 11.3. That year, it was the No. 1 cause of death among teenagers and people in their 20s and 30s.
More than 4,000 women committed suicide in 2019, including young female K-pop artists Koo Hara and Sulli.
In 2016, a quarter of the country’s 6,200 funeral directors were women, and with more than 130,000 girls and women dying each year, requests for female funeral directors are expected to rise further, Korea Employment Information Service said.
Yet some resistance to women in the mortuary business remains.
Shin Hwa-jin, 21, who plans to work at a funeral home after graduation, said she was shocked to hear a female mortician relate a conversation with her mother-in-law.
“Her mother-in-law asked her: ‘How dare you think of cooking my meals with the hands that touched a dead body?’” she said.
“What’s your name?”
“No, you’re not.”
“I’m your daughter.”
“No, you’re not. What’s your name? . . .”
“We should get him a tape recorder.”
“He’s human. He needs a human voice.”
“But his is almost gone.”
“That doesn’t matter.”
Staring into the face of an undead ghost in a green tweed jacket and flat-cap over toast and cornflakes is unnerving at the best of times; and traumatic at the worst. Especially when that ghost is your father. And the cornflakes have gone soggy.
But unlike gothic novels or films where ghosts happily offer themselves up as symbols of repressed memories, traces of crimes against innocents, and (usually) murderous pasts, this ghost has never crossed over into the realm of the metaphorical. Inconveniently, it decides to remain very, very human. Actually, that depends on your definition of human.
Even more inconvenient is the fact that this ghost refuses to follow the script and disintegrate with the morning light. Instead, it prefers to haunt the modern comforts of an electric armchair; swapping dreary castles for daytime television and crumbling dungeons for motorised beds.
And that’s just the start of my day living with a living ghost. Or Alzheimer’s as it’s otherwise known. Or, more correctly, my father’s Alzheimer’s.
Living with Alzheimer’s, both as a carer and sufferer, is a growing phenomenon in the UK. Often confused with dementia, Alzheimer’s refers to a physical disease which affects the brain while dementia is simply a term for a number of symptoms associated with the progressive decline of brain function. These symptoms can include memory loss, difficulty with thinking and problem solving, and challenges with language and perception. There are over 400 types of dementia—with Alzheimer’s and vascular dementia as the most common forms. According to the Alzheimer’s Society of the UK, dementia is now the leading cause of death in the UK with someone developing it every three minutes. Alzheimer’s is classified as a “life-limiting” illness according to the NHS, but sufferers can live for many years after the initial diagnosis, depending on the progression of the disease. Divided into three stages, early, middle, and late, the symptoms of Alzheimer’s gradually become more severe as the disease progresses and more parts of the brain are affected.
In the early stages, having Alzheimer’s as a companion wasn’t too unpleasant; the emptiness hadn’t fully taken over and I had more human than spectre to talk to. I could still pretend to have a normal(ish) life with only the minor inconvenience of a (mostly) present parent, despite the occasional wandering through doors unexpectedly and lunatic outbursts. The human part kept his smiling eyes, watching the world orbit around the sweat-stained tea-pot and apple tart. But the Alzheimer’s relentless erasure of my father left a morbid spectre sitting in his chair at the kitchen table.
In the middle stages, my father’s personality and identity dropped away like discarded clothes. His manner of speech was the first to surrender to the disease. Forgetting words rapidly metamorphosised into hours of repetitive questioning, as if seeking to ground himself in concrete knowledge of the now while his fingers grabbed vainly at a slipping sense of reality. The final stages of the disease witnessed his childish cries for help without knowing what or who he wanted.
“Gone childish” is an archaic term that was once used to describe dementia and Alzheimer’s sufferers before these diseases were better understood. Capturing the vulnerability these diseases inflict on their sufferers, the phrase sums up the centrality of memory to the human experience. If our identities are formed by our experiences, and these experiences are stored in our memories, shaping who we are and how we make decisions, what can we do when we have no memory? Without a roadmap of precedence, how can you plan for the future or know yourself without knowing how you got to where you are now? Like children, Alzheimer’s sufferers lose a sense of the past and futurity. They become transfixed in the present like ghosts trapped in limbo.
The last stages of my father’s disease cemented his role in the family home as the new phantasm. Like a well-behaved, conventional ghost he punctuated our nights with night-walking, ghoulish shrieks, hallucinations, and knocking on doors at all hours while the day-time witnessed empty eyes peering out from behind the safety of a purple blanket. Innocent of blame, our ghost blocked our escape from the house. For fear of hurting himself, we couldn’t leave him alone but grew resentful for being held hostage by a madman with no memory or awareness of his own actions.
After being stripped of memory and identity, my father’s Alzheimer’s left a shell of body; a ghastly reminder of the person that had once inhabited it. Bereft of the markers of humanity, this animated mannequin asked, “What makes up a human? Is it the mind? Or the body? And what happens when you take one from the other?”
Researchers have identified the cause of Alzheimer’s as the build-up of abnormal structures in the brain called ‘plaques’ or ‘tangles’. These structures cause damage to brain cells and can block neuro-transmitters, preventing cells from communicating with each other. Over time, parts of the brain begin to shrink with the memory areas most commonly affected first. Why these build-ups occur or what triggers them is not yet understood, but researchers now know that it begins many years before symptoms appear.
Ancient Roman and Greek philosophers associated the symptoms dementia with the ageing process. However, it was not until 1901 when the German psychiatrist, Alois Alzheimer, identified the first case of the disease. Medical researchers during the twentieth century began to realise that the symptoms of dementia and Alzheimer’s were not a normal part of ageing and quickly adopted the name of Alzheimer’s disease to describe the pattern of symptoms relating to this type of neurological degeneration.
No physical markers like the puckered lines of surgery scars or the uneven hobble of a game leg signposted my father’s declining health. But the slow creep of this living death brought on grief long before his body was expected to fail. Without the essence of the person, all of their quirks and curiosities, which once animated a familiar body, how do you grieve for someone’s loss before they have died? And how do you cope with the guilt?
This type of grief is usually referred to as anticipatory grief. It is a type of grief that is experienced prior to death or a significant loss. Typically, it occurs when a loved one is diagnosed with a terminal or life-threatening illness, but it can also happen in the face of a personal diagnosis. However, it can often trigger feelings of guilt because people feel ashamed for grieving their loved one’s death before they are dead.
With my father’s memory gone, my connection with him was broken. During the later stages of the disease he forgot my name and my existence. Fading from my life, his body remained as a perverse mockery of the person that had once inhabited it. Now all that haunts me are the memories of peering over barley stalks before the autumn harvests at a grizzled old farmer in a flat cap and tweed jacket, a hand reaching out to help guide the walk home.
— What physician-assisted death is like for a family
Margaret Handley wrote the essay so her children understood their grandmother’s experience and to help others learn about physician-assisted dying.
By Meghan Holohan
It started with weakness and pain when walking. Then Jacqueline Shapiro had a deep lesion on her leg before she broke it, oddly, and doctors struggled to set it. The pain medications caused her to have bad reactions and her energy waned. Eventually doctors learned that the 85-year-old had lymphoma. She underwent three grueling months of surgery, radiation and chemotherapy, but it only left her exhausted and feeling worse.
“It can cause delusions and a sort of psychosis. And it just was horrible, just horrible. And it was really hard for her to get her pain stabilized,” Margaret Handley, her daughter who is an epidemiologist living in the San Fransisco Bay area, told TODAY. “If you looked at those episodes medically, they were going well, but it was just part of an escalating discomfort for her. She increasingly felt like ‘I don’t think this is a good place for me to be.’”
Shapiro worried about spending the rest of her life undergoing painful treatments that might not even cure her cancer.
“She didn’t want to be lying there dwindling while people take care of her,” Handley said.
When a palliative care doctor visited Shapiro to discuss her pain, they started talking about California’s End of Life Act. People with terminal illnesses, who meet a certain criteria, can request drugs to aid dying, according to the California Department of Public Health. Similar legislation exists in eight other states. Compassion & Choices, a nonprofit working to improve patient rights and individual choice at the end of life, recently reported that Brittany Maynard’s advocacy of “death with dignity” inspired the passage of medical aid dying laws in Washington, D.C, Colorado, Hawaii, New Jersey and Maine.
Shapiro met those requirements. Hearing about the option of medically assisted death seemed to lessen her burden.
“She told me right away after the doctor left, ‘That’s what I’m going to do — physician-assisted dying. I don’t want to compete with this disease — that’s not what I want to do with the rest of my life,’” she wrote. “I sat with her and my sadness and then, over the next few days, we set upon the logistics to put her right-to-choose into motion.”
While her oncologist thought there was a possibility that the cancer could go into remission, Shapiro wasn’t sure if she could endure more treatment. Then she spoke with a doctor from the physician-assisted dying group, who described how the process works. He noted that many people request the drugs but don’t ultimately go through with it. Handley felt impressed by how all three doctors acted when advising her mother.
“I don’t think that (the doctors’ input) affected her decision,” Handley said. “But it was also much better that she heard them and witnessed them doing their work and felt like she was part of the narrative, not outside of it.”
Shapiro loved nature and the forest. As a young woman, she spent her summers at Yosemite and lived in the Sierra Nevada mountains until age made a remote living situation a little tougher. She had a garden with plants from the forest and an ornery cat name, Darcy, named after Mr. Darcy from “Pride and Prejudice.” While she was sick, she worried about his well-being. Making the decision for physician-assisted death put her mind at ease about what would happen to her pet, her plants and her life. This allowed Shapiro to say goodbye to her family the way she wanted, watching nature shows and cat videos, enjoying one another’s company.
“We were lucky to know it was coming and to be able to say let’s have these moments together,” Handley said.
Handley and her brother sat with their mother, with Darcy on her lap. As Handley read the poem, “Evening” by Rainer Maria Rilke, her mom passed away.
“It was a really powerful experience to be able to sit with someone who is making this choice,” Handley said. “That was a good experience for us to share.”
Handley said she wrote the essay because she felt there were so few personal stories about what physician-assisted death is really like. She also hoped that by sharing the experience her three children would also better understand her mom’s choice and experience.
“I wanted to write down what happened with my mom’s decision-making so that they would understand,” she said. “I thought this was just adding a little more real personal experience of what (physician-assisted death) looks like in one given situation.”
Demonstrating grief through wailing and song has long been a historic, sacred part of honouring and remembering the dead. From the Chinese to the Assyrians, Irish and Ancient Greeks, oral rituals of outward mourning were a responsibility that fell (and continue to fall) to women.
In Ancient Greece, while women may have lacked political and social freedom, the realm of mourning belonged to them. Their role in remembering the dead granted them their only position of power in a society where they possessed no autonomy. Yet this power was also believed to supersede mortal constraints, giving women the ability to do something that men could not.
The Greek funeral was composed of three parts: the prothesis, or preparation and laying out of the body; the ekphora, or transportation to the place of burial; and the burial of the body or the entombment of cremated remains. It was during the prothesis that the women began their ritual of lament. First, they cleansed the corpse, anointed it and decorated it with aromatic garlands as it lay atop its kline (bier). Once the body was prepared, scores of female relatives gathered around it to beat their breasts and tear the hair from their scalps as they sang funeral songs. They wished to communicate the awful weight of their grief in order to satisfy the dead, whom they believed could hear and judge their cries. In contrast, the men kept their distance to salute the dead, physically signifying their separation from the realm that belonged to women. Some art from the Geometric period suggests they may have joined the female mourners in writhing to the lament, though they were spared from the excruciating gesture of ripping out their hair.
The funeral song served as an extension of the physical pain women inflicted upon themselves during the prothesis. Its purpose was to communicate a cry of uncontrollable pain, a hysteric melody that was believed to be rooted in feminine emotions; thus, only women could be the vessels for this pain. In the depths of their sorrow and self-torture, female mourners in the Geometric period would have sung a melody from one of the four major funeral song categories: threnos, epikedeion, ialemos or goos. These songs were personal and meaningful to the bereaved. In her book Aspects of Death in Early Greek Art and Poetry (1979), which, through the art they have left behind, analyses how the Ancient Greeks viewed death, Emily Vermeule writes that goos was the most intense kind of funeral song. It might have been reserved for lovers or close family members, as its theme was centred on the relationship between two lives shared, the one now lost.
Leading the funeral lament was the song leader, also called the eksarkhos gooio, or the chief mourner. In early times, she was a professional mourner, but could also be the mother or close female relative of the dead. The song leader served as the liaison between those who mourned and those who had passed, guiding the bereaved through the proper course of remembrance in order to mollify the dead. As she led the female mourners in lament, she was careful to cradle the head of the corpse. Touch was necessary in order to open the ears of the dead. But once the ears were opened, the living women had to tread carefully. Not only could the dead hear funeral laments sung for them during the prothesis, they could also determine whether the presence of the living was good or malevolent. This is the reason, writes Robert Garland in The Greek Way of Death (1985), that Odysseus is advised against participating in Ajax’s funeral. Mourners entrusted their song leader with the responsibility of appeasing the dead to ensure their smooth transition into the spirit world.
As time went on, the role of female song leader would serve as the predecessor to an occult offshoot, the goes, who used song as a vehicle to transcend mortal constraints. Under the goes, funeral songs were no longer songs: they were spells, used to lure the dead back to earth. The goes was akin to a witch, due to her supernatural powers; she had even mastered the art of necromancy and could temporarily bring corpses back to life. Yet, even before the goes and the eksarkhos gooio, women in Ancient Greece had ties to the occult side of death. If the eksarkhos gooio was the mother of this occult tradition and the goes the maiden, the egkhystristriai was the crone. Before the classical period, the egkhystristriai was believed to have officiated at the burial of the body. Like an occult high priestess, her powers stemmed from the ritual of making blood sacrifices to the dead. Later, these sacrifices turned into the more modest ritual of offering libations, exemplified as Antigone pours offerings over her brother Polyneikes after she performs rites over his body.
By the fifth century BC mourning rituals had become less elaborate and deliberately reduced the importance of the female role. The number of female lamenters who surrounded the dead dwindled from scores of close relatives to only a few. Laments became more antiphonal and grew to involve men. Gestures such as tearing the hair were replaced by the symbolic gesture of cutting the hair short. These later changes suggest that the Greeks believed their dead were in less need of appeasement, eradicating the need for a song leader with supernatural inclinations. But they attempted to diminish the role that women had in the death process, thus dismantling a space in which women held dominance. In the classical period, women were relegated to the background of the funerary ritual, writes Maria Serena Mirto in Death in the Greek World (2012), because men feared it would threaten social cohesion and their desire for death to be pro patria, for one’s country. This is evident from Greek state funeral records, such as that in Kerameikos, the Athens cemetery, in which female lamenters are only briefly mentioned, suddenly peripheral to the ritual they had previously orchestrated.
The trend of removing women from the centre of death is not exclusive to Ancient Greece. While some cultures, such as the Assyrians, fought to preserve the role of female lamenters, others have been unable to do so.As Richard Fitzpatrick reported in the Irish Examiner in 2016, in Ireland, the tradition of female keeners, who wail in grief, began to die out in the mid-20th century. In the United States, male funeral directors replaced the long-standing tradition of female layers-out. Women were left behind, as the funeral directors attempted and succeeded at monetising the death industry, a legacy that continues to haunt the recently bereaved, who must deal with costly funeral arrangements.
Today, however, we find ourselves in the midst of a death renaissance, spearheaded by morticians, activists and artisans alike – a majority of whom are women. Ancient mourning rituals and traditions are resurging. Perhaps the role of the female song leader as a spiritual caster of spells will find its way back, too.
Arun Shourie is an unflinching seeker. He has an exemplary ability to face the toughest questions. After a bracing meditation on the problem of suffering in Does He Know a Mother’s Heart (2011), Shourie now turns to Preparing for Death. There used to be a joke that the purpose of literature is to prepare you for the good life, while the purpose of philosophy is to prepare you for the good death. But it is hard to understand our own extinction. Broadly speaking, two diametrically opposite views are invoked to reconcile us to death. One is that we don’t really die; in some form, through an incorporeal soul or something, we continue to exist. The other unflinchingly accepts that we just are evanescent matter and nothing else. Both approaches address the question of dying by simply saying “there is nothing to it.” There is something to this strategy, but it cannot make sense of the significance of life. It seems we can either make sense of life or of death, but not of both.
Shourie’s book takes a brilliantly different pathway. The book has three distinct themes. The first, the most powerful and meditative section of the book is not so much about death as the process of dying. He documents with detail, “great souls” experiencing the often painful dissolution of their own body — the Buddha, Ramkrishna Paramhansa, Ramana Maharshi, Mahatma Gandhi, and Vinoba Bhave, and, as a cameo, Kasturba. All of them give lie to Sigmund Freud’s dictum that no one can contemplate their own death. But what emerges from these accounts is not so much the conclusion that they all faced death unflinchingly; most of them have a premonition. It is also not about capturing the moment where the good death is leaving the world calmly. It is rather what the suffering body does to consciousness, all the memories and hard decisions it forces on us.
But the relationship between the body and consciousness goes in two different directions at once. On the one hand this suffering is productive: consciousness works through this pain. On the other hand, even the most exalted soul does not escape the utter abjection of the body. The most poignant moment in this section is not the calm and plenitude with which these exalted souls face death; it is the moments where even the most powerful souls are reduced to abjection by the constraints of the body. The only one rare occasion where Ramana Maharshi ever loses his cool is in his now utter dependence on others for most basic bodily functions. The problem of dying is not that you cannot ignore the body; it is that the body does not ignore you.
The second theme of the book is to take a sharp scalpel to false comforters of all religions and philosophies that promise the everlasting soul, or the preservation of bodies only to subject them to torment in hell. This metaphysical baggage makes dealing with death harder and is a total distraction. This section is less generous in its interpretive sympathies. The third theme of the book, interspersed in various parts, is about the discipline of dealing with your own body as it is in the process of dying. The book impressively marshals a variety of sources, from the Tibetan Book of the Dead, with its incredible imaginative exercises that make you take in the whole of existence, to Jain sources of Sallekhana, and various meditative techniques to inculcate a certain kind of mindfulness. But mostly one gets the sense that the ultimate preparation for death is simply love, something that can endow the evanescent moment with significance.
But this is a seeker’s book. It is in parts profound probing, honest but not dogmatic. Its immense value comes from the fact that the book is both a book and an anthology on death, with extracts from not just the words of those experiencing the process of dying, but an astonishing range of sources: from Fernando Pessoa to Michel de Montaigne, from yoga to the Tibetan Book of the Dead. For the politically inclined, there is an ambivalently revealing account of the Prime Minister’s visit to Shourie while he was in the ICU. All throughout, the book is laced with judiciously selected poetry: the startling moment where Gandhi recites the Urdu couplet to Manu: Hai baha- e-bagh-e duniya chand roz/ Dekh lo iska tamasha chand roz, a register you might associate more with Guru Dutt than Gandhi. There is a lot of Kabir, of Basho poetry and haikus. One stunning one: Circling higher and higher/At last the hawk pulls its shadow/From the world.
This haiku caught my attention because I happened to be reading a stunning essay by Arindam Chakrabarti at the same time, “Dream, Death and Death Within A Dream”, in Imaginations of Death and the Beyond in India and Europe (2018), a volume edited by Sudhir Kakar and Gunter Blamberger, that reads as a great philosophical complement to this one. That volume has a powerful piece by another brilliant philosopher, Jonardan Ganeri, on illusions of immortality that deals with a source Shourie cites at length: Pessoa. Chakrabarti’s essay ends with the insight of Yoga Vashishtha: To be born is to have been dead once and to be due to die again. Shourie is perhaps right: Can we really unravel what it means for the hawk to pull its shadow from the world? Does the shadow reappear if it flies lower?
A good death is achieved by advocating for, and acting on, what is safest for the pet, what is most meaningful for the caregiver, and what will nourish the veterinary team
By Kathleen Cooney, DVM, CHPV, CCFP
Animal euthanasia has come a long way in the past 15 years. With the increased attention given to the human-animal bond, particularly during COVID; the emotional complexity of animals; and the recent and welcomed focus on veterinary wellness, the importance of a good death has risen to center stage. In forward-thinking veterinary practices, the euthanasia appointment is no longer an unpleasant burden in the day, but rather a rare gem of connectedness and intimacy so many of us look for in our professional lives. It provides teams the chance to slow down, to listen to stories, to take deep breaths in quiet reflection in an otherwise chaotic schedule. Euthanasia, while sad and heartbreaking, can lead to rich personal satisfaction when performed well. When love is at the heart of our work, the veterinary profession finds peace, even when life is lost.
Good euthanasia has evolved past the simple “one step” of giving an injection. It orbits around consistent components such as the right timing, compassionate staff, skillful techniques, and loved ones gathered close. The focus has been shifting to ensure the pet’s last moments are comfortable and peaceful, rather than just getting it over with as soon as possible—quality over quickness, in most cases. When it comes to euthanasia, if it’s worth doing, it’s worth doing right, especially since there are no do-overs.
To understand the scope of the “good death” revolution, we need to explore some key game-changing influences that have brought about the shift. The first worth mentioning is the attention paid by the American Veterinary Medical Association (AVMA) and other governing bodies to euthanasia techniques and animal welfare. Numerous revisions have been made to AVMA’s Guidelines for the Euthanasia of Animals, most recently in 2020. The document highlights the value and significance of proper technique choices and the ethical considerations we all must weigh, regardless of the species in question. Are they perfect? No, but they are extremely well-thought-out and closely match peer-reviewed literature. They will improve as research progresses and as society dictates.
A second influencer then has to be society’s demand on veterinary professionals to deliver a death worthy of the life itself. It is well understood pet owners largely view their animals as family members or loving companions. As evidenced further on in this article, loving pet owners regularly view the euthanasia appointment as a modest funeral. More and more are seeking those special touches that pay added respect for their companion.
As a home-euthanasia specialist, I’ve had many families over the years attend the euthanasia of their pet wearing suits and ties. Even though no one would see them, they dressed up to honor the life and the loss. Jessica Pierce, PhD, bioethicist and purveyor of the good death revolution, advocates for what she refers to as the sixth freedom: the freedom to die a good death. She adds this freedom to the already well-known five freedoms of animal welfare. “A good death is one that is free of unnecessary pain, suffering, and fear; it is peaceful; and it takes place in the presence of compassionate witnesses. It is, above all, a death that is allowed its full meaning.” The euthanasia of a family pet is significant and for many, will be their first experience with death.
A third major influence was/is the recognition by many in the veterinary profession that death needed to be more meaningful. The kind of experience we are talking about here is one that leaves the entire veterinary team feeling they provided the best medicine possible and supported the client throughout. Approximately 20 years ago, a small number of veterinarians and technicians throughout North America found just how enriching full devotion to the euthanasia experience can be. They shifted their appointments to focus on the bond as much as the act of euthanasia itself.
Early adopters had numerous things in common. They:
Took time to preplan and provide highly individualized care
Increased euthanasia appointment times
Offered home services
Provided sedation or anesthesia to all pet patients
Elevated bereavement support
In return for these specialty touches, clients showered them with thank you cards and told other pet owners about the wonderful care they had received. Through eventual collective sharing of their successes in advanced euthanasia work, other veterinary professionals joined in and the modern revolution began. Since 2011, at least seven books have been written focusing entirely on companion animal euthanasia (or contain chapters on the subject), more end-of-life care guidelines are available, and the number of pet bereavement organizations has skyrocketed. Today, there are more and more veterinarians specializing in euthanasia work, many of which offer animal hospice services as well. Animal hospice is a philosophy of care aimed at providing emotional and medical support for the dying pet and caregivers. As of early 2020, the International Association for Animal Hospice and Palliative Care (IAAHPC) touts more than 800 members, a number sure to grow in the coming years.
Have you ever thought about how much really goes into a euthanasia appointment? If you start to explore all the components of a good death experience, it’s no wonder euthanasia appointments are lengthening.
Here is a list of 14 essential components of companion animal euthanasia as developed by the Companion Animal Euthanasia Training Academy (CAETA).* Spelling out “good euthanasia,” each aspires to minimize stress for the pet, provide emotional support for the caregiver, and streamline the actions of the veterinary team.
G: Grief support materials provided
Examples: Printed pet loss guides, books, or direct links to online resources.
O: Outline caregiver and pet preferences
Examples: Talk about what’s important to the caregiver and pet. Match what they need.
O: Offer privacy before and after death
Examples: Make sure a family has time to be alone with their pet if requested.
D: Deliver proper technique
Examples: Always use the most efficient and appropriate technique based on the pet’s health and available supplies.
E: Establish rapport
Examples: Slow down and emotionally connect with the caregiver and pet before proceeding.
U: Use of pre-euthanasia sedation or anesthesia
Examples: Sleep before euthanasia reduces anxiety and pain, and increases technique options.
T: Thorough, complete consent
Examples: Every euthanasia must be properly documented in records.
H: Helpful and compassionate personnel
Examples: Engage staff to assist who are naturally empathetic. The use of a “euthanasia attendant” is strongly encouraged (more about this later).
A: Adequate time
Examples: Slow down, block out enough time to complete all 14 components.
N: Narrate the process
Examples: Describe what each step of the process looks like, being mindful to keep language simple and uncomplicated.
A: Avoid pain and anxiety
Examples: Be gentle when handling the pet, use sedation whenever possible, and go slow to reduce anxiety.
S: Safe space to gather
Examples: Consider using a quiet room in the hospital or performing the euthanasia at home.
I: Inclusion of loved ones
Examples: Talk to caregivers about who should to be there, including other household pets bonded to the one being euthanized.
A: Assistance with body care
Examples: Preplan with families around what’s important to them and carry out their wishes as if the pet were your own.
In addition to veterinarians carrying out the medical act of euthanasia, vital support staff help ensure everything goes well. Empathetic veterinary technicians, veterinary social workers, assistants, receptionists, and grief support personnel work together to ensure the pet is Fear Free and the client is carefully looked after. CAETA advocates for use of what it calls the euthanasia attendant. This person is responsible for guiding the family unit through the appointment from beginning to end. While many people may be involved in the pet’s care, one consistent person increases the likelihood that everything flows smoothly.
If you’ve been watching for change, you’re sure to have noticed the increase in specialty mobile euthanasia services around the world. According to online directory In Home Pet Euthanasia, nearly 600 mobile services have been listed since 2009 as providing home euthanasia services in Canada, the U.S., and England. Nearly 80 percent specialize in euthanasia work or the broader field of animal hospice, including euthanasia services. The shift toward home euthanasia is well-founded and necessary for many families. Pets feel safer at home. And for loving owners, being at home for their pet’s euthanasia provides them privacy and reduces the challenges of driving and interacting with others while in the midst of grief.
Home euthanasia has proven extremely rewarding work for those who offer it. It’s also gaining in popularity, with one service reporting its team of veterinarians assisted upward of 50,000 pets in the home setting in 2019. That’s an impressive number and indicates the trend of home euthanasia is here to stay.
Like any other progressive movement, advanced euthanasia did not happen overnight. And there are lingering obstacles that continue to stifle necessary change. Number one is the old paradigm that if it’s not broke, don’t fix it. It can be hard for veterinary teams to make lasting change around euthanasia. Reshaping a hospital’s culture takes time and commitment, but it can be done and done well.
Consider the following steps to create lasting change:
Dedicate one month a year to euthanasia-related discussions
Get everyone’s input on desired improvements
Create a euthanasia manual and refer to it regularly
Hold euthanasia rounds to review successes/challenges
Have multiple team members obtain advanced euthanasia training
These days, the veterinary profession recognizes the value of appropriate self-care. In this respect, self-care with regard to euthanasia begins long before the appointment. It is becoming standard practice to discuss a veterinary team member’s professional limits around euthanasia. North American Veterinary Community (NAVC) and the Human Animal Bond Research Institute (HABRI) human animal bond certification program focuses on this concept in its euthanasia module. It describes how veterinary teams should take time to determine who enjoys (yes, enjoys) euthanasia work, to write down how many euthanasias one can help in a day, week, etc., and how the team plans to practice self-care. Examples include team outings, fun food days, and setting limits on the amount of time worked in a day. The likelihood of compassion fatigue is high if care is not properly taken from the onset of euthanasia-related work.
As far as we’ve come, there is always room for growth. New techniques, improved euthanasia education opportunities, and better client support tools are on the horizon. We continue to hone our skills around gentle animal handling and pay increased attention to where we gather for euthanasia. This has never been truer than during the COVID pandemic. Veterinary teams have shifted the delivery of care, ensuring euthanasia remains an essential procedure. Creative approaches to preplanning, social distancing, technique selection, and appointment timing have played vital roles in protecting the human-animal bond. The veterinary profession dealt with these necessary modifications swiftly and compassionately. And it’s important to mention that while this article has been focused on euthanasia, death is a process, not always just a moment in time. Good death also refers to the meaningful journey leading up to death, be it natural or via active euthanasia. In the words of Benjamin Franklin, “Well done is better than well said.” To help the good death revolution flourish, we must act accordingly. A good death is achieved by advocating for, and acting on, what is safest for the pet, what is most meaningful for the caregiver, and what will nourish the veterinary team. If you haven’t already, how will you join the revolution?
No, I’m not suffering from a terminal disease (as far as I know). Nor have I been infected with the novel coronavirus that causes covid-19. But thanks mainly to the pandemic I have been motivated to complete about 90 percent of the necessary steps for end-of-life planning. I have taken note of the nearly 202,000 Americans who have died unexpectedly from covid-19 or its complications in the past seven months.
Most of these people, it’s fair to say, were not planning on a sudden death. Many died alone in hospitals, and too often they didn’t have the opportunity to bid loved ones farewell. Caring.com reported that before the pandemic hit, fewer than half those 55 and older had completed estate-planning documents (such as a will, a living will, and designating a medical power of attorney). Among those 18 to 34, it was a paltry 16 percent.
The No. 1 reason for everyone: I haven’t gotten around to it.
Covid-19 has claimed the lives of several people I know in recent months; sadly, they weren’t the only deaths in my personal and aging circle. Barry Owen, 67, a friend and former partner, died of pancreatic cancer in May, a year after being diagnosed. Shortly after being told he had Stage 4 of the disease, he posted on his Caring Bridge site, “To borrow a line from ‘Grass,’ a favorite childhood poem by Carl Sandburg: ‘What place is this? Where are we now?’ ”
That question — “Where are we now?” — resonated for me as the pandemic spread unabated. Who knows when the bell will toll for thee?
Actually, I’m not alone in having jump-started my death planning.
Recently, the New York Times reported on just such a “boom” due to the pandemic. So many questions. Who do I want to act as my medical power of attorney? Why do I need a living will? Do I want to be cremated or not? What songs do I want played at my funeral?
Not surprisingly, there are now new Web services — with checklists — specifically for this kind of planning. One of them, Lantern, whose mission is to be “the single source of guidance for navigating life before and after a death,” reported a more than 120 percent increase in users since the beginning of the pandemic.
With the obituary pages growing ever thicker these days, I’m reminded of the nadir of the HIV epidemic when gay men dropped out of sight only to turn up in a death notice soon after. In 1986, at age 29, I’d been given an AIDS diagnosis, then synonymous with a death sentence. Fortunately, it turned out the doctors had erred in making my diagnosis. But during those weeks when I feared dying, I began to make an end-of-life plan.
I didn’t get far. I got only as far as engaging a lawyer to draw up a will when I learned that my lesion was not Kaposi’s sarcoma, one of the cancers associated with AIDS. No longer facing an untimely death, I put my head back in the sand — which is to say I stopped responding to his emails — and the lawyer actually fired me as an unresponsive client. When I pleaded for one more chance, he gave it to me and I completed my first “Last Will and Testament,” and a living will, too, that detailed what medical treatments I wanted — and would forgo — if I could no longer give consent myself.
In 2006, I added a codicil to that first will when I bought a house with my partner, Jim. Oh, and I designated him as my medical power of attorney, bumping my sister down to the “backup” position.
Still, as I crossed the threshold to 50 and then again to 60, I made no other plans. In 2018, a year after Jim and I legally separated (we’d married in 2013), a new lawyer castigated me for taking no action. By leaving things as they were, my soon-to-be-ex would still inherit my part of our house equity (rather than my siblings) and he’d be making life and death decisions for me in the event I was incapacitated. (Yikes!)
Again, I found myself stuck in denial — over the failed marriage, and that like everyone else I’d die one day, too.
By nature I am a procrastinator, but this pandemic — all those deaths — has forced a new reality on me. In recent months, I’ve taken various steps to make sure I’m ready — or at least “readier” — for what my friend and literary agent Richard Pine likes to call, “The End.”
My will and living will are now updated. (I got rid of all mention of my ex in estate finances or end-of-life decisions.) In our family cemetery plot, I’ve chosen my place, and there are new notes in a manila folder for a memorial service and an obituary, although I’ve not actually written a draft like other really well-prepared friends I know. With a nod to Leona Helmsley and her much-spoiled Maltese, my new puppy will go to previously agreed-on guardians, along with a crate, some kibble and some money to cover future costs.
If anything, like others these days, I’ve come to understand the importance of getting one’s affairs in order. Greg Brock, 67 and a retired journalist, frets about having unfinished business, especially after his sister “dropped dead” a year ago.
“It was a shock, and her children were left with so many headaches with her estate, including no funeral plans,” he said.
Since then Brock has vowed to get his “act together, starting with the end.” He has bought a gravesite and is now ordering the headstone, which he admits “will be weird.” He hopes that looking at his headstone will spur him on “to organize other aspects of my life.” Good luck, friend.
I’m impressed by those I know who have such lofty but wise intentions: To set things in order sooner than later. But “why do today what I can do tomorrow?” has long been one of my favorite mantras.
Well, I’ve now ditched that aphorism, thanks to Marie Kondo, author of the best-selling “The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing.” I’ve gone though much of my stuff — applying her “delight test” — jettisoning and donating shirts and sheets, pots and pans, and bed linens and bandannas. (Although, had I known the pandemic would be still with us, I would have saved all those old bandannas to be used as masks/face coverings.)
The pandemic has also prompted me to say things I might not otherwise have. I’ve been making it a point to acknowledge those whom I love in a forthright manner, which has brought about reciprocal responses.
At the outset of the pandemic, I emailed Barry Owen a short note; at the time he appeared to be holding steady. I reminded him of our mutual friend, Denise Kessler, and explained that about the time she turned 90, we both “began ending all of our conversations with “I love you.” She and I continued that ritual until two weeks before she died at age 98, I wrote Barry, ending with the same message to him, “I love you.”
In his reply, he updated me on his condition. “No news is good news, which is to say, I’m still here.” He explained that he and Dan, his husband, “speak frankly with each other about death and what is it called? Oh yeah, end-of-life planning. But we don’t dwell on my condition or the future. We live our shared lives as normally as possible.”
And then he signed the email, “Love, Barry.”
In his final weeks, Barry completed the necessary to-dos in preparation of his death, his husband told me. And then he died, a year after his diagnosis, and a week after his first wedding anniversary.
By the time of his death, three months into the pandemic, I had finished my own death planning. I am prepared — but not ready to go.
Where to get help online
For those who need help getting started, here are some resources:
●Lantern (lantern.co) is a free website with checklists and articles about end-of-life preparations.
Everplans (everplans.com) is a subscription-based online product for creating, organizing and storing your end-of-life plan.
The Conversation Project (theconversationproject.org) is a website focused on helping people talk about their wishes for end-of-life care.