Recently, I’ve been reminded again how much words matter. And especially so when it comes to talking or writing about the death of a dear one.
For example, a friend told me she really is not a fan of the word bereaved. She prefers the word alone. I get it, and this is probably a better word for several reasons.
The death of a spouse or partner certainly results in a lot of aloneness. But it’s not limited to partners. The death of a parent, best friend, child or other dear one can leave one feeling very alone. It’s bigger and more personal word than bereaved.
In another example, a friend said she doesn’t care for the word grief anymore. The way I understood it, she meant that, as she had been learning how to cope with the death of her beloved spouse, the word grief felt as if it’s drawing her backward. This at a time she’s trying to adjust going forward without him. This made me stop and think.
I think these are two reminders of how complicated it is to talk about death, and how personal it is. So I started reflecting on myself. And I realized I have quite a list of do’s and don’ts as well! Mine center on common euphemisms. For instance, I personally avoid words such as lost, passed, passed away, late, taken, departed and other euphemisms. I would rather hear or read the actual word — died. Especially when it comes to my own loved ones.
In one episode of “Downton Abbey,” actress Maggie Smith, who played the role of dowager Lady Grantham, had a visitor. When that person referred to her husband as “was taken,” she said something like this: Lord Grantham was not taken, he died.
Now I realize not everyone feels as strongly as I do about this topic. And I realize these other words are in very common usage, and friends and family do not mean to upset or irritate us by using them. Actually, even many clergy and funeral directors use those very euphemisms. So be it. And they are commonly written in obituaries and used in eulogies.
We already are well aware that most people struggle with what to write in a card or note to a friend. But how to refer directly to the person who died is a somewhat different challenge.
So what is the point? Well, I think it’s basically we need to figure out what your friend or relative prefers. It’s complicated of course. You may know the person well enough to know what to say. But a surefire way to know is — just listen to them. You will hear the right word.
Celebrating a new year — as Jews the world over will do this week, when Rosh Hashana begins on Friday at sunset — is all about making changes. It’s a time for new beginnings, for wiping the slate clean and starting over from scratch. In that spirit, on Rosh Hashana Jews say prayers and listen to readings that celebrate the creation of the world and of human life.
But Rosh Hashana also strikes a different, seemingly discordant note. Unlike so many other New Year’s traditions, the Jewish holiday asks those who observe it to contemplate death. The liturgy includes the recitation of a poem, the Unetaneh Tokef, part of which is meant to remind Jews that their lives might not last as long as they’d hope or expect. “Who will live and who will die?” the poem asks. “Who will live out their allotted time and who will depart before their time?”
And we’re not talking about a gentle death at the end of a reasonably long life; we’re talking about misfortunes and tragedies that can cut any of our lives short. “Who shall perish by water and who by fire,” the poem continues, “Who by sword and who by wild beast / Who by famine and who by thirst / Who by earthquake and who by plague?”
This focus on death might seem misplaced, bringing gloom to the party. But as a research scientist who studies the psychological effects of spiritual practices, I believe there is a good reason for it: Contemplating death helps people make decisions about their future that bring them more happiness. This is an insight about human nature that the rites of Rosh Hashana capture especially well, but it’s one that people of any faith (or no faith at all) can benefit from.
When planning for the future, people typically focus on things that they think will make them happy. But there’s a problem: Most people don’t usually know what will truly make them happy — at least not until they are older. Across the globe, research shows, people’s happiness tends to follow a U-shaped pattern through life: Happiness starts decreasing in one’s 20s, hits its nadir around age 50 and then slowly rises through one’s 70s and 80s, until and unless significant health issues set in.
Why the turnaround at 50? That’s when people typically start to feel their mortality. Bones and joints begin to creak. Skin starts to sag. And visits to the doctor become more frequent and pressing. Death, hopefully, is still a good ways off, but it’s visible on the horizon.
You might think this morbid prospect would further decrease contentment, but it ends up having the opposite effect. Why? Because it forces us to focus on the things in life that actually bring us more happiness. Research by the Stanford psychologist Laura Carstensen has shown that as we age, we move from caring most about our careers, status and material possessions to caring most about connecting with those we love, finding meaning in life and performing service to others.
That’s a wise move. When people in the Western world want to be happier, research shows, they tend to focus on individual pursuits. But that same research confirms that this strategy doesn’t work well: Pursuing happiness through social connection and service to others is a more reliable route.
Of course, you don’t have to be old to confront death. During the SARS outbreak and the Covid pandemic, younger adults changed what they valued, research showed. When death suddenly seemed possible for anyone, even those in the prime of their lives, younger people’s opinions about how best to live suddenly began to look like those of seniors: They turned toward family and friends, finding purpose in social connection and helping others.
You don’t even need to face something as drastic as a pandemic to experience some version of these changes. Research shows that simply asking people to imagine that they have less time left, as congregants do on Rosh Hashana, is sufficient.
Rosh Hashana hardly has a monopoly on this insight. Christian thinkers such as Thomas à Kempis and St. Ignatius of Loyola urged people to contemplate death before making important choices. Stoics like Marcus Aurelius argued that meditating on mortality helped people find more joy in daily life.
But the particular brilliance of Rosh Hashana is that it combines thoughts of death with a new year’s focus on a fresh start. As work by the behavioral scientist Katy Milkman and her colleagues has shown, temporal landmarks like New Year’s Day offer an effective opportunity for a psychological reset. They allow us to separate ourselves from past failures and imperfections — a break that not only prods us to consider new directions in life but also helps us make any changes more effectively.
There is a lesson and an opportunity here for everyone. Contemplate death next Jan. 1 (or whenever you celebrate the start of a new year). Any brief moments of unease will be well worth the payoff.
The one big thing that people have in common is that we all will die, and we likely will experience the death of someone we love, too.
And yet despite this shared future, death can be hard to talk about, because it’s not an experience that anyone can report back from to say how it went. When you or a loved one starts approaching death, the existential stakes can go from theoretical to personal, sometimes feeling emotionally, physically and spiritually fraught.
That’s why it can help to hear the insights of people who see death all the time, because understanding it now can help us better process grief about others and feel more at ease when thinking about our own mortality.
I had conversations with palliative and hospice care physicians, nurses and social workers that comforted me, surprised me and challenged my own assumptions about death. Maybe they will for you, too.
Here are some of the biggest misunderstandings they shared with me about death and what the reality actually is:
The physical process of dying doesn’t look like it does in the movies.
This was a repeated theme among the experts I spoke with. Pop culture may have you thinking that death happens quietly and quickly, with eyes closing and arms crossed, but dying from natural causes often looks different in real life.
“My own dad said to the nurse, ‘I’m about ready to hang it up,’ and then he died minutes later. But that type of death is very uncommon,” said Penny Smith, a hospice quality manager and registered nurse in Washington state.
In her decadeslong career, Smith said she’s only come across a few instances in which people died quickly.
“It’s usually more of a process where they go into that unresponsive state, and there’s all kinds of things going on with their body. Their color’s changing, their breathing is changing and then they finally slip away,” she said.
Smith started posting TikTok videos about working in hospice care during the COVID-19 pandemic shutdown of 2020 and has since amassed around 640,000 followers on the platform. She uses skits and sound effects to educate people on what it’s like to be in the room with someone who is dying, covering topics like deathbed visions to the sounds that dying people make.
Common responses to her TikToks are comments of relief, acceptance and commiseration at seeing someone describe an experience that resembles how their own loved ones died.
“I, as a hospice nurse, have been with so many families where they were really disturbed by what they were seeing, or scared. And I would say: ‘That’s normal. We see that all the time.’ The relief is palpable,’” Smith said.
In one TikTok, Smith explains that when a person’s body is “shutting down,” it’s normal if they do not want water. A top comment on the video reads: “Thank you for this. My mom stopped drinking when we knew she was going to pass and I still felt like I should have tried to have her drink water more.”
Among all the physical processes of dying, Smith said the biggest misunderstanding she sees is when family members worry that their loved ones are dying of starvation because they’ve stopped wanting to eat.
“These are people who are already dying. They don’t need the food,” Smith said. “And when the family starts to try to force them or coerce them into eating just by, ‘Come on, just have a bite just to eat something,’ it just sets up so much stress between the family and the person.”
Similarly, families often worry that the use of morphine and other opiates will hasten the death of loved ones, according to Frances Eichholz-Heller, a senior social worker for the palliative care consult service at NewYork-Presbyterian/Columbia University Irving Medical Center.
“Some people will say to me, ‘Well, we had an uncle who was in the hospital dying, and then as soon as they put the morphine on, he died really quickly,’” Eichholz-Heller said. “I have to explain to them: ‘Well, he probably died really quickly because he was dying. He wasn’t dying because of the morphine, but they put him on the morphine to help.’”
Families can live with a lot of regret over what they should have done.
If you are seeking to support a loved one who is dying, be mindful of how your own fear and discomfort could impact what a dying person shares with you, said Dr. Aditi Sethi, a North Carolina-based hospice physician and end-of-life doula.
According to Sethi, some dying people try to talk about their experience with loved ones but the families dismiss it because of their own discomfort, using language like “You’re not dying, don’t worry about it.”
“So many times, loved ones have the most regret,” Sethi said. “They’re so terrified of losing their loved one that they can’t be fully present to their loved one at the time when they need them the most, really — to hold their hand and to really honor what they’re going through, and have a space to share what they’re experiencing in this epic journey they’re about to embark on.”
But if you had a strained relationship with the person before they were dying, don’t feel like you have to force a connection that is not authentic, either. “Your relationship with the dying person is personal, and if you didn’t have a good relationship, you are not obligated to go and be with that person,” Smith said.
It’s also important to provide space for people to be themselves when they are grieving, said Ladybird Morgan, a California-based registered nurse, palliative care consultant for the company Mettle Health, and co-founder of the Humane Prison Hospice Project nonprofit.
“I really ultimately believe that what happens is what needs to happen. And I see a lot of suffering for families that get left behind when they feel like they should have done something different,” Morgan said. “You grieve the way you’re going to grieve. You let go the way you’re going to let go. I tend to want to be careful about saying, ‘You should do X, Y and Z.’”
Not everyone wants silence or a somber mood when they are dying.
Health care providers and family members can make assumptions about what a dying person would find comfortable, without considering what that person truly enjoys. Some people may desire silence, but others may welcome raucous celebrations.
Smith recalled worrying about a football game party happening in the room of a dying woman until one of the patient’s adult sons reassured Smith that this was her passion.
″[The son] said: ‘Oh, my gosh, she was the queen of football parties every Sunday [with] everybody in the neighborhood. Yes, she loves this,’” Smith said. “I was new in my hospice career and making assumptions about what I thought a dying person would want. I thought they would want a quiet, dark room, and that’s not necessarily the truth.”
Not enough people plan or talk about how they want to die.
Most Americans say that given the choice, they would prefer to die at home, but about 1 in 5 deaths in the U.S. occur after admission to an intensive care unit. In the book “Extreme Measures: Finding a Better Path to the End of Life,” Dr. Jessica Zitter details what she calls the “end-of-life conveyor belt” — a type of care in which dying ICU patients receive painful treatments to be kept at alive at all costs.
“Unfortunately, by the time someone is on the conveyor belt, it’s often too late to talk to them about what they want. And then everybody is trying to play catch-up. And it’s hard to get it right when the chips are down and there’s so much emotion,” said Zitter, who specializes in palliative medicine and critical care.
“So my recommendation is to talk about these issues early on in life, maybe starting when you become an adult. Start to think about your mortality, and visualize how you would want things to go for you when you get into that stage of life, the end stage. Communicate honestly.”
“The people that I notice that have the least amount of distress are the ones … [who] have lived really fully, and that they can say to themselves, ‘I was here.’”
– Ladybird Morgan, a palliative care consultant at Mettle Health.
Filling out forms for so-called advance care planning goes a long way. But “it’s as important that you, number one, identify a person you trust — or two or three [people] — that can honor your wishes,” Sethi said, “and have the conversations ahead of time, before you’re in the state where you can’t communicate your needs and wishes.”
Some hospice workers recommended Five Wishes, an advance care planning program, as one way to get clarity on how you want things to go.
Morgan recommended playing a card game called GoWish with a friend, a partner or someone else you hope will follow your end-of-life wishes. “[The cards] have different statements on them about possibilities of what you might want or not want,” she said. “And you make stacks of the ones that you like, the ones that you know you don’t care about, and the ones that you’re not sure about.”
Someone playing the game may find it difficult to choose which cards represent their values, which is why Morgan suggests having two people play together, so that it can be a conversation starter.
Keep in mind that there is no one right way to die, and preferences may differ.
“There are people who feel that every moment of life is precious and that they value the length of life over the quality of life,” Eichholz-Heller said. “So they are willing to endure a certain amount of suffering to be able to be kept alive. Then there are other people who value quality of life over length of life. And they would rather focus on comfort, even if it means that they won’t live as long.”
There are still a lot of negative associations with hospice care, even though it can be helpful.
There’s a difference between palliative care and hospice. Palliative care workers help to make patients comfortable at any stage of their life if they’re suffering; hospice is a medical service specifically for people with a short-term life expectancy. While anyone living with a serious illness can seek palliative care, Medicare will help cover hospice care costs for people in the U.S. if their health care provider certifies that they are terminally ill and have six months or less to live.
Some people wrongfully assume that going into hospice automatically shortens the life of a patient. Smith said she has been called a murderer for working in hospice care, adding that the worst myth about hospice workers is that they kill their patients.
“People think that when you go on hospice, it’s a death sentence and that death is imminent,” Smith said. She cited former President Jimmy Carter, who entered hospice care in February and is still alive today, as one prominent example of how that is not always the case.
In fact, research shows that seeking palliative care at an early point can improve quality of life. Published in 2010, one study on advanced lung cancer patients found that offering early palliative care on an outpatient or ambulatory basis led to fewer clinically significant depressive symptoms and a longer median survival.
“When patients are suffering, they use so much of their energy just to fight the suffering that if we can make them comfortable, they sort of stabilize,” Eichholz-Heller said. “And a lot of times, it really helps them to live longer.”
Hospices can differ in their approach to care and the additional services they offer. There are resources that can help you figure out the right questions to ask to select the best hospice for you or a loved one.
We can’t control death.
There can also be a misunderstanding about the medical community’s ability to defeat death — even from health care workers themselves.
“The biggest misunderstanding that I see [among] patients, families and even health professionals around the issue of death is that we think we can control it,” said Dr. Solomon Liao, a UCI Health physician in California who specializes in palliative medicine and geriatric pain management.
“We believe that with all of our machines, technology and medications, we can determine when or even if that happens. Instead of accepting death as a natural endpoint of this life, we get depressed and even angry when it happens. We avoid planning for it or even talking about death, and then are shocked when it happens.”
The reality is that we can’t control death ― and we’ll all experience it at some point. “The people that I notice that have the least amount of distress are the ones — not so much that they’ve controlled every element, but that they have lived really fully, and that they can say to themselves, ‘I was here,’” Morgan said. “And people around them can honor that and acknowledge that like, ‘Yeah, we saw you, we felt you.’ … And that was so important for them, allowed a deep relaxing into what was coming next.”
At the same time, it’s OK not to be ready.
Morgan said many conversations around death and dying have focused on making sure someone is ready and not as much on cases in which a person loves life until the last minute and is not ready to go.
“It’s OK to miss life,” she said. She recalled talking to a client about how he knew everyone else was going to be all right after he died, and how that was heartbreaking for him.
In our conversations, hospice and palliative care providers suggested that it’s helpful to keep an open mind about death — leaving space for it to be “both and,” as Morgan told me.
Death can be devastatingly sad, but it doesn’t only have to be a somber occasion, as Smith’s TikTok skits show. Dying may be painful due to a terminal illness, but it’s not inherently so, Sethi said.
“It can be positive and hard,” Morgan said. “It can be, ‘It was exactly what needed to happen, and they had a beautiful death’ and ‘Wow, was that hard to see them go because I would’ve loved to have had them around for 10 more years.’”
There’s no shortage of home decluttering methods— take Marie Kondo’s popular minimalist approach, the KonMari Method, for example. But when it comes to downsizing your belongings, including furniture, clothing, shoes, kitchen essentials and even documents, to prepare for your older years, Swedish death cleaning is an approach that’s worth considering.
Swedish death cleaning is a well-known concept in Swedish and Scandinavian culture, where you work on eliminating unnecessary items from your home, so loved ones won’t be burdened with the task after you pass.
The thorough organizing method involves editing everything from furniture and clothing to the ever-growing piles of documents that’s been difficult to control over time. It’s a slow process that’s been all the rage lately, thanks to Peacock’s new show, The Gentle Art of Swedish Death Cleaning, which is produced by Amy Poehler. While Swedish death cleaning is all about holding onto essential belongings, pinpointing the items you want to keep and part ways with isn’t an easy process.
So, follow the checklist below to get started and decide whether this buzzy cleaning method is right for you.
When starting, focus on areas you may find the easiest to tackle. According to Magnusson’s book, the attic or basement may be best since they are more likely to have unnecessary excess items, like broken seasonal decorations. Choose belongings you don’t have emotional attachments to and determine the category you want to scrap first, such as unwanted clothes, books or even half-empty bottles of skincare. There’s actually no time limit or definitive checklist to know when you’re done. It’s all about how you feel and the goals you want accomplished.
The Gentle Art of Swedish Death Cleaning
The Gentle Art of Swedish Death Cleaning
1. Start with your closet.
There’s no need to start with personal and sentimental items, like love letters or your children’s photographs. In fact, our closets and drawers may be the easiest to organize. You’re sure to have two or more garments of the same color and size that you never wear.
Choose clothes that no longer fit, discard damaged shirts or pants and donate items that no longer suit your lifestyle. Since you may have a bulk of clothes to sort through, don’t worry about how long it’ll take. Start with seasonal clothing and gradually work your way through your piles over the course of a few months (or even years if you must!).
2. Declutter by size.
Go for the large items first, such as any furniture or rundown decor hidden away in the garage —think broken tables, chairs or smelly rugs. Then, move on to smaller items you can easily discard in boxes. We’re talking about shoes you barely wear, any excess magazines and more!
If you find it easier, go room by room instead of decluttering your house as a whole. You can start off in the kitchen by ridding your cabinets of the 20 plates hidden in the back or burnt pots you still keep in the oven. As you clean, you may find many “just in case” items you’ve been holding onto for emergencies. Sadly, they only create clutter and should be discarded too.
3. Start buying less.
The fewer items you have, the less time you’ll need to clean! It doesn’t matter what age you start Swedish death cleaning, it pays to limit shopping to avoid feeling overwhelmed. And don’t worry, as this doesn’t mean you have to stop buying the things you love. It’s simply about taking time to rethink your purchases— for example, there’s no need to buy yet another pair of shoes when you already have a large sneaker collection.
4. Discuss the process with loved ones.
Your family and friends may not understand why you want to start this process, but it’s still important to share the journey with them. Plus, they may have items they want to keep or pieces they want you to cherish until the end (a school painting or Christmas gift are just a few ideas to consider). It might also be helpful to invite them on your decluttering journey. It can be a beautiful and nostalgic way to reflect on memories throughout your life.
Julie McFadden, a hospice nurse in California. McFadden has spoken publicly about end of life care as she tries to educate people about how death with dignity takes place.
Many people might not like talking about end-of-life care or death until they’re faced with it themselves, but this hospice nurse wants to remove the taboo from the topic and educate people instead.
As an intensive care unit (ICU) nurse for over a decade, Julie McFadden, 40, focused on keeping patients alive, but when she made the switch to hospice care eight years ago, her attention turned towards making people feel comfortable as they neared the end.
McFadden, from California, regularly talks about the realities of hospice care, and what happens when a patient opts for medical aid while dying, on social media. She told Newsweek: “My main point is to make everyone a little less afraid of death. I want to change the way we look at death and dying.”
Medical aid in dying (also referred to as death with dignity, physician-assisted death, and aid in dying) is the prescribing of life-ending medication to terminally ill adults with less than six months to live, who are mentally and physically capable of ingesting the medication independently.
At present, only 10 states and the District of Columbia permit this process, but there is growing support elsewhere. A survey of over 1,000 people in 2023 by Susquehanna Polling and Research concluded that 79 percent of people with a disability agree that medical aid in dying should be legal for terminally ill adults who wish to die peacefully.
States where it’s permitted include Colorado, California, Washington, Hawaii, Maine, Montana, Oregon, and Vermont. Legislation is also being considered in Massachusetts, New York and Pennsylvania.
How the End of Life Drug Is Administered
As a hospice nurse in California, where a bill was passed to permit death with dignity in 2015, and became effective from June 2016, McFadden has assisted many patients who wanted to die on their terms.
She believes that there is real beauty in someone being able to have full autonomy over their death and choosing when they go, but she knows it’s a polarizing issue.
“People have to remember that not everyone has the same beliefs and I think it’s a beautiful thing that someone gets to have control over,” McFadden told Newsweek. “It’s powerful to witness someone be so alert, say goodbye to their loved ones, have their loved ones watch them take this drink and then die, but still be willing to be there to support them.
“I think most people in the U.S. have no idea that this law even exists, and even when I give very descriptive explanations of what the law is, what it means, what the criteria is, there’s still people who think I’m just overdosing patients with morphine.”
In order to acquire the medication, an individual’s request must be approved by two doctors, they have to undergo a psychological evaluation to ensure they aren’t suicidal, and doctors have to confirm that the person is capable of making their own decisions. Patients with certain conditions do not qualify, including those with dementia.
If approved, the person must take the medication themselves, and they can have family, friends, and hospice staff present if they wish.
Since June 2016, in California 3,766 death with dignity prescriptions have been written, and 2,422 deaths registered. To protect the confidentiality of any individual who makes this decision, death certificates usually note an underlying illness as the cause of death.
McFadden continued: “There are a few drugs mixed in, it’s taken all at once and the initial drugs kick in very quickly, within three to seven minutes. This person who ingested this drug will fall asleep or basically go unconscious. I say fall asleep just so people can picture what it looks like, but they’re unconscious.
“Then, the body is digesting and taking in the rest of the drugs that are also in that mixture, which will eventually stop the heart. It’s a general sedative and then they take two different cardiac drugs to stop the heart.
“They have a change in skin color and changes to their breathing, in what we call the actively dying phase, which is the last phase of life.”
Julie McFadden pictured, a hospice nurse in California. McFadden spent several years as an ICU nurse before going into hospice care in 2015.
People Have A Lot of Misconceptions
Regardless of whether you’re in a state that permits physician-assisted death or not, dying isn’t regularly talked about in a positive way.
One of the reasons why McFadden wants to have a more open conversation about it is to remove any prior misconceptions that people might have and educate them on what really happens.
“I have not seen anyone show signs of pain, but people are always concerned about that,” she said. “In general, if you’ve done this for a long time, if you’ve been in the healthcare system and work as a nurse or by someone’s bedside, you know what a body in pain looks like, it’s very obvious.
“A person who is unconscious and can’t verbally say they’re in pain will show you with their body language. Most people that have taken this medication who I have witnessed did not show those signs. I witness it day in, day out, but it’s pretty miraculous to see how our bodies, without even trying, know how to die. They’re built to do it.
“People get really angry and think I’m trying to hurt people. I always want to educate people around this topic, because the main thing people don’t want is for their loved ones to suffer at the end of life.”
As an ICU nurse formerly, McFadden explained to Newsweek that she was trained to keep patients alive, and they “didn’t have conversations about death early enough.” Despite patients being near death, they were kept alive through machinery for weeks or months, before ultimately dying on the ward.
Many of the country’s biggest medical associations are conflicted by death with dignity, with some choosing to endorse it, and others speaking against it. The American Public Health Association, and the American Medical Student Association are among the bodies to endorse it, but it has been publicly opposed by the American Medical Association and the American College of Physicians.
Hospice nurse Julie McFadden, 40, from California, has been discussing death with dignity. Death with dignity is permitted in California, so McFadden has shared her experiences of helping patients go through that process.
Talking Openly About Death
In 2021, McFadden set up her TikTok account (@hospicenursejulie) to speak openly with her followers about death and answer any questions people might have. Many of her videos have gone viral with millions of views, and while she does get a lot of positive feedback, there is also plenty of negativity.
There are people who wholly disagree with her advocacy for death with dignity as they claim she is playing God, or that she’s promoting suicide. But by having an open conversation, the 40-year-old hopes to make people less fearful of dying.
Speaking to Newsweek, she said: “Most of my audience is general public, that’s why I don’t talk like I’m speaking to other nurses or physicians. I talk like I’m speaking to my families who I talk to in everyday life. I think death just isn’t talked about, or it’s not explained well.
“I’m seeing so many times that people who are willing to have difficult conversations about their own death, who are willing to say they’re afraid to die, those patients who were willing to ask me those things and talk to me about death, had a much more peaceful death.”
Family members or close friends may choose to be involved in washing and dressing the body after death has occurred. Caring for a body is not easy and can stir up strong emotions. See Moments After a Death. Many people turn to health care providers and funeral directors for help. They find comfort and assurance in entrusting the body to those who provide professional services. The deceased may have left instructions for their after-death care to be handled by the health care team and chosen funeral home. Other people practice religions or belong to communities that view care of the body as a family responsibility. Their faith community, elders or neighbours provide guidance and support for hands-on care of the body. For some, this is a way of honouring the person – a final act of kindness to him or her.
This article outlines the steps involved in the care of the body after death.
In advance of the death
Talk to the health care team in advance about family or friend involvement in after-death care. You may also want to talk to the health care team about the supplies and assistance that will be required. Washing, dressing and positioning the body
Washing and dressing the body is an act of intimacy and sign of respect. Those who were most involved in the person’s physical care may feel the most comfortable in doing this. Continued respect for the person’s modesty is essential.
Regardless of whether the person died at home or in hospital, hospice or nursing home, washing and positioning the body is best done where death occurs before stiffening of the body (rigor mortis) sets in. Rigor mortis happens within two to seven hours after death. Regardless of the location of care, you may need four to six people to help in gently moving and turning the body.
At home, you can wash the body in a regular bed. However, a hospital bed or narrow table will make the task easier. Since the body may release fluids or waste after death, place absorbent pads or towels under it. It is important to take precautions to protect yourself from contact with the person’s blood and body fluids. While you are moving, repositioning and washing the body, wear disposable gloves and wash your hands thoroughly after care.
Washing the person’s body after death is much like giving the person a bath during his or her illness.
1. Wash the person’s face, gently closing the eyes before beginning, using the soft pad of your fingertip. If you close them and hold them closed for a few minutes following death, they may stay closed on their own. If they do not, close again and place a soft smooth cloth over them. Then place a small soft weight to keep the eyes in position. To make a weight, fill a small plastic bag with dry uncooked rice, lentils, small beans or seeds.
After you have washed the face, close the mouth before the body starts to stiffen. If the mouth will not stay shut, place a rolled-up towel or washcloth under the chin. If this does not provide enough support to keep the mouth closed, use a light-weight, smooth fabric scarf. Place the middle of the scarf at the top of the head, wrapping each end around the side of the face, under the chin and up to the top of the head where it can be gently tied. These supports will become unnecessary in a few hours and can be removed.
2. Wash the hair unless it has been washed recently. For a man, you might shave his face if that would be his normal practice. You can find step-by-step instructions in the video Personal Hygiene – Caring for hair.
3. Clean the teeth and mouth. Do not remove dentures because you may have difficulty replacing them as the body stiffens.
4. Clean the body using a facecloth with water and a small amount of soap. Begin with the arms and legs and then move to the front and back of the trunk. You may need someone to help you roll the person to each side to wash the back. If you wish, you can add fragrant oil or flower petals to your rinse water. Dry the part of the body you are working on before moving to another. Some families or cultures may also choose to apply a special lotion, oil or fragrance to the person’s skin.
5. Dress or cover the body according to personal wishes or cultural practices. A shirt or a dress can be cut up the middle of the back from the bottom to just below but not through the neckline or collar. Place the arms into the sleeves first and then slipping the neck opening over the head, tucking the sides under the body on each side.
6. Position the arms alongside his or her body and be sure the legs are straight. If the person is in a hospital bed with the head raised, lower the head of the bed to the flat position.
If a funeral home is assisting with the funeral, cremation or burial, call to arrange for transport of the body to their facility. If the death has occurred in a hospital, hospice or long-term care facility, the staff will arrange for the body to be picked up by the funeral home of your choice. In hospital, once the family agrees, the body is moved to the morgue and kept there until transported to the funeral home.
If your family is planning a home funeral or burial, cover the body in light clothing so it will stay as cool as possible. A fan, air conditioning, dry ice or an open window in the room where you place the body will help to preserve it.
As one of Lauren Richwine’s clients lay in bed, his stepdaughter wrote a note and slid it into the shirt pocket over his motionless chest. Friends from the local music scene cried at his side as they prepared to carry the former bassist out of his home, permanently.
Cancer killed the young father. Instead of being rushed away to prepare for burial, his family kept him at home for a day. He rested in a sunroom, Richwine said, where the people in his life grieved and his children climbed in and out of bed with his body.
Richwine runs Death Done Differently — a Fort Wayne company specializing in “community-led death care.” She does end-of-life planning and informs people about alternatives to conventional funerals.
“Some people (say), ‘Isn’t it going to be traumatizing to the children, or couldn’t it be traumatic to see or be with someone after they’ve died?’” Richwine told IndyStar. “And I think, in my experience, it’s the opposite. It’s traumatic when we remove them too fast because we haven’t had time for this to really sink in.”
But as of this week, her work is on hold. On Wednesday she launched a new lawsuit against Indiana after the state shut her business down.
Attorney general’s office says she needs funeral director license
Death Done Differently caught the attention of the Indiana Attorney General’s Office in 2021. Someone filed a complaint against Richwine with the office. The complaint didn’t allege she harmed or deceived anyone, according to a copy reviewed by IndyStar, but said she “may require a license from the state to provide funeral services.” It doesn’t say who complained.
After giving Richwine the chance to reply, the office asked the State Board of Funeral and Cemetery Service for a cease-and-desist order.
Death Done Differently “offers several services that constitute the practice of funeral service,” the office said. It points to services like discussing body disposition, helping with legal paperwork and “readings, music, conversation, healing touch, or general companionship with the dying individual.”
State law says the practice of funeral service includes “the counseling of individuals concerning methods and alternatives for the final disposition of human remains.”
The board agreed. It issued a cease-and-desist order against Richwine on Aug. 21.
Richwine says her work is protected by the First Amendment
Her lawsuit claims Indiana is restricting her free speech because her work is speaking with and educating clients. Richwine’s attorneys want a judge in federal Northern District of Indiana court to issue an injunction that would stop the state from denying her “ability to speak with adults regarding death care.”
“There are a lot of people who currently talk about funeral options, funeral care that are not funeral directors,” Richwine said.
She gave the example of pastors. Some have “healthy relationships” with funeral homes and can be a link between congregants and funeral providers.
“Are they going to now be not allowed? Where does this end if they don’t want you talking about any of the laws and any of the funeral code at all?”
IndyStar has asked the attorney general’s office for its response to the lawsuit.
Former client: ‘She was just there to facilitate’
Andrea Schwartz’s family called Richwine hours after her daughter, Nova, was stillborn. It happened five years ago.
She told IndyStar Richwine played a different role than the funeral home her family worked with.
“Our experience was she was just there to facilitate, give us information, show us what our choices were, support us through it,” Schwartz said. “But then as far as the actual funeral, all the procedures and everything were done through a funeral home with their own funeral director.”
Richwine gave “warm support and comfort.” It was like night and day compared with Schwartz’s past experiences with elderly deaths in the family.
“It was never a positive experience” working with corporate funeral homes, she said. It was cold and impersonal, “like you’re just a number to them.”
“Kind of feeling like you were at a car sales lot the whole time,” Schwartz said.
Lawsuit says traditional funerals ‘medicalize’ death
Richwine’s lawsuit says she advises people about options other than the “historically recent innovation” of “embalming the body, holding a ceremony in a funeral parlor, and cremation or burying in an expensive casket.”
That process “medicalizes death,” the suit claims. It points to home funerals as one alternative, adding that bodies don’t present health risks to those in their vicinity for at least three days “in ordinary circumstances.”
“There’s a weird dynamic at work, where we have been normalized to relate to someone when they die as … not really belonging to us anymore,” Richwine said. “That’s part of what my work comes out of, this very strong belief that they still belong to those loved ones and the relational ties that were created, those deserve to be honored and respected.”
