The coronavirus pandemic has drawn new business to start-ups that provide end-of-life services, from estate planning to a final tweet.
One day in April, as the coronavirus ravaged New York City, 24-year-old Isabelle Rodriguez composed a tweet she would send from the grave.
She wasn’t dying. She wasn’t even sick. In fact, her risk of contracting Covid-19 had been reduced after she was furloughed from her job at a Manhattan bookseller and retreated to her rural hometown, Callahan, Fla. But when she came across the poem “Lady Lazarus,” by Sylvia Plath, Ms. Rodriguez knew she had found the perfect words to mark her digital legacy:
Herr God, Herr Lucifer
Ms. Rodriguez logged on to Cake, a free service that catalogs users’ end-of-life wishes, instructions and documents, and specified that she wanted the verse sent from her Twitter account after her death. “Any of my friends know I’m obsessed with Sylvia Plath,” Ms. Rodriguez said. “That was the best way to put my personality out there one last time.”
Through Cake, Ms. Rodriguez also filled out a “trusted decision maker” form, appointing her younger sister to call the shots should she end up incapacitated. She was still debating other important details: Did she want to be buried or cremated? If the latter, would her ashes be scattered, pressurized into a diamond, composted into tree food? Also, how much would it annoy the guests at her funeral if she requested that her favorite album, “Wolfgang Amadeus Phoenix,” be played on loop?
Ms. Rodriguez conceded that it might seem a little weird to be considering all of this in her mid-20s. On the other hand, young people around the world were getting incredibly sick, incredibly fast.
End-of-life decisions can be overwhelming, but making those choices when she was healthy gave her more control. Knowing that she’d ease the burden on her family if the worst happened also gave her peace of mind. “It would be easier for people around me to know what I want,” she said.
Before the pandemic, end-of-life start-ups — companies that help clients plan funerals, dispose of remains and process grief — had experienced steady to moderate growth. Their founders were mostly women who hoped a mix of technology, customization and fresh thinking could take on the fusty and predominantly male funeral and estate-planning industries.
Still, selling death to people in their 20s and 30s wasn’t easy. Cake’s team sometimes received emails from young adults, wondering if the site wasn’t a tad morbid. Since Covid-19, this has changed. Millennials are newly anxious about their mortality, increasingly comfortable talking about it and more likely to be grieving or know someone who is.
“The stigma and taboos around talking about death have been way reduced,” Cake’s co-founder Suelin Chen, 38, said. This has driven conversation across social media, spurred interest in deathfluencers (they will discuss how funeral homes are responding to the coronavirus but also whether your pet will eat your eyeballs) and increased traffic to end-of-life platforms. From February to June, people signed up with Cake at five times the normal rate.
Another new company, Lantern, which calls itself “the single source of guidance for navigating life before and after a death,” saw a 123 percent increase in users, most of them under 45.
Lantern’s tone is soothing and earnest, but not everyone takes that tack. Cake skews playful. It features a tombstone generator and suggestions like “Viking funeral” and “shoot my ashes into outer space.” New Narrative, an event-planning company for funerals and memorials, introduces itself with a wink: “We’re not your grandma’s funeral (… unless it’s your grandma’s funeral).”
It’s a tricky opportunity for these start-ups to navigate. “When you have a brand that’s directly interfacing with people in the throes of loss and grief, you have to walk a fine line,” said Liz Eddy, 30, Lantern’s co-founder and chief executive.
All these founders stress they’re not trying to capitalize on the coronavirus. But this hasn’t stopped anyone from pivoting hard toward Covid-19. The companies have created new forums and content on how to plan for death, honor the newly dead and grieve virtually. They have initiatives with major health care providers to disseminate their products more widely and formed new partnerships with influencers. The start-ups have even begun to coordinate with one another, sharing tips in a cross-company Slack channel called “Death & Co.”
They are all hoping the pandemic will be the event that turns end-of-life planning — from designing a funeral to writing a will and final tweet — into a common part of adulthood.
The Obituary Game
In 2012, a friend invited Ms. Chen and her fiancé to dinner and suggested they play an unusual party game: Write and share their own obituaries. “It’ll be fun!” the friend said. “They do it at Stanford Business School.”
At first, Ms. Chen was delighted by the exercise: Both she and her fiancé wrote, in the imagined past tense, about a music album they hoped to one day record. But when Ms. Chen started reading what she had written about her career, she was seized with panic and started bawling at the table.
“I just lost it,” she recalled. “It was confusing to me, because I loved my job. I was happy in the most obvious ways, but there was part of me …” She wasn’t sure how to describe the upswell of emotion.
Around this time, Ms. Chen was advising health care companies in commercial strategy. While interviewing last-line cancer physicians, she would constantly run a calculation in the back of her head: “If this treatment extends life by three months, how much money is it worth?” And yet she’d wonder: But at what quality of life? The system of prolonging life at all costs seemed out of whack.
Ms. Chen had also recently lost her grandfather, who died at 95 after a long period of suffering. He lived in Taiwan, where death in very old age is treated as a celebration, Ms. Chen said. And yet there had been a lot of family conflict around the experience.
Amid the pain and relief of her grandfather’s being at rest and the joyful commemoration of his life, Ms. Chen understood that she needed a new path. She didn’t yet know what it would be, but a few years later she met Mark Zhang, a palliative care physician and technologist, at an M.I.T. health care “hackathon.” The pair won first place at the event and went on to found Cake. The platform now includes resources and templates to help users write their obituaries along with guidance for how to get them published.
The venture-backed company makes money through partnerships and will eventually add fee-based services. The pandemic has been especially busy. Cake’s services, for example, soon will be integrated into the website of the British bank RBS/NatWest.
In April, Ms. Chen learned that Partners HealthCare, a large health care system in Massachusetts, was recommending Cake to all its members. Ariadne Labs, run out of the Harvard School of Public Health and Brigham and Women’s Hospital, also came calling. They wanted help distributing their end-of-life conversation guide beyond a relatively small audience of doctors and patients. They also wanted real-time feedback from a young and healthy audience like Cake’s.
Cake also teamed up with Providence Health System, a network of 51 hospitals and 1,000 clinics in seven states, to share Cake’s “trusted decision maker” form, the document specifying an individual’s medical preferences if the person becomes incapacitated. Through Cake, individuals could submit the form to their doctor without needing a notary and two nonfamily witnesses, which are often required but difficult to get under quarantine.
The next step is offering premium services, tailored to different types of users. “Are you here because you just lost someone, or because you just had a kid, or have an aging parent, or because a celebrity just died and you had an existential crisis?” Ms. Chen said. “We’re trying to automate based on what we know about the person.”
The Pandemic Hits
In April, Ms. Chen learned that her head of product’s grandfather had died from Covid-19. She had heard of people texting and messaging their condolences, but even email seemed inappropriate, overly impersonal. Unsure of what to do, she turned to Cake. Following an article from the site, Ms. Chen shipped her colleague soup, rolls and cookies with a note: If and when you’re ready, I’d love to hear more about your grandfather.
“In the modern age, the norms around supporting people who are grieving are not super clear,” Ms. Chen said. “It used to be that you belonged to a religious community or lived in a small town, but now we’re far away from where we grew up. We’re more secular.”
During the pandemic, condolence-related traffic on Cake doubled. To address the need, the company started a forum where users can crowdsource their questions and concerns.
Lantern provides its own grief and condolence content, including a “pandemic-proof” guide to “inclusively addressing grief at work.” In recent months, more people are grieving on the job, where the emotional distress for people of color over high Black and Latino rates of coronavirus infection is compounded by anguish over police brutality.
“Especially during Covid, it’s how can you incorporate the grieving process into 9-to-5 and day-to-day work?” said Alica Forneret, 31, who runs grief workshops and just started a namesake consulting agency to help companies address this question. “Employers, managers and H.R. need to understand there’s an extra burden on people of color and especially Black people when they sit down at their computer in the morning and are expected to engage and perform.”
For Ms. Forneret and other millennial founders, preparing for death and navigating grief during the pandemic has become a form of self-care. That has created new opportunities and partnerships. When Ms. Eddy pitched funders, she situated Lantern’s end-of-life services as an untapped market in the $4.5 trillion global wellness industry.
“We’ve been called a niche market,” she said. “But death and dying is possibly the least niche market out there.”
Corporations are rethinking the wellness programs they’re offering employees, Ms. Eddy said. They’re no longer just gym memberships and kombucha on tap. Studies have found that being able to talk about your mortality makes you a happier person and improves your relationships. The thinking, for employers perhaps, is that access to end-of-life services can make people happier (and more productive) at work.
This market potential is also why Near, a start-up that connects users with grief and end-of-life support services, like death doulas and art, sound, music and massage therapists, recently decided to seek investment. The company also moved its debut from September to June and is expanding its offerings to even more unconventional end-care providers like end-of-life photographers.
“Before Covid, we were looking at being a smaller platform. We’d be able to keep up with need through bootstrapping,” a Near co-founder, Christy Knutson, 36, said. “But the demand is far greater.”
This spring, a beauty writer and skin-care company chief executive, Charlotte Palermino, approached Lantern about co-hosting an Instagram Live. She had been watching her friends “panic post” death rates and was feeling increasingly anxious.
“I know people who got really sick, were suddenly on ventilators in their 30s,” Ms. Palermino, 33, said. She received such an overwhelming response from her followers that in June, she filmed a similar video for her Generation Z audience on TikTok.
Death & Co.
In May, a large senior care company asked Ms. Eddy about a partnership. Ms. Eddy, who declined to identify the company, was intrigued but skeptical. In search of guidance, she did something that would normally be unexpected. She reached out to Ms. Chen at Cake, Lantern’s closest competitor.
Ms. Chen wasn’t surprised to hear from Ms. Eddy. In fact, she said, this kind of collaboration is frequent among end-of-life chief executives. “There’s a lot of texting and calling all the time: who are the good investors, the partners, give me the lowdown on these people,” she said.
The most common means of communication among end-of-life founders — and where Ms. Eddy went to reach Ms. Chen — is the cheekily titled Death & Co. channel on Slack. It was born in December during End Well, a conference about improving the culture, products and policy around end of life.
After one of the sessions, a handful of female founders gathered for an impromptu happy hour. They bonded over the rarity of having so many women running companies in the same industry, all them, in one way or another, trying to challenge the corporate, predominantly male funeral industry.
They discussed the difficulties of securing funding as womenand the challenges of trying to make a distinctly unsexy product accessible and affordable. Ms. Chen said a male founder had told her: “No one thinks about death. I don’t. I’m immortal.” Ms. Eddy said another had told her that he thought she’d be more successful if she created the “Tesla” of end-of-life services.
The women decided to start a WhatsApp group, which one of them named “Death Chicks.” A couple of months later, with more people wanting to join, including a handful of men, Ms. Eddy moved everything to Slack and renamed it Death & Co. For some months, the group was largely dormant. That changed in March.
“At the beginning of coronavirus, we came together and said this can all be reimagined with alternative, more modern solutions,” said Christina Andreola, 31, the founder of New Narrative, who joined the Slack channel in March. “My colleagues were asking: How can we team up to be competitive?”
The channel has around 70 members. They have worked together on a white paper about the funeral industry and Covid-19, raised funds for personal protective equipment for funeral directors and created short video guides for health care workers to talk about end-of-life options with their patients. Eterneva, a company that turns ashes into diamond jewelry, used the group to start a series of Instagram Lives about collective grief. LifeWeb360, which creates multimedia memorial scrapbooks, teamed up with New Narrative to create resource guides for planning virtual memorials.
The women have also freely shared connections and leads. Ms. Knutson of Near joined Death & Co. in March. She used the group to meet end-of-life photographers, a small and elusive set, and expand her provider list of death doulas, caregivers who help dying individuals navigate the end-of-life process.
“Overnight I walked into a virtual room with loads of smart, driven leaders who are building things that it would have taken me months if not years to hear about otherwise,” she said.
Not everyone is finding what he or she needs at Death & Co. Ms. Forneret, one of the few Black members, left after the police killing of George Floyd in Minneapolis in May. She said that the channel had done a lot of good for the industry and that she worked closely with Ms. Eddy and other members. But at this moment, she wants to align herself with other founders of color, she said.
In mid-June, Ms. Forneret participated in a Zoom panel featuring five Black entrepreneurs. The topic: how to have a “good death” in a racist society. The event was organized by Alua Arthur, 42, who runs a death doula training company, Going With Grace.
Ms. Arthur serves as an adviser to Cake and Near and has become a de facto spokeswoman for Black-owned death care businesses, especially in the last couple of months. She has become exhausted in this role and said end-of-life start-ups should be working harder to reach communities of color, which are largely underserved in the industry.
Even so, all of these founders share a mission: to democratize end-of-life planning and care. Ms. Arthur said the searchable database and broad collection of providers on Near were a step in the right direction.
Trust and Will, a company that bills itself as Turbo Tax for estate planning, charges a small fraction of what most lawyers do. Eterneva, the company that turns your loved one’s body into bling, just rolled out financing. Cake’s and Lantern’s basic preplanning services are free. Given that the average cost of a funeral in 2019 was $7,640, this kind of foresight could reduce the cost of dying. Because maybe you don’t want to languish on a ventilator or need a fancy coffin.
At the very least, when we can personalize our deaths the way we do our weddings and our wardrobes, we can feel a little more control over life’s greatest uncertainty. It’s something of a silver lining to this very scary moment.
“We’re never going back to the way it was,” Ms. Chen said. “That’s a positive thing — to accept the reality that we’re not immortal.”
Jennifer Miller is the author most recently of the novel “Mr. Nice Guy.” Her next book follows a year in the lives of first-generation college students.
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For centuries Bali’s Trunyanese people have left their dead to decompose in the open, the bodies placed in bamboo cages until only the skeletons remain.
It is a ritual they haven’t given up — even as the COVID-19 pandemic upends burial practices worldwide with religious leaders in protective gear, cemetary workers in hazmat suits, and mourners banned or unable to comfort each other because of social-distancing rules.
Across Indonesia funeral workers are now required to wear protective equipment and bodies are laid to rest quickly, all in a bid to prevent the spread of the deadly respiratory disease.
But in Bali local officials claim the novel coronavirus, which has infected at least eight million and killed more than 430,000 globally, has yet to reach the remote north east where the Trunyan live.
“The funeral process remains the same but now we have to wear masks,” explained village head Wayan Arjuna.
Tourists are temporarily banned from visiting for fear of them bringing in the disease, he adds.
“We’re afraid of getting COVID-19,” said Arjuna, but added there was no suggestion of stopping the open-air burial process.
Unlike many in the rest of Hindu-majority Bali, the Trunyanese — who fuse animist beliefs and traditional village customs with their own interpretation of Hinduism — do not bury or cremate their dead.
Instead they let nature take its course as the corpses decay in the open, believing it to be a way to keep a link with the deceased.
“This makes us feel connected to our loved ones,” Arjuna said.
“Like when my grandmother died, I felt like she was close”, he added.
– Skull Island –
It is a short boat ride to their open-air cemetery from tiny Trunyan village, overlooked by volcano Mount Batur and a sprawling Hindu temple carved out of volcanic rock.
There are 11 cages for the corpses — placed close to a fragrant banyan tree that hides the putrid smell of death, locals say.
In one cage, a recently deceased woman could almost have been mistaken for someone sleeping, but her waxy greying complexion revealed the truth.
Nearby, a flesh-less foot poked out of clothing left on the bodies, while a skeletal jaw lay agape in another cage.
“I used to be a little scared working here, but it’s been so long now that I’m used to it,” said veteran guide Wayan Sukarmin, who was spent 20 years showing people the custom on what outsiders have dubbed “Skull Island”.
When AFP visited in February before the World Health Organisation declared a pandemic and travel restrictions were put in place, signs warned visitors to wear appropriate clothing and refrain from using bad language.
Rubber sandals, cigarette packages, toothpaste tubes and pots and pans were scattered around the site, along with baskets filled with coins and crumpled money — all left by mourners for dead relatives to use in the afterlife.
“Locals won’t take anything because it belongs to the dead. That’s our belief,” Sukarmin said.
“I don’t know what the consequences would be if you took something but I believe in karma,” he added.
– Millennia-old custom –
If the cages become full then older corpses are moved to an open ossuary, to make way for new ones.
Then when there is no flesh left, the skulls of the long dead are placed upon a stone altar, until they too crumble back into nature.
Nearby, there is a second cemetery for the unmarried and children, while a third location is for those who died unnatural deaths like murder or passed away from acute illness.
The Bali Aga — or mountain people — who live in these isolated villages, claim to be descendents of the original Balinese and the main temple in Trunyan village dates back to the 10th century according to historical records.
The origin of the custom of open-air burials is subject to debate.
One legend has it that the area’s early inhabitants fought over the prized Banyan tree, so to keep the peace, leaders decided to place the dead there, believing the smell from the corpses would make the spot less attractive.
Another story suggests that the ritual was adopted to avoid angering the rumbling volcano nearby by cremating people.
“There are several versions of the legend so I can’t decide which one is correct,” Arjuna said.
But these open-air burials are now so rooted in the culture that few expect much to change in Trunyan, even as the pandemic ravages the world.
“It’s relatively easier to prevent infections in isolated and faraway places,” said Bali’s virus taskforce chief Dewa Made Indra.
“There aren’t any reported cases in Trunyan. But if that happens then we’ll handle it with special procedures and I think the villagers will understand.”
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The Tragic History of How Pandemics Have Disrupted Mourning
On a recent Monday in a New Jersey cemetery, social worker Jane Blumenstein held a laptop with the screen facing a gravesite. A funeral was being held over Zoom, for a woman who died of COVID-19. It was a brilliantly sunny day, so a funeral worker held an umbrella over Blumenstein to shield the laptop from any glare, as synagogue members and family members of the deceased sang and said prayers.
The experience was a “surreal” one for Blumenstein, who is a synagogue liaison at Dorot, a social-services organization that works with the elderly in the New York City area. “I felt really privileged that I could be there and be the person who was allowing this to be transmitted.”
The roughly 20-minute ceremony was one of countless funerals that have taken place over Zoom during the COVID-19 pandemic. As authorities limit the size of gatherings — and hospitals limit visitors in order to prevent the spread of the novel coronavirus — loved ones have been unable to gather for traditional mourning rituals in the aftermath of a death, so it has become the norm for those who die to do so without their families by their sides, able to say goodbye only virtually, if at all.
The rising death toll has overwhelmed funeral homes and cemeteries, further limiting what is possible. Across religions and around the world, end-of-life traditions have been rendered impossible: stay-at-home orders have stopped Jewish people from sitting shiva together; overwhelmed funeral services have meant Islam’s ritual washing of the body has been skipped; Catholic priests may have had to settle for drive-through funerals, in which the coffin is blessed in front of just a few immediate family members.
The effects of COVID-19 will be felt for many years to come, but those who have lost loved ones are feeling those effects immediately — and, for many, their pain has been exacerbated by the inability to say goodbye. The horror of these rushed goodbyes may be looked back on as a defining feature of the COVID-19 pandemic. But, as the tragic history of pandemics reveals, it is something that disease has forced human beings to struggle with throughout history.
For example, during a 1713 plague epidemic in Prague, a shortage of burial supplies heightened the pain of rushed burials. The emotional toll is evident in a Yiddish poem written shortly after the outbreak, translated for TIME by Joshua Teplitsky, professor of History at Stony Brook University, who is writing a book about this period. At the sight of the dead being carried away day and night, “all weep and wail!,” the poem says. “Who ever heard of such a thing in all his life?” The poem describes people working around the clock and through the Sabbath to saw planks for coffins and sew shrouds.
In one 1719 book, a rabbi recalls counseling a man who was anxious about burying his plague-stricken father in the local cemetery because of a government requirement to coat the body in a chemical to accelerate decomposition. He asked the rabbi if it would be more respectful to bury his father in a forest far outside of the city. The rabbi told the man to follow the rules, likely thinking that “if the body gets buried in the woods, in a very short time, it will be lost, and if it’s in the cemetery, the rabbi is expecting that when this plague passes, visitors will go pray and pay their respects,” says Teplitsky.
Indeed, Teplitsky found a prayer printed circa 1718-1719 that he believes women may have recited while walking around a cemetery years after the epidemic, asking the dead for forgiveness for the lack of a traditional funeral and burial five years earlier.
Centuries later, during the 1918-1919 flu pandemic, Italians were likewise thrust into a world in which funerals had to take place quickly, without ceremonies or religious rites. According to research by Eugenia Tognotti, an expert in public health and quarantine, and a professor of history of medicine and human sciences at the University of Sassari, Italy, many expressed horror at hurried burials in letters to friends and relatives, which are preserved at the Central State Archive in Rome. “The more common lamentations are: ‘Not priests, nor crosses, nor bells’ and ‘one dies like an animal without the consolation of family and friends,’” Tognotti told TIME. Another woman wrote to a relative in Topsfield, Mass., “Here [in Italy] there is a mortal disease named Spanish flu: the sick die in four or more days, a bucket of lime is thrown over the dead bodies, and then four workers take them to the graves like dogs.”
The horror was similar in the U.S., especially in Philadelphia, an epicenter of the pandemic. Columba Voltz was an 8-year-old daughter of a tailor back then, who said that funeral bells tolled all day long as coffins were carried into a local church for a quick blessing and then carried out a few minutes later, according to Catharine Arnold’s Pandemic 1918: Eyewitness Accounts from the Greatest Medical Holocaust in Modern History. “I was very scared and depressed. I thought the world was coming to an end,” Voltz recounted.
Inside one such house, Anna Milani’s parents laid her 2-year-old brother Harry to rest with what they had on hand:
There were no embalmers, so my parents covered Harry with ice. There were no coffins, just boxes painted white. My parents put Harry in a box. My mother wanted him dressed in white — it had to be white. So she dressed him in a little white suit and put him in the box. You’d think he was sleeping. We all said a little prayer. The priest came over and blessed him. I remember my mother putting in a white piece of cloth over his face; then they closed the box. They put Harry in a little wagon, drawn by a horse. Only my father and uncle were allowed to go to the cemetery. When they got there, two soldiers lowered Harry into a hole.
The same concerns that would have limited attendance at the cemetery when Harry Milani was buried reared their heads more recently during the 2014-2016 epidemic of Ebola, a disease that can be spread through contact with the remains of those it kills. More than 300 cases came from one Sierra Leone funeral, and 60% of Guinea cases came from burial practices, according to the World Health Organization. In Liberia, mass cremations ran counter to traditional burial practices that include close contact with bodies. In Sierra Leone, the dead were put in body bags, sprayed with chlorine and buried in a separate cemetery designated for these victims. As traditional burial practices were curbed in an attempt to stop the spread, the dismay caused by this situation, Tognotti notes, was the same feeling experienced by those Italians of the early 20th century who wrote of the pain of the flu pandemic.
Sometimes, however, victims of epidemics who knew the end was near were actually hoping for a departure from the usual norms of burial and mourning: they wanted their deaths to be used to remind authorities to take these crises seriously.
This idea of the political funeral is particularly associated with the AIDS epidemic of the 1980s and 1990s. The activist group ACT UP spread the ashes of victims over the White House lawn, and staged political funerals—open-casket processions, such as the one that brought Mark Lowe Fisher’s body to the Republican National Committee’s NYC headquarters ahead of the 1992 presidential election. “I have decided that when I die I want my fellow AIDS activists to execute my wishes for my political funeral,” Fisher wrote, in a statement entitled Bury Me Furiously. “We are not just spiraling statistics; we are people who have lives, who have purpose, who have lovers, friends and families. And we are dying of a disease maintained by a degree of criminal neglect so enormous that it amounts to genocide.”
The inability to give loved ones proper send-offs is often a hidden cost of these pandemics, Tognotti says, and should not be ignored by officials. Even with modern knowledge about disease transmission, awareness of the reasons for public-health guidance doesn’t lessen the desire to participate in rituals. “The emotional strain of not being able to dispose of the dead promptly, and in accordance with cultural and religious customs, has the power to create social distress and unrest and needs to be considered in contemporary pandemic preparedness planning,” she says.
In this pandemic, a new openness about talking about mental health issues could help. For example, New York state launched a hotline so residents can talk to a therapist for free, and some sites host virtual sessions to discuss grief. Mourners can opt for live-streaming and video conferencing and include more people virtually than before.
For others, these virtual gatherings and brief blessings at the cemetery are placeholders. In March, after Alfredo Visioli, 83, was buried in a cemetery near Cremona in northern Italy, with no relatives allowed to attend and a brief blessing from a priest, his grand-daughter Marta Manfredi told Reuters that, “When all this is over, we will give him a real funeral.”
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From mafia propaganda to moral outcry, what’s stopping us from embracing water cremation technology?
When you die, your body is going to decompose.
It starts from the moment you pass. Your organs begin to shut down. Hair stops growing, skin recedes. Some parts of the body take longer than others, but eventually, as with all things, it all starts to break down.
If you opt for a traditional burial, your remains will spend years nestled within a casket underground, progressing into a deeper state of decomposition. If you opt for a traditional flame-based cremation, you eliminate any further decomposition by burning it to a halt.
But there’s also another alternative — one designed to accelerate the decomposition process through the medium of water. It’s known as alkaline hydrolysis, or water cremation. One part spa, one part chemical blend, a few hours of a swirling soak, and your earthly remains are no longer.
“It’s basic chemistry,” explains Anas Ghadouani, leader of the research group Aquatic Ecology and Ecosystem Studies. “You have organic matter and you add a base to it and it just decomposes. You can write the equation to it. It’s very simple.”
Despite this, alkaline hydrolysis remains one of the most divisive and misunderstood practices in contemporary funeral technology.
Alkaline hydrolysis is a form of cremation that uses water and chemicals to break down the human body to its bare minimum. Salts, amino acids, peptides. Like flame-based cremation, it produces ash that can be taken home. Unlike flame-based cremation, it’s illegal for use on human bodies in almost 30 states in America.
The concept itself isn’t new. Amos Herbert Hobson of Middlesex, England, patented the first alkaline hydrolysis machine all the way back in 1888. He used it to dispose of animal carcasses.
In the century and a half since, the technology has evolved, and it has the potential to shake up the death industry.
The process is straightforward. Bodies are placed in a machine containing a chemical mixture of water and alkali. The mixture is then heated and cycled. Over the course of hours, the body is accelerated through its natural decomposition process, resulting in a residual liquid made up of amino acids, peptides, salt, soap and bones — the last of which is broken down into white ash.
Joseph Wilson, now founder and CEO of leading alkaline hydrolysis manufacturer Bio-Response Solutions, helped design the first commercial-use human alkaline hydrolysis unit in 2005.
“I was stunned that there was a way to dispose of tissue without burning,” said Wilson. “You don’t have any external pumps or tanks or chemicals. It’s all there at the machine.”
There are undeniable benefits to this process. In 2011, a study from the University of Groningen compared conventional burial, cremation, alkaline hydrolysis and cryomation and found that alkaline hydrolysis had the lowest overall environmental footprint.
The low temperature also means pacemakers and joint replacements can remain inside the body. In flame-based cremation, these are extracted to prevent a reaction — pacemakers, especially, are incredibly volatile when subjected to extreme heat.
Yet despite the fact that flame-based cremation subjects the remains to intense fire, alkaline hydrolysis is seen as the more graphic option for potential funerals, when both are just as valid. Legal roadblocks and cultural concerns have plagued water cremation since its inception.
And there’s a simple reason for that: Alkaline hydrolysis has a reputation shaped by years of misrepresentation. Nobody wants to feel like they’re disrespecting their loved ones.
Media, morals and the mafia
Most people’s first experience of alkaline hydrolysis is through popular culture.
In the second episode of Breaking Bad, audiences sees drug dealer Jesse Pinkman dissolve a dead body in his apartment’s bathtub using hydrofluoric acid he’d sourced from his high school’s chemical stores. He returns the next day only to find the acid had eaten through the bathtub itself and floorboards beneath, before finally falling through to the floor below.
Despite the effective cinematics, Breaking Bad is far from realistic. Hydrofluoric acid, while highly corrosive, doesn’t have the capacity to completely liquefy remains overnight — it’s at the wrong end of the pH scale. It certainly doesn’t have the capacity to eat through a bath and the floor.
Even if it could, the science doesn’t check out — Mythbusters proved it.
Whether it’s a question of gulping down Soylent Green or shunting bodies into acid barrels, television and film haven’t been kind to the practice of alkaline hydrolysis.
Outside of television, urban legends have tarred alkaline hydrolysis with further negativity. In 2011, researchers had to debunk claims the Sicilian mafia disposed of human remains in a process called lupara bianca, or white shotgun. Just like in Breaking Bad, the mafia supposedly used acid — an entirely different, cruder chemical process.
Mafia urban legends and shows like Breaking Bad create a sense of violence surrounding water cremation that simply doesn’t hold up. Water cremation, at its core, is no more than the acceleration of a natural process.
The reality: As with almost all aspects of the death industry, there is a level of respect and dignity. You don’t see what happens in the retort of a flame-based cremator, but you won’t see what happens inside an alkaline hydrolysis machine either.
What remains to be dealt with, however, is what comes out the other side. Ashes are one thing — you can pop them on the mantle in a decorative urn, sprinkle them at sea or even have them launched into space — but what about the residual liquid?
One of the biggest roadblocks to the acceptance of alkaline hydrolysis technology is the issue of wastewater. Because of its association with death, the liquid is perceived as too unsanitary to be processed normally. Say it goes through the same recycling plants that supply residential areas, the idea of drinking the essence of a dead body sounds abhorrent. It’s hard enough swallowing the idea of recycled sewage water. Remains? Inconceivable.
But technology already exists to tackle almost any kind of wastewater.
Sewage water is filtered for reuse in municipal treatment plants. Organic material is broken down in anaerobic digesters, which convert the material into methane or “biogas.” Specially designed ultrafiltration systems can even tackle aqueous nuclear waste.
“Any liquid waste that we have, we can deal with,” says Ghadouani.
Yet in Australia, residual liquid from water cremation isn’t permitted to be treated via the municipal water treatment facilities or digesters. More worryingly, there’s a disconnect here — and it’s one that, for the most part, is behind the closed doors of the funeral industry.
“One of the most common things the public doesn’t know,” says leading US thanatologist and death educator Cole Imperi, “is that when someone is embalmed, all the blood that comes out of your body, where does that go? It goes down the drain.”
In fact, almost all the human waste that comes from hospitals and funeral homes as a result of the embalming process is permitted to be processed through these official channels.
“So if you’re allowing byproducts from funeral homes to go into the municipal water system for treatment, why are you discriminating against one particular disposition method?” Imperi asks. “It’s an interesting kind of cognitive dissonance.”
– Pandemic drives medically assisted deaths online
The coronavirus has stripped many of a say in the manner and timing of their own deaths, but for some terminally ill people wishing to die, a workaround exists. Medically assisted deaths in America are increasingly taking place online, from the initial doctor’s visit to the ingestion of life-ending medications.
Assisted dying laws allow terminally ill, mentally competent patients in 10 U.S. jurisdictions to hasten the end of their life. Waiting periods of 15 to 20 days mean that patients with acute COVID-19 won’t likely meet the requirements of these laws.
But the move to digitally assisted deaths during the pandemic has enabled other qualified patients to continue to exercise the right to die. While telemedicine is helping some people die on their own terms, it also makes the process harder on family members, who must now take a more active role in their loved one’s final act.
Assisted dying in America
I have spent the last four years studying assisted dying in America, particularly in Oregon and Washington, which have the country’s longest-standing assisted dying laws. California, Colorado, the District of Columbia, Hawaii, Maine, Montana, New Jersey and Vermont also allow medical assistance in dying.
A quirk in these laws has enabled the process to go virtual. While extremely restrictive in most ways, U.S. assisted dying laws don’t require a physician or other health care provider to be present at an assisted death.
Assisted dying laws require two doctors to independently evaluate a patient’s request for medical assistance in dying. But patients must be physically able to ingest the life-ending medication themselves, a safeguard that ensures they are acting voluntarily.
In Canada, by contrast, clinicians typically administer the lethal dose through an injection. Normally that’s a faster, safer and more effective method. But COVID-19 concerns are compelling some Canadian providers to suspend assisted deaths.
Attending to the dying
Though U.S. physicians aren’t required to attend an assisted death, many patients and their families do have help. In 2019, according to the Oregon Health Authority, 57% of all assisted deaths in Oregon were attended by a physician, another health care provider or a volunteer.
Trained volunteers – many of them former nurses, social workers and behavioral health experts – are critical in helping patients navigate the tricky path toward an assisted death. They know which physicians are willing to see aid-in-dying patients and which pharmacies stock the necessary medications.
In the United States, doctors prescribe a compound of four drugs – digoxin, diazepam, morphine and amitriptyline – to be mixed with water or juice. Within minutes of drinking the cocktail, the patient falls asleep, the sleep progresses to a coma, and eventually the patient’s heart stops.
Volunteers help mix the medication and supervise the ingestion, allowing families to be emotionally present with a dying loved one.
Now, because of the coronavirus, volunteers are accompanying patients and families over Zoom, and physicians complete their evaluations through telemedicine, based on recommendations released by the American Clinicians Academy on Medical Aid in Dying in March 2020.
Telehealth – a health care solution long used in remote areas – has become a critical tool of the COVID-19 pandemic. But some aid-in-dying physicians have drawn on telemedicine to reach far-flung patients for years.
“My patients love telemedicine,” Dr. Carol Parrot, a physician who lives on an island in Washington, told me during a Skype interview in 2018. “They love that they don’t have to get dressed. They don’t have to get into a car and drive 25 miles and meet a new doctor and sit in a waiting room.”
Parrot says she sees 90% of her patients online, visually examining a patient’s symptoms, mobility, affect and breathing.
“I can get a great deal of information for how close a patient is to death from a Skype visit,” Parrot explained. “I don’t feel badly at all that I don’t have a stethoscope on their chest.”
After the initial visit, whether in person or online, aid-in-dying physicians carefully collate their prognosis with the patient’s prior medical records and lab tests. Some also consult the patient’s primary physician.
‘Tough and tender situations’
The pivot to telemedicine hasn’t significantly changed that process. But patient advocacy organizations and physicians say the pandemic has amplified existing problems of access to assisted dying.
“These are tough and tender situations even without COVID,” said Judy Kinney, executive director of the volunteer organization End of Life Washington, via email.
During the pandemic, residents in these institutions who lack access to a digital device – or the skills to videoconference with a doctor – may not be able to qualify for the law, according to Dr. Tony Daniels, a prescribing physician from Portland.
Meanwhile, a family member who objects to assisted dying may more easily undercut the process when a volunteer isn’t there in person to make sure a patient’s final wishes are carried out.
Dying via telemedicine can be hard even on family members who stand behind their loved one’s decision, my research finds. Without a volunteer or physician present, families must assume a more active role in the dying process.
That includes mixing the life-ending medications themselves. Pre-pandemic, many families told me that preparing the lethal cocktail would make them feel like they were facilitating – and not just morally supporting – a loved one’s death. They were glad to outsource this delicate task.
Now they don’t have that choice.
Yet the option to assist in a loved one’s final act may be a comfort in this pandemic. It allows dying people to choose the manner and timing of their own death – and ensures they won’t be alone.
Complete Article ↪HERE↩!
– death and ageism in the times of Greek myth and coronavirus
The loss of life from the spread of coronavirus has been on an enormous scale. In the USA more Americans have now died from COVID-19 than in the entire Vietnam war.
Notwithstanding some poignant and passionate speeches by particular individuals (notably New York Governor Andrew Cuomo), much of the discourse has focused on the economic, political and policy division, rather than grief for the victims.
This broadly sanguine response might be due to perceptions that it is mostly older people dying from coronavirus, although experts warn younger people can die too. Witness the relief at new reports that children under 10 have not accounted for a single transmission of the virus. The deaths of older people have been comparatively discounted, not the least because many were socially isolated even before the pandemic.
The Greeks of antiquity reflected on the death of the young and the old in some very creative mythical narratives. Greek myth reflects on and reminds us of some of the less attractive characteristics of human life and society, such as sickness, old age, death and war. In the ancient Greek world this made it harder to put old age and death into a corner and forget about it, which we tend to do.
Achilles, the hero of Homer’s Iliad, actually has a choice in the timing of his life and death.
He can have a long life without heroic glory, back on the farm, or he can have a short life with undying fame and renown from his fighting at Troy. The fact that he chooses the latter makes him different from ordinary people like us.
Achilles’ heroism is fundamentally linked to his own personal choice of an early death. But it also means his desperate mother, the goddess Thetis, will have to mourn him eternally after seeing him for such a short time in life. Such is the pain for the loss of a child in war.
A play by the master Athenian dramatist Euripides is even more focused on young and old death. The play Alcestis was produced in Athens in 438 BC, making it the earliest surviving Euripidean play (about ten years before the plague at Athens).
In the play, the king of Thessaly – an appallingly self-interested person called Admetus – has previously done the god Apollo a favour, and so Apollo does Admetus a favour in return. He arranges for him to extend his life and avoid death in the short term, if he can find someone to take his place and die in his stead.
Admetus immediately asks his father or mother to die for him, based on the assumption that they are old and will presumably die soon anyway. But the father, Pheres, and his wife turn down Admetus, and so he has to prevail on his own wife, Alcestis, to die for him, which she agrees to do.
The story of the play is based around the day of her death and descent to the Underworld, with some rather comic twists and turns along the way. Death (Greek Thanatos) is a character in the play, and he is delighted to have a young victim, in Alcestis, rather than an old one. “They who die young yield me a greater prize,” he says.
The light of day
There is a particularly spiteful encounter between Admetus and his father on the subject of young and old death:
Yet it would have been a beautiful deed for you to die for your son, and short indeed was the time left for you to live. My wife and I would have lived out our lives, and I should not now be here alone lamenting my misery.
I indeed begot you, and bred you up to be lord of this land, but I am not bound to die for you. It is not a law of our ancestors or of Hellas that fathers should die for their children! … You love to look upon the light of day – do you think your father hates it? I tell myself that we are a long time underground and that life is short, but sweet.
The Alcestis of Euripides, and other Greek myths, remind us, should we ever forget, that love of looking upon the light of day is a characteristic of human existence, both for the young and the very old.
Complete Article ↪HERE↩!
This is different from saying we need to talk about death and dying (which we also need to do). I mean instead that we should focus our minds on what the human corpse means in this new pandemic reality.
Consider the number of dead bodies in the world before coronavirus. Based on global mortality statistics, approximately 56,842,500 humans died over the course of 2019. That’s roughly 155,732 people a day.
In the US, approximately 2,898,060 people died that year, which means about 7,939 a day. In the UK, the death rate for 2019 was 620,268, averaging 1,700 people a day.
It is easy to gloss over these statistics, since most of us never really think about millions of dead bodies. But what these numbers illustrate is that dead bodies are an everyday constant, we just don’t pay attention to them unless our job directly involves the dead.
So dead bodies are completely normal -– until suddenly they’re not. Until a novel virus sweeps the globe and produces a dead body count with life altering repercussions.
In order to manage and cope with the millions of dead bodies produced every year, different countries create what I call a “national death infrastructure” or NDI. The various parts of this infrastructure range from the local (a neighbourhood cemetery) to the global (systems in place for international repatriation). But crucially, the National Death Infrastructure is largely invisible to most of our lives.
Now COVID-19 is making NDIs visible. Indeed, the coronavirus pandemic is relentlessly demonstrating what happens when NDIs are not prepared for an unplanned spike in human mortality. We have seen thousands of coffins unattended in Italy, temporary emergency morgues in New York, and Spanish officials storing dead bodies at an ice rink.
Disturbing as many people find these news stories, everything happening to manage COVID-19 corpses is from various “mass fatality” and “disaster victim identification” playbooks. I know this because, as director of the Centre for Death and Society at the University of Bath, I’ve participated in consultations on governmental postmortem preparedness.
What’s different, of course, is that most people already oblivious to the NDI are wholly unprepared to see dead bodies rapidly produced in multiple countries, at the same time, and reported hourly on the news.
Imagine though, if details were broadcast for a year on how every one of the around 56 million people across the planet died – how they died and in what circumstances. Seeing this kind of detail in death might help people realise how important the infrastructure dealing with dead bodies really is, and why it needs to be financially supported by national governments.
Because right now, huge numbers of families cannot mourn their dead in the ways they expect to. We have seen this situation before with AIDS-related deaths, where next-of-kin were told a funeral was unsafe because HIV caused the death.
As I explain in my new book, Technologies of the Human Corpse, none of this was correct but that didn’t stop it from being said. And now COVID-19 flips the situation on its head. Funerals are currently not safe because living family members could spread COVID-19 by interacting with fellow mourners. The human corpse, this time, isn’t the viral issue. So the kind of funerals many of us are used to will have to wait.
And even for the kind of services that are now taking place, funeral directors in the US and the UK are running out of personal protective equipment (PPE) and body bags.
This is a bigger issue in cities like London and New York, but it will quickly affect small places too. Funeral industry workers are the essential frontline staff that both the living and the dead critically need right now, and like their colleagues in medicine and pathology, they are putting their lives at risk to ensure the national death infrastructure operates.
The current situation is not sustainable and governments will need to move quickly to manage the ever increasing numbers of dead bodies and make sure the funeral industry front line has the supplies it needs. They will also need to be prepared for a public backlash if they fail to do so.
Right now we all seem to be suffering from what I call “virological determinism” – we are blaming everything on a virus, when in fact blame lies with human failure to adequately follow existing public health pandemic response and preparedness planning. Failure which has created a situation where for weeks and months to come we will be confronted by mounting mortality statistics and dead bodies. More dead bodies than most national death infrastructures can manage.
So we need to talk about dead bodies and we need to do it now. And we should never forget that the COVID-19 dead bodies are mounting up because humans failed to effectively anticipate what new viruses almost always do – create human corpses.
Complete Article ↪HERE↩!