Preparing for the death of a loved one is difficult no matter the circumstances.
But Annalisia Wilharm said she never expected a doctor would deliver the bad news about her grandfather via a video screen on a robot.
Wilharm was sitting by her grandfather’s bedside in the ICU of the Kaiser Permanente Medical Center in Fremont, California, last Monday night when the machine rolled into their room and a doctor, appearing via live video link, offered his grim prognosis. Her grandfather Ernest Quintana, 78, died the next day.
“I think they should have had more dignity and treated him better than they did,” Wilharm told CNN. “No granddaughter, no family member should have to go through what I just did with him.”
Wilharm told CNN her family knew that her grandfather would die soon. But they’re angered by the way the situation was handled and how the news was delivered. She said she and her family hope no one else receives the same treatment.
Ernest Quintana died after being told by a doctor who visited him via robot that there were no more treatment options left.
“I was so scared for him and disappointed with the delivery,” Wilharm said, choking up. “And I could tell by the look on his face what that did to him.”
A spokeswoman for the hospital offered “sincere condolences to the family” in a statement sent to CNN.
“We take this very seriously and have reached out to the family to discuss their concerns,” said Michelle Gaskill-Hames, a senior vice president and area manager of Kaiser Permanente Greater Southern Alameda County.
“Our physicians and nurses were in regular, in-person communication with the patient and family about his condition from the moment he entered our hospital,” she added. “The evening video tele-visit was a follow-up to earlier physician visits — it did not replace previous conversations with patient and family members and was not used in the delivery of the initial diagnosis.”
For years, Quintana had lived with chronic obstructive pulmonary disease, a progressive lung disease that make makes it hard to breathe. It includes emphysema and chronic bronchitis.
Last Monday, doctors at the hospital conducted tests to assess the state of Quintana’s lungs. That evening, Wilharm told her mother and grandmother — Quintana’s wife of 58 years — that the pair should go home and get some rest.
Soon after a robot with a video screen came into the room, accompanied by a nurse who remained silent. A doctor on the screen began speaking to them.
Wilharm said she had no idea who the doctor was or where he was located.
She filmed the interaction on her phone as the doctor relayed the results of her grandfather’s tests.
In the footage viewed by CNN, the doctor on the screen tells Quintana, “Unfortunately there’s nothing we can treat very effectively.”
The doctor explains they can give Quintana morphine to make him more comfortable, but that would make breathing more difficult.
Wilharm then tells her grandfather the doctor is recommending hospice care at home.
“You know, I don’t know if he’s going to get home,” the doctor says, adding that the best treatment plan at that point was to begin focusing on Quintana’s comfort.
Wilharm told CNN that at that point she had to call her mother and grandmother so they could get back to the hospital.
“It didn’t matter (to the hospital) that his wife of 58 years wasn’t there for that,” she said.
Wilharm told CNN that her family was under no illusions about her grandfather’s condition.
“We knew that we were going to lose him,” Wilharm told CNN in a phone interview Saturday. “Our point is the delivery (of the news). There was no compassion.”
When her grandmother returned to the hospital, she asked the nurses about the robot. According to Wilharm, they explained the hospital was small and the robot was used to make rounds at night.
Gaskill-Hames, the hospital spokeswoman, said the health care provider is “continuously learning how best to integrate technology into patient interactions.”
“In every aspect of our care, and especially when communicating difficult information, we do so with compassion in a personal manner,” she said, adding that the term “robot” is “inaccurate and inappropriate.”
“This secure video technology is a live conversation with a physician using tele-video technology, and always with a nurse or other physician in the room to explain the purpose and function of the technology,” Gaskill-Hames added. It “allows a small hospital to have additional specialists such as a board-certified critical care physician available 24/7, enhancing the care provided and bringing additional consultative expertise to the bedside.”
Wilharm told CNN that a doctor had visited Quintana in person earlier in the day.
Wilharm said the in-person doctor was “very sweet” and held her grandfather’s hand as she spoke with him about hospice care and his options.
Gaskill-Hames said the hospital does not encourage the use of technology to replace personal interactions between patients and health care workers.
“We understand how important this is for all concerned, and regret that we fell short of the family’s expectations,” she said.
Wilharm agrees.
“That was one of the worst days of my life,” she said.
Dr. Steve Hadland learned over time to appreciate the “majesty and mystery” of death.
By Ellen Shehadeh
Dr. Steve Hadland began his medical career as an emergency room physician, fixing people and saving lives at all costs. These days he treasures his work as a hospice physician associated with Hospice of Petaluma, tending to the terminally ill and allowing them to die in comfort. Two extremes, one might say, but understandable given the intervening events in his life.
Steve’s practice melds a deep belief in social justice, reverence for life in all forms and enduring, self-described conservative views about end-of-life practices. His youthful face and genial manner, combined with an easy laugh and a soothing voice, belie the depth of his thinking, intellect and perceptions. He is informed not only by medical writings but also by psychology, literature, philosophy and classical music. One feels both calm and welcome in his presence.
Steve was the youngest in a conservative family growing up in Chicago. He attended university in Iowa City, studying astrophysics as a stepping stone to an astronaut program, and later majored in neuroscience. “University was a political and social awakening, as well as an intellectual one,” he says. He participated in marches and protests against the Vietnam War and for civil rights.
He longed to break out even further from his roots, however, and what better place than California, where “legend loomed for surfing and blondes.” He never quite managed the surfing thing, but wasted no time marrying his first wife, a blonde, during the summer of love, which coincided with his first year at Stanford Medical School. Their marriage of seven years included major involvements in the civil rights, anti-war and human potential movements.
All along, he had thoughts and profound feelings about end-of-life experiences, in part influenced by a Tolstoy novella, “The Death of Ivan Ilyich,” which he read in a death and dying course at Stanford. “It inspired me then, and continues to inspire me, year after year,” he says of the book, which he recommends “to anyone who really wants to know about what it’s like to die.”
Steve’s first job out of medical school, in 1972, was in a Kaiser emergency room. The nurses recognized his empathic nature and would steer the most difficult patients his way. Yet he recoiled at the Herculean efforts by staff to revive a dying patient, “all the excitement, the IVs,” and how quickly and “disrespectfully” staff abandoned a corpse when resuscitation efforts failed. At the time, there was no such thing as “do not resuscitate” or hospice.
Steve sought a different kind of medical experience and, in the fall of 1974, he arranged an interview with Dr. Michael Whitt in Point Reyes Station. He remembered the area from a drive many years before; “It cast a spell on me,” he says. Dr. Whitt’s liberal medical practice included home births, which at the time were popular in alternative communities, but Steve was stunned that he would deliver babies without liability insurance.
Steve’s conservative orientation and lack of maturity led him to decline a job offer by Dr. Whitt but, many years later, he would run a small integrative medical practice and pain management clinic out of his Point Reyes Station home. Ironically, he never secured liability insurance. “The influence of West Marin,” he quips.
Newly divorced in 1978, Steve encountered a single mother of three from Holland who was working as a Kaiser receptionist to pay her way through nursing school. They married two years later and, after 38 years, “it looks like it’s going the distance,” he says, laughing. Anneke van der Veen became an emergency room nurse, but they never worked together professionally, realizing the potential pitfalls of mixing business with pleasure.
Steve had traveled to England in 1978 to visit the first modern hospice. Although he was impressed with the approach, “I could tell I wasn’t ready for it,” he says. It was 12 years later that he helped start a hospice in Santa Clara, which he ran for five years along with an oncologist friend. He explains: “The world said, ‘You seem to be ready.’”
As society’s views about death and dying dramatically changed over the years, so clearly have Steve’s. Fifty years ago, death was a taboo subject and doctors rarely broached it with their terminal patients or even gave them an honest diagnosis. Now people take advantage of many choices, like refusing to eat and drink or using lethal medications now sanctioned by law. In California, the End of Life Option Act allows a patient to self-administer a lethal cocktail, but only after being judged by two physicians to be of sound mind and six months from death.
Some people object to the strictness of this law, which does not allow someone to assist in a patient’s suicide if the patient is physically or mentally unable to self-administer, even if it had been the patient’s expressed wish. In some states such assistance could be considered euthanasia or even murder.
Steve agrees with this self-described conservative view. “I don’t think it’s a bad thing; we don’t know what’s going on [inside their head]” or what kind of life these patients, some with Alzheimer’s and dementia, might have that we cannot fathom, he says. Surprisingly for a hospice worker, he was still opposed to the law when it was passed in July 2017, because “it’s a slippery slope.” How slippery? He cites a law in the Netherlands that now allows not only terminally ill patients but also depressed people to legally receive the fatal cocktail.
Steve explained that under California law, doctors may not legally list the cause of death as suicide when a patient has taken his or her own life. But the law “does allow a reference to the use of aid-in-dying meds as a contributing factor in the death, including the underlying fatal illness.” Steve, as a personal practice, does not include aid-in-dying medicines on the death certificate “to protect the patient from any backlash involving the choice of an induced death.”
Today Steve appreciates what he calls the “majesty and mystery” of death. Along with survivors, he participates in ancient rituals—“beautiful ceremonies” like washing and dressing the body—and finds it deeply humbling.
Steve is a spiritual man. He is influenced by the teachings of Jean Klein, a European who had an awakening in India. Although it is difficult to summarize Klein’s ideas, one important teaching is, “I am not identical with my thought process.” Steve believes that most of what one knows can be understood through other means, “coming from the heart and a sense of pure being.” This understanding has given him confidence to communicate with a dying person without words. “There is something in me that I know will make a difference. I am not anxious or worried, and am not in my head,” he explains.
About society’s recent openness to discussing death and dying, Steve cannot be more positive. It used to be, “If I don’t talk about it, it won’t happen.” The effect of the hospice movement has been to “lift the lid about frank, open discussions about death and dying. It helps people plan and frees them from living in a false reality, or a web of lies,” he says.
Naturally, one so intimate with death has opinions and thoughts about what awaits us all in the end. And what is the best death, to go quickly or to linger for a while? Not surprisingly, Steve believes that for himself, the ideal death would be when you know it is coming. “You get to finish your life, and say your goodbyes,” he says.
Steve also believes in a “continuity of consciousness.” This idea came to him intuitively years ago, after the death of his beloved dog, Misha, whose picture is prominently displayed on his office wall among other family photos. He tells this story, choking back tears.
“As I stood over the grave, I called out loud, ‘Where have you gone?’
A small voice inside asked, ‘Did you love me?’
‘Yes.’ ‘Do you still love me?’
‘Yes.’
‘Then that’s where I am.’”
Steve says, “My co-workers, patients and families living with the experience of dying have taught me much of what I know about love. Not the romantic love, of course, but something more encompassing, a feeling of compassion and connection with others that grows into this deep feeling of commonality and love.”
From the peaks of the Blue Ridge and the Great Smoky Mountains, to the river valleys of the French Broad and Catawba, North Carolina has a long history that is steeped in rich Appalachian traditions. Despite the Hollywood “hillbilly” stereotype, Appalachians carry a sense of pride for their culture, language, and heritage.
Isolated from the outside world, Appalachian regions have long struggled with rough rocky terrain for farming and plagued with poverty. Immigrants from Europe began migrating to the area in the 18th century with a large proportion of the population being Ulster Scots and Scotch-Irish. Many pioneers moved into areas largely separated from civilization by high mountain ridges and our pioneer ancestors were rugged, self-sufficient and brought many traditions from the Celtic Old World that is still a part of Appalachian culture today.
If you grew up Appalachian, you usually had a family relative who was gifted and could foresee approaching death, omens or dreams of things to come.
There was always a granny witch to call on when someone was sick and needed special magic for healing. Superstitions about death were common and were considered God’s will. One thing for sure, no matter how hard you fought it, death always won.
Appalachian folks are no stranger to death. For the Dark Horseman visited so frequently, houses were made with two front doors. One door was used for happy visits and the other door, known as the funeral door, would open into the deathwatch room for sitting up with the dead. Prior to the commercialization of the funeral industry, funeral homes and public cemeteries were virtually nonexistent in the early days of the Appalachian settlers.
For Whom the Bell Tolls…
In small Appalachian villages, the local church bell would toll to alert others a death has occurred. Depending on the age of the deceased, the church bell would chime once for every year of their life they had lived on this earth. Family and friends quickly stop what they were doing and gather at the deceased family’s homestead to comfort loved ones. Women in the community would bring food as the immediate family would make funeral preparations for burial. The men would leave their fields to meet together and dig a hole for the grave and the local carpenter would build a coffin based on the deceased loved one’s body measurements.
Due to the rocky terrain, sometimes dynamite was used to clear enough rock for the body to be buried. Coffins used to be made from trunks of trees called “tree coffins”. Over time, pine boxes replaced the tree coffins. They were lined with cloth usually made from cotton, linen or silk and the outside of the coffin was covered in black material. If a person died in the winter, the ground would be too frozen to dig a grave. In this case, the dead would simply be placed in a protected area outdoors until spring.
After the bell tolls, every mirror in the home would be draped with dark cloth and curtains would be closed. It was believed that by covering the mirror, a returning spirit could not use the looking glass as a portal and would cross over into their new life. The swinging hands on the clock were stopped not only to record the time of death, but it was believed that when a person died, time stood still for them.
Preparing the Body
Before the use of embalming, the burial would be the next day since there were no means of preserving the body. To prepare the body, the deceased would be “laid out” and remained in the home until burial. The body would be placed on a cooling board or “laying out” board. Depending on the family, the “laying out” board might be a door taken off the hinges, a table, ironing board or piece of lumber. Many families had a specific board for the purpose of laying out the body that had been passed down from generations.
The “laying out” board would then be placed on two chairs or sawhorses so the body could be stretched out straight. Depending on what position the person was in when they died, sometimes it was necessary to break bones or soak parts of the body in warm water to get the corpse flat on the board. As rigor mortis began to set in, some folks have actually heard bones cracking and breaking which would cause the corpse to move as it began to stiffen. The board would then be covered with a sheet and a rope was used to tie the body down to keep it straight and to prevent it from suddenly jerking upright.
Post-mortem picture of the body placed on a cooling board or “laying out” board.
Scottish traditions used the process of saining which is a practice of blessing and protecting the body. Saining was performed by the oldest woman in the family. The family member would light a candle and wave it over the corpse three times. Three handfuls of salt were put into a wooden bowl and placed on the body’s chest to prevent the corpse from rising unexpectedly.
Once the body was laid out, their arms were folded across the chest and legs brought together and tied near the feet. A handkerchief was tied under the chin and over the head to keep the corpse’s mouth from opening. To prevent discoloration of the skin, a towel was soaked in soda water and placed over the face until time for viewing. Aspirin and water were also used sometimes to prevent the dead from darkening. If the loved one died with their eyes open, weights or coins were placed over the eyes to close them.
Silver coins or 50 cent pieces were used instead of pennies because the copper would turn the skin green. Once the corpse was in place, the body would then be washed with warm soap and water. Then family members would dress the loved one in their best attire which was usually already picked out by the person before they passed. The body of the dead is never left alone until it was time to take the deceased for burial.
Sitting Up With the Dead
After the body has been prepared, the body is placed in the handmade coffin for viewing and placed in the parlor or funeral room. The custom of “sitting up with the dead” is also called a “Wake”. Most times a handmade quilt would be placed over the body along with flowers and herbs. The ritual of sending flowers to a funeral came from this very old tradition. The aroma from the profusion of flowers around the deceased helped mask the odor of decomposition.
Flowers as a form of grave decoration were not widely used in the United States until after the mid-nineteenth century. In the Southern Appalachians, traditional grave decorations included personal effects, toys, and other items such as shells, rocks, and pottery sherds. Bunches of wildflowers and weeds, homemade plant or vegetable wreaths, and crepe paper flowers gradually attained popularity later in the nineteenth century. Placing formal flower arrangements on graves was gradually incorporated into traditional decoration day events in the twentieth century.
Family members “Sitting Up” with the dead in the parlor or funeral room.
The day after the Wake, the body would be loaded into a wagon and taken to the church for the funeral service. Family and friends walked behind the wagon all dressed in black. The church bell would toll until the casket was brought into the church. This would be the last viewing as friends and family walked past the casket to take a final look at the body. Some would place a variety of objects in the coffin such as jewelry, tobacco, pipes, toys, a bible and every once in an alcoholic beverage.
Today, a strong sense of community continues to dominate Appalachian burial customs even though the modern funeral industry has changed the customs slightly. The social dimension has changed completely since caskets are commercially produced and graves are seldom dug by hand. Modern funeral homes have made the task of burial more convenient but the downside is there is less personal involvement. Personalized care for the dead is an important aspect of family and community life in Appalachia. And we can certainly say for sure that the days of conducting the entire procedure necessary to bury a person, all done by caring neighbors, with no charge involved, are no longer practiced.
From DIY funeral services to death doulas, B.C. is on the leading edge of a trend that wants to make death a part of life, and a better experience for everyone. Meet the women leading the trend.
There may be no table more full of life than the corner booth at Paul’s Omelettery on Granville Street, where a group of women are talking over breakfast about death.
Three of the women are licensed funeral directors, two specialize in end-of-life planning, one is a celebrant, another an apprentice death doula — someone who assists families before and after death, the way a midwife does with a birth.
They call themselves the D’Posse.
The name is a playful nod to the word “death,” but their aim is thoughtful and resolute: to transform the way we commemorate and bury our dead, to bring death back to life.
Glenn Hodges, manager of Vancouver’s Mountain View Cemetery, has dubbed them “the disruptors” — part of what he says is a growing number of end-of-life workers, many of them women, who are quietly, respectfully, and often joyfully, working to take death out of the hands of the corporate monopolies, and give it back to families.
Although many funeral homes in B.C. still bear the names of the families that originally established them, many of these are owned by Service Corporation International, a conglomerate headquartered in Texas. SCI owns 45 funeral homes in B.C., about a third of the funeral service providers in the province. (SCI, which trades on the New York Stock Exchange, has repeatedly tangled with consumer advocates over everything from its pricing to sales techniques.)
Funeral director Ngaio Davis spent 20 years working for a number of providers in the corporate funeral industry before breaking away to start Koru Cremation, Burial and Ceremony (korucremation.com), which she runs out of a cheerful space on Kent Avenue in Vancouver.
Like the other women at this monthly breakfast, Davis says she was drawn to the funeral industry because she wanted meaningful work. “I wanted to do something that felt worthwhile,” says Davis.
Coming face to face with death never made Davis uneasy — but the funeral industry did.
“There are a lot of wonderful, compassionate people in the corporate funeral homes,” says Davis. What bothered her, she says, was the focus on profit: “What’s the bottom line?”
Davis says one funeral home she worked for stipulated that commissioned sales staff be in every meeting with grief-stricken clients to have the “face time” to push extras. At another job interview, she was grilled on what her average sales “per call” were — this was not the work she wanted to be doing.
Lisa Hartley is a ‘celebrant’ who officiates at weddings as well as funerals.
‘What can I help you do?’
Despite decades of scrutiny, the North American funeral industry has changed little since Jessica Mitford’s 1963 expose, The American Way of Death, in which she called the funeral industry a “huge, macabre, and expensive practical joke on the American public.”
A big part of that macabre joke is the cost.
The average traditional funeral in Canada costs $10,000, according to Stephen Garrett of the Memorial Society of B.C., and GoFundMe counts funerals among its fastest-growing fundraising categories.
“From a basic cremation at about $1,200, costs range up to $15,000 or $20,000 — which is fine if it’s in line with your budget. But that’s where we get into problems with funeral homes pushing that on people,” said Garrett.
In addition to basics, such as registration of death, transportation, sheltering and disposition of the remains, costs — and funeral home profits — skyrocket once the bells and whistles are added: the expensive casket, which may be incinerated days later, embalming (not a legal necessity in B.C.), makeup, hairdressing, flowers, grief counselling, memorial, and follow-up house calls to sell products, such as future burial services, to survivors.
Five years ago, Davis decided to do something different.
Davis says her approach to death is informed by her Maori heritage. “Maori practices around death and dying are very strong. You are with your dead. You don’t just let them be taken away and be controlled by others. The family is the one who is crafting and planning what happens, and what will be the final ceremony.”
At Koru, the reception room is simply decorated with none of the trappings of a traditional funeral home: no sombre music, heavy curtains, or staff in dark suits.
Clients can plan as elaborate or as simple a funeral, ceremony and cremation or burial as they wish. Koru also specializes in green burials — biodegradable casket or a simple shroud, and no embalming — and will facilitate DIY, family-led or “home funerals.”
“This week, I’m looking after a family that wants to take their father and husband back home to his condo in North Vancouver. They want to have him there, they want to give him a sponge bath, dress him, and let him spend his last night there with his wife,” Davis explains.
Davis will transport the man and bring a special table so he can be laid out in his own home. “We will move him onto the table so it’s more comfortable for them to bathe him and dress him,” said Davis.
The next day, Davis will return with the casket, which will be placed in the condo’s common room because it won’t fit in the elevator.
“They are lining the casket with sheep wool that one of the kids brought from Scotland, and then we will go to the cemetery,” said Davis.
“His wife knows what she wants. They’ve been married for 60-plus years — they want those last moments together.”
At Paul’s Omelettery, over the warm clatter of breakfast dishes, cups and spoons, Lisa Hartley, a celebrant who officiates at weddings as well as funerals, recalls meeting Davis when her father-in-law died unexpectedly in his West End apartment.
His death had come quickly and the family was unprepared.
“We didn’t know what to do. Someone said, ‘Call Ngaio,’” says Hartley. “Her first question to us was, ‘What can I help you do?’”
They didn’t have to go to a funeral home, something Hartley was uncomfortable with.
“Ngaio came over to the apartment, and sat on the sunny balcony with her checklist, and we went through all the options.”
The family chose to keep Hartley’s father-in-law at home for a short period, and her husband decided he wanted to participate in the washing of his father’s body. “I never expected him to do something like that,” says Hartley. “But it really helped him.”
While the family gathered in the apartment, Davis completed the preparations.
“When she had him ready, she wrapped his body in a beautiful red velvet cloth, but she came to us first and said, ‘Peter is ready to go now.’”
Hartley was deeply moved by the experience, and now works closely with Davis and other alternative providers as a funeral celebrant. “My special interest is in sustainability in death care,” says Hartley. That means being more hands-on, in DIY and home funerals.
Hartley’s ceremony design process includes in-depth meetings with the client and family and friends to talk about the person. “It’s quite beautiful, and it’s often the start of the healing process. People get to tell stories about the person that has died. I recently had one person who said, ‘I feel better already,’” says Hartley.
Jennifer Mallmes is a death doula who founded the End-of-Life Doula program at Douglas College.
When death is expected, a death doula can help the family prepare for what Jennifer Mallmes, founder of the End-of-Life Doula program at Douglas College, calls “a gold-star death.”
“Planning really does help with the death and bereavement process, even when people don’t want to die,” said Mallmes. “Barring sudden or unexpected deaths, you can have some choice in how you go. Who do you want around? Who do you not want around?”
A death doula will help individuals and families faced with an illness or a diagnosis that a death is coming plan home care or hospice care, work with funeral services. They can also help with making what life is left fulfilling: “We can help with a life review, ask what are the things I still want to do? We might look at services to help them accomplish those things.”
Death isn’t just a business, it’s a way of life
Garrett said that although the funeral business is slow to change, Baby Boomers are pushing the trend toward the “reclamation” of death and dying.
“The Boomers demographic changed the world they lived in — they questioned authority, lived through the Summer of Love, built the environmental movement,” says Garrett. “We’re on our way out, and that’s going to change things, if only because of the large numbers.”
About 34,000 to 35,000 people a year die in B.C. “That death rate in the next 10 to 12 years is going to head north of 45,000,” says Garrett. “We’ve got 916,000 Baby Boomers living in British Columbia with only one way off the planet.”
Glen Hodges is the manager at Mountain View Cemetery in Vancouver.
Although Statistics Canada doesn’t keep numbers on the kinds of funerals people hold, Glen Hodges says he has seen changes in people’s attitude toward death. Part of that has been the renaissance of the city’s only cemetery.
Mountain View shut down briefly after running out of grave space in 1986, but a new master plan created more space. Mountain View built columbaria (condos for cremains) to house niches for cremated remains, and reclaimed unused graves from families — a complex and provincially regulated process that applied to plots purchased at least 50 years ago and never used by family members in that time.
Hodges says the city has also been working to re-establish the cemetery as a place for the living.
“A cemetery is not just a utilitarian place for disposal of the dead and keeping of public records,” said Hodges. “(It is also) a sacred place to remember and commemorate, and it has a larger role within the community.”
That includes family oriented community events, such as its annual All Souls Night, which draws up to 2,000 people.
“We invite people to wander into the cemetery to light candles and leave mementos for their loved ones and be in a contemplative atmosphere filled with candles and music and in a place that is safe for them to speak of the dead and talk with others.”
Mountain View doesn’t require grave liners, so green burials are possible, as well as reburials, an option that allows families to open the grave and reposition any remains still there so a new casket can be added.
Hodges regularly hosts free workshops hosted by D’Posse members Reena Lazar and Michelle Pante of Willow EOL (end of life).
The workshops, says Pante, are designed to help people figure out how embracing their mortality can change the way they live. “Our lives are limited, they are precious and finite, so we ask how does that fact affect how we live?” said Lazar.
The workshops help people explore their thoughts and feelings about death and guide them through the process of creating what Pante calls “heart wills,” or love letters for the family and friends who will survive them.
Their clientele ranges through all age groups, says Pante, although many are healthy and in the Boomer demographic.
Boomers may be fuelling the trend toward a more compassionate, affordable, personalized experience after their final exits, but for Davis and her growing network, death isn’t just a business — it’s a way of life.
Many find their way to Koru after a negative experience elsewhere, says Davis — whether it was sales pressure that shamed them into overspending, a service that didn’t reflect their loved one’s personality, or a makeup job that made them look like a stranger.
“Here was this very important moment in their lives, and they were robbed of it. It could be a special time, or it could be something you never want to go through again. So I’m just doing my little bit to change that.”
Stephen Garrett, seen here at Mountain View Cemetery in Vancouver, is the executive-director of the Memorial Society of British Columbia.
The Planner
Stephen Garrett, executive director of the Memorial Society of B.C., a non-profit society serving 240,000 members, believes that much of the expense and discomfort families inherit when a loved one dies can be avoided with good planning. To help people making final arrangements, Garrett has designed the “All Ready To Go Binder” to help with the death planning process.
“When my sons were 21 and 23, I invited them over for beer and pizza. I had the death binder in the middle of the table,” said Garrett. “They were a bit shocked — they didn’t want to think about me being dead and I didn’t want to think about it either — but as a responsible parent, this was my gift to them.”
The mood changed as he went through his wishes and let them know that he would be throwing in a family holiday: an all-expenses-paid trip to India, where he wants his ashes to be sprinkled in the Ganges River. Making a plan that’s personal, that includes opportunity for meaning, is part of what can make the process fun, said Garrett.
The binder is available on the society’s website for a nominal fee, and Garrett would like to see every family in B.C. have one.
The All Ready to Go Binder is a place for everything from your last will and testament, to advanced care directives, funeral arrangement forms, and other details such as people to call, copies of personal identification, and celebration-of-life plans.
The purpose of the Memorial Society is to help families prepare for and plan affordable services by partnering with ethical providers. The Memorial Society of B.C. offers lifetime membership for a one-time $50 fee. Members receive discounted prices of 15 to 30 per cent with participating funeral providers and access to support, advocacy and planning.
By The Numbers
$7,181: Average Cost of a traditional funeral (includes viewing, burial, embalming, transport of body)
28.6%: Percentage increase in average traditional funeral costs between 2004-2014
87%: Percentage increase in average traditional funeral costs between 1980-1989
Natural burial is challenging cemetery design and our increasingly toxic death management practices, while also finding potential for new expressions of thoughtfulness and beauty along the way.
Toxic cemeteries are contributing to early deaths but examining the history of burial practices can teach us to live better.
By Foreground
In the 19th century, new cemeteries were designed for more than the dignified internment of departed loved ones. The landscape or garden cemetery provided much needed green open space for increasingly crowded cities. Cemeteries were the first public parks, where people came to picnic, relax and court. The pressure of today’s growing and diversifying populations and expanding cities are, again, challenging cemetery design, as well as burial practices. But as well as century-old concerns regarding space and the potential health risks of living close to overcrowded urban burial grounds, a new raft of threats are emerging. Modern burial practices have evolved to become highly toxic contributors to landscape contamination.
Jerusalem’s ancient Mount of Olives cemetery buries texts and objects which cannot be destroyed.
The world is increasingly concerned with environmental degradation, yet funeral practices have been largely overlooked until recently. In the mid-1990s, the National Centre for Groundwater Research and Training at the University of Technology, Sydney, examined nine cemeteries and crematoria around Australia. It found the biggest problem with these facilities was the potential for contamination from infiltrating stormwater carrying toxins from caskets and bodies to the underlying water table. But it took another decade for significant wide-ranging studies to emerge. The UK’s Environment Agency 2004 report into potential groundwater pollutants from cemeteries considers many factors leading to soil and groundwater contamination from human burial, including the organic and inorganic matter of bodies, coffins and other non-body grave contents.
Cemeteries are among the most toxic of modern landscapes in both their immediate and ongoing environmental impacts and intensive use of resources. The 2014 documentary A Will for the Woods outlines the problem of a typical American-style funeral, citing the toxic, resource-intensive materials of caskets that have become common in much of the world. “In the U.S. alone, approximately 33 million board feet of mostly virgin wood, 60,000 tons of steel, 1.6 million tons of reinforced concrete, and five million gallons of toxic embalming fluid are put into the ground every year.” They note further the large tracts of land and high maintenance of constant mowing, watering, and the application of chemicals.
Cremation is mistakenly thought to be more green. It actually releases considerable particulate pollution, CO2 (approximately 50 kilograms per cremation, on average), and toxins such as dioxins, furans, and mercury into the atmosphere.
Then there are a host of more modern elements such as mercury from dental fillings, pacemakers, esophageal tubes and other body implants which leach into groundwater once the body has decayed. Another significant pollutant emerged as people began to be buried with their mobile phones and other electronic devices. The trend was noticed in the United States when batteries started exploding during cremations.
Various environmentally-friendly techniques are being explored to dispose of bodies, including freeze-drying, shattering and dissolving. These offer significant space and land savings with minimal energy use and pollution compared with cremation. They also offer new, as yet unexplored, potentials for interment design and funeral landscaping.
A landscape history of burial grounds
Until a little over a century ago, cemeteries were located in churchyards or nearby. As churches were typically sited on high ground, there were few problems with leaching into groundwater or waterways. Still, overcrowding and the fact that urban graveyards were not always on elevated ground contributed to the potential for corpses to pollute groundwater, especially during epidemics of disease and plague, such as cholera and yellow fever. It wasn’t until Dr John Snow, one of the founding fathers of modern epidemiology, proved the vital connection between groundwater and the spread of disease that it was acknowledged. Snow’s famous map – an original type of infographic – of 13 public wells and clusters of cholera outbreak in London’s Soho in 1854 led to water testing that isolated the responsible bacterium. In 1924, Walter Bell wrote that he believed the lessons had still not been learnt from London’s Great Plague of 1664, when groundwater below “thickly buried” church grave yards contaminated the parish wells.
The local ecology of the Cumberland plains will be enhanced and protected.
The mass-migration of rural workers to cities during the industrial revolution in Britain meant that new urban cemeteries were needed. However, so too was recreational open space. Long before Birkenhead Park inspired Frederick Law Olmsted’s Central Park in New York, landscaped cemetery-parks of Europe such as Pere Lachaise Cemetery, which opened in 1804 in Paris, quickly led to similar cemeteries in the United States. The same motivations to provide public parks for healthful recreation encouraged ‘rural’ cemeteries to provide a soothing, meditative natural environment and escape from urban crowding. Mount Auburn Cemetery near Boston, consecrated in 1831, was the first rural, or garden, cemetery in the United States and stills serves its dual role as sacred site and pleasure ground.
Aspect Studios design for Bunurong Memorial Park enhances biodiversity as well as social diversity, providing for multiple community open space activities much like 19th century garden cemeteries.
Olmsted worked closely at the Sanitary Commission with Montgomery Meigs, quartermaster general of the Union Army during the Civil War. Meigs sought Olmsted’s advice in landscaping cemeteries. Olmsted prophetically warned that the current fashion for elaborate and artificial gardening should be avoided because it would disappear and advised planting a sacred grove for the war dead using indigenous trees.
The pursuit of urban environments inclusive of the civilising influence of nature was a project that attempted to mitigate the pollution – literal and figurative – of the industrial city. A new and civilised urban landscape was proposed, whose open environment would contribute to “making the city more and more attractive as a place of residence”. There is something of this 19th-century ambition in 21st-century efforts to cleanse cities of contaminating influences. Both publicly- and privately-sponsored greening of city spaces can lead to the eviction of those some might consider undesirable.
More than half of all the cemeteries in the UK were constructed between 1851 and 1914, encompassing the initial emergence of multifunctional landscaped garden cemeteries, followed by the move to more efficient lawn cemeteries. It is likely a much larger proportion were established in Australia during that same time and following the same fashions. Melbourne General Cemetery, opened in 1853, was Victoria’s first ‘modern’ cemetery, designed like a large public park covering 43 planted hectares with generous walking paths and scenic views.
Woodland Crematorium and Cemetery in Stockholm, designed by Erik Gunnar Asplund with Sigurd Lewerentz, is among the most famous and beautiful burial grounds in the world. Although the design evolved during the course of the project from 1915 to 1940, the tranquil, rolling landscape, devoid of graves, echoes some of the aspirations of natural burial grounds. MoMA has exhibited the architectural and landscape drawings of Asplund since 1978. The curators note of Woodlands that the designers wished to “communicate the importance of nature, to which all living things ultimately return”. In 1994, the Woodland Cemetery became one of the few works of 20th-century architecture to make UNESCO’s World Heritage List.
Despite recent concerns over the toxicity of modern burial practices, old cemeteries and burials still have potential to contribute to soil and groundwater toxicity. In particular, Civil War graves in the United States contain bodies that were embalmed with various unregulated secret formulas, laced with arsenic. Embalming was a growth industry during the Civil War era, being the best way to preserve bodies to be returned to distant loved ones. Arsenic does not degrade as bodies rot and so is deposited in the soil and eventually groundwater. It is a carcinogen associated with skin, lung, bladder and liver cancers, among other diseases and cognitive deficits in children.
Another emerging concern with older graves is rising groundwater levels and higher tides. As sea levels rise with global warming, this could lead to contaminated leaching in the near future. It is already having effects in vulnerable low-lying communities where cemeteries are among land urgently being protected.
Natural burials can mitigate, and perhaps eliminate, pollution
There are several reasons why natural burials – also termed green burials or green funerals, organic burials, woodland burials and bushland burials – are becoming more popular. However, a consistently strong motivation is to reduce environmental impacts, including direct toxic contamination of existing sites, and the protection of particular landscape ecologies. Natural burial can do this in several ways: digging shallowly without heavy earth-moving equipment, preparing the body without chemical preservatives or disinfectants, using a compostable coffin or shroud or none at all, avoiding burial of any other toxic or non-biodegradable items, having no headstone or high embodied-energy marker, and conducting any services including food, printing, transport, music and more and in a sustainable non-polluting, no- or low-energy way.
Landscape architect and academic Andy Clayden of the University of Sheffield, researches the planning, design and management of cemetery landscapes. He has led a team that co-authored the first book to review the history and past 20-year growth of natural burials: Natural Burial: Landscape, Practice and Experience, published in 2014. In a paper last year his team focused on the significant contributions of natural burial sites to ecosystem services in England. The ecological benefits are mirrored by shifting perceptions as “natural burial is transforming the traditional cemetery, with its focus on an intensively managed lawn aesthetic, towards a more habitat rich and spatially complex landscape with its own distinctive identity.” Coupled with an ethical-aesthetic shift in death management, this approach is opening many areas of potential engagement and exploration for designers across the full spectrum of services.
A number of organisations have emerged to variously support and oversee natural burials. The United Kingdom’s Natural Death Centre is the oldest, established in 1991 and offering support, advice and extensive links to information for the public. The Green Burial Council in North America, founded in 2005, offers certification as well as education and advocacy. Also established in 2005 is Canada’s Natural Burial Association, serving both the public and burial operators. In 2014 a diverse group of professionals in Australia founded the Natural Death Advocacy Network (NDAN) with a wide remit to advocate, as well as encourage discussion and conduct and disseminate research.
One important aspect of natural burials is the covering a body receives. A co-founder of NDAN and passionate advocate for natural burial, Dr Pia Interlandi, has researched the effects of clothing and textiles on decomposition. Her PhD involved rigorous immersion in the rituals associated with preparing the body for interment. Garments from this investigation have been exhibited at the London Science Museum and London Print Studio. In 2012, she started her current practice, Garments for the Grave, where she now designs custom-made biodegradable burial garments with client family participation.
Australian natural burial sites
Bushland or natural burial is possible in portions of many cemeteries throughout Australia, although there has been little attention given to their complex landscape design. Two years ago Burnie City Council looked to offer a dedicated natural burial site in Tasmania, acknowledging the rising interest in natural burials while, capitalising on the state’s clean, green image and natural scenery. Kemps Creek Cemetery, which includes the Sydney Natural Burial Park, claims to offer Sydney’s first eco-burial area. A different and popular service is being offered in the south-west of Victoria. Upright Burials opened in 2010 as Australia’s first vertical burial ground. As well as taking up much less space than conventional burial, the Kurweeton Road Cemetery adheres to many further environmentally-friendly processes such as an absence of any grave-markers. The exact location is GPS recorded and provided to family and friends. Queensland funeral directors advise of two ‘green’ burial sites within cemeteries both operated by local councils: one as part of the memorial gardens at Lismore in northern NSW and another, which is the state’s only registered green burial site, within Alberton Cemetery on the Gold Coast.
An award-winning master plan for Acacia Remembrance Sanctuary within Itaoui Woodland Park was the first of its type planned in Australia. Developed by landscape architects McGregor Coxall working with Chrofi, the project encompassed 10 hectares of degraded, yet protected bush ecology west of Sydney. The design philosophy looked to establish a model that would not only protect, but reinstate the flora and fauna of the site. It has considered ongoing maintenance as part of full environmental considerations, including having all energy requirements generated on site, on-site water treatment and reuse, and limited slashing of the indigenous grasslands to create pathways instead of introducing exotic grasses and regular mowing practices.
Aspect Studios were responsible for the design of 11 hectares of native gardens at Bunurong Memorial Park, which opened in 2016. Much like early garden cemeteries, the realised proposal caters for the wider community’s need for open space, accommodating weddings, funerals and fitness groups, as well as picnicking and play. Bunurong also includes a new natural burial area, Murrun Naroon.
Reconsidered design approaches for cemetery landscapes, both expanding and new, are clearly an important area of innovation that will curb land contamination. However, new building opportunities can also reset expectations. Harmer Architecture’s Atrium of Holy Angels Mausoleum in Fawkner Memorial Park north of Melbourne was a rare chance to interpret a very old form. The nature of mausolea help contain any contaminants by isolating bodies and congregating remains, which takes up less space and resources.
Perhaps a similar translation of considered species, ecology and aesthetics is needed, as was slowly adapted when Australian landscape gardeners and designers such as Edna Walling looked to the British ‘wild garden’ of William Robinson. The wilderness of Britain is not the wilderness of New South Wales or Victoria or the many smaller patches of ecologies that Walling became familiar with while documenting roadside vegetation and that changed her approach to landscape design.
If the natural burial movement is to achieve its fullest potential to enhance environments, rather than just refrain from harming them, designers should aim to serve both new sensitivities around death and memorialisation, as well as new sensitivities toward our threatened environments.
Restoration experts in the Czech Republic have been set an unusual task – to dismantle four towering pyramids made up of centuries-old bones from more than 40,000 human bodies, clean them up and then reconstruct them as before.
A restoration expert walks through the Sedlec Ossuary in Kutna Hora, Czech Republic, February 14, 2019.
The restoration project, expected to last two years, is aimed at preserving the bones, the chief attraction at the Sedlec ossuary church, a site on the outskirts of the mediaeval mining town of Kutna Hora in the central Czech Republic.
The project also aims to restore and strengthen the church building which houses the bones and skulls.
The site, which draws half a million visitors every year, not only features the four large pyramids of bones – it also boasts a chandelier, a coat of arms and various other decorations made from every bone in the human body.
“Many people find it weird today and come to see this as some dark spectacle, a house of horrors,” said Radka Krejci, in charge of operations at the local parish.
“But we do not want it to be perceived like that, it is a place of reverence, a burial place.”
The bones came from a cemetery adjacent to a monastery founded by the Cistercian order in 1142.
The burial ground was enlarged during a plague epidemic in the 14th century. In 1318, about 30,000 people were buried here and more joined them in the 15th century during religious wars between Roman Catholics and the Hussites.
A lack of space prompted the decision to exhume the bones and place them in a depositary, one of a number of such sites around Europe, during the 16th century. Legend says that a half-blind monk built most of the bone structures.
The present appearance of the bone structures dates from 1870 and is the work of Czech wood-carver Frantisek Rint, who added the various decorations to the original pyramids.
The renovation is necessary due to the aging of both the bones and the ossuary.
“The bones will be cleansed of surface dirt and then soaked in lime solution. This is a natural method of preservation which was also used during the creation of these pyramids,” said conservation expert Tomas Kral.
To make sure the structures are rebuilt in the original format, the restoration team has hired a firm, Nase Historie, to produce computer models of the bone pyramids using photos and videomapping.
Climate change is on everyone’s mind as initiatives for renewable energy and sustainable public habits adapt to a more environmentally-friendly approach.
While numerous avenues for reducing the adverse impact of energy production and ocean contamination dominate most of the narrative around preserving the ecosystem, many more obscure and often overlooked practices lead to the accretion of environmental contaminants.
One of those areas is the traditional Western approach to burial practices and its subsequent impact on local ecosystems. Embalming fluid, typically composed of formaldehyde, ethanol, and water, is commonly used in burials throughout Western culture to preserve bodies for funeral services before being put to rest.
However, the proliferation of costly funeral services has led to increased exposure to formaldehyde, both to individuals who work with it directly and the environment. Compounding the issue is the myriad metals — such as bronze and steel — that are laid to rest during funeral services that do not readily compose in the soil. As demand for cemetery land undoubtedly grows, the adverse impact of the contaminants synonymous with funeral practices grows.
Transition Green Burials is a company focused on promoting the conversion to more eco-friendly burial practices, known as ‘green burials’ or natural burials.
Identifying Sources of Burial Pollutants
Formaldehyde produces the most concerning ecological threat with common burials practices because of its widespread use and identity as a dangerous animal carcinogen.
Highly toxic to animals, formaldehyde is implicated in cancer, nervous system disorders, and lateral sclerosis. Formaldehyde can also break down into urotropine during decomposition, an anti-bacterial chemical commonly used in antibiotics for bacterial infections, but that is harmful to the natural bacteria in the soil.
Pesticides and herbicides are often used in the internment process too, compounding the negative effects of formaldehyde on the soil surrounding burial areas. The downstream effects of the chemicals used in the internment process can eventually even lead to contamination of underground water sources.
Outside of common internment practices, cremation processes also lead to the emission of mercury and toxic plastic into the environment. Further, high carbon loads are needed for the cremation process, leading to increased carbon emissions, one of the fundamental focuses of environmental initiatives like The Paris Climate Agreement. With nearly 50 percent of Americans selecting cremation today, few realize the pollutants that are dispersed into the air from the procedure.
Many conservation groups, like the Green Burial Council, are seeking to promote more eco-friendly practices by limiting the use of embalming fluids, herbicides, and pesticides in the process. Further, some groups are promoting the use of biodegradable coffins, design to break down over time, mitigating the long-term impact of steel or brass caskets that can destroy habitats as burial grounds expand.
Transitioning to Fixed Cost Green Burials
The Green Burial Council cites the rise of certified green burial sites across the US as an indication of the legitimacy of their cause, and their emphasis on protecting worker health, reducing toxic pollutants, and promoting habitat conservation is gaining traction among various burial grounds and activists.
Similarly, Transition Green Burials is taking a hybrid approach to the issue with a focus on both the environmental impact and financial advantages of green burials through their TransitionCoin, which is designed to incentivize people to change conventional burial practices.
TransitionCoin provides a fixed cost for green burials — including all of the associated services required in the course of the burial. The targeting of a fixed price is derived from the rapidly increasing cost of funeral home services, which can reach as high as $25,000 and can lead to financial struggles among grieving families.
With a fixed cost for any green burial, people who select TransitionCoin can reduce financial costs and contribute to the growing Green Burial Movement.
The conventional burial practices among Western countries using caskets and multiple proceedings through a funeral home is also more of an isolated and recent phenomenon that began following the Civil War in the US. Several religions — including Judaism — forbid the embalming of the deceased out of religious tradition, and preserving chemicals or embalming fluid are also rarely used in Islamic burials.
Green burials grounds and services have also emerged across the US already. States like California and South Carolina have certified green burial preserves set up that are registered with the Green Burial Council. The Green Burial Council provides certified standards for funeral services, cemeteries, and burial product manufacturers. There are currently 39 states with funeral providers accredited by the Green Burial Council for eco-friendly burials.
The notion of analyzing green burial practices is one of the more obscure concepts within environmental conservation, but, nonetheless, is important to take into consideration as the widespread use of formaldehyde and pesticides continue. Transition Green Burials and the Green Burial Council are actively promoting the shift to a more eco-friendly approach, and it is beginning to gain traction among both environmental activists and funeral parlors.
