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Knowing Someone Has Your Back At The End Of Your Life

By Sara Zeff Geber, PhD

While we were celebrating Passover and Easter with our loved ones and family, National Health Care Decisions Day came and went. It was on Saturday, April 16. It was designated to remind us that no matter our age, planning for the inevitable day when we cannot make our own health care decisions is more than a good idea; it is essential. Not planning for that inevitable event is like flying a plane that you don’t know how to land. The only people who don’t need a plan are those who meet their demise like my father: standing and talking to a friend one minute, and in an instant was lying on the floor – dead. If you are sure that is your fate, then don’t waste your time doing any planning. However, be advised that the ultimate result of not providing end-of-life instructions is that when you find yourself in the hospital toward the end of life (as many people do), the hospital ‘care protocol conveyor belt’ takes over and you will be hooked up to whatever life-support is available to keep your body nourished and your heart pumping.

What Do People Want?

Let’s look at some facts and some history about end-of-life care. Studies on end-of-life preferences demonstrate quite clearly that the vast majority of people want to die at home. However, because of a lack of willingness to talk about preferences for end-of-life care and advance care planning, over one-fifth of patients still die in the hospital. If your wish for the end of your life is an extended stay in an acute care unit of a hospital, hooked up to machines designed to keep you alive, then by all means ignore all of these statistics and opportunities to make other choices. My friend Mitch, a retired ER doc, told me how frequently he watched as family members argued about whether to keep their elder relative alive through extraordinary measures (feeding tube, mechanical ventilation, urinary catheterization, dialysis, etc.) or to let them die a more natural death. Often these well-meaning relatives were confused about what the elder wanted, or remember hearing it differently than another relative. In the end, and in the absence of written instructions, the final decision was almost always “keep her alive.”

End-of-Life Care Will Cost You

For those who still are not convinced that planning is the best way to ensure an end-of-life experience that is under your control and as comfortable as possible, you may also want to consider the cost implications of hospital care versus palliative or hospice care at home.

End-of-life costs for people with chronic diseases can be $57,000/yr. and up. Medicare will generally pick up most of that, depending on medigap coverage, pre-approvals and cooperating providers, and how long you are expected to live, but one study found that out-ot-pocket expenditures for end-of-life treatments and care are still averaging close to $12,000., with a range that goes up to close to $100,000. in the final year of life.

Medicare has covered hospice care since 1983 and usage of this benefit has slowly been increasing. In 2018, for example, 50.7% of those who died had taken advantage of hospice care for their final weeks or months of life. The savings associated with using hospice, rather than in-hospital care or a nursing home is estimated to be $117.-$400. per day.

The best-known way of creating an advance directive (also known as a healthcare proxy or power-of-attorney for health care decisions), is to work with an attorney who specializes in estate planning. They will suggest that you create a full set of end-of-life documents, which usually includes a will, a power-of-attorney for financial decisions, an advance directive, and possibly a trust. They will give you a worksheet and have a series of discussions with you about your preferences for end-of-life care and who you would choose to make decisions for you about your health and finances if you could not make them yourself. In addition to denial about the urgency of creating these documents, the cost of a complete estate plan can range from $1000-$8000., depending on how complex it needs to be.

Quick and Easy Advance Directive Online

If you are now convinced that advance care planning is important and necessary but you aren’t ready to do the full estate plan, there is a way to produce and file just the advance directive document, online – and it’s free! Since 2009, Vital Decisions has worked with individuals through health insurers to set up their wishes, should they be unable to communicate their wants at the end of life. Today, in addition to their insurance partners’ clients, they also offer a free program for the general public. It’s called My Living Voice and it guides you through three stages of preparing an advance directive: 1) setting a healthcare proxy 2) Talking through values 3) Goals of Care and Treatment wishes. So check it out, in honor of National Health Care Decisions Day, and give your loved ones the peace of mind of knowing what you want at the end of your life. Plus, it will give you peace of mind that you have communicated your final wishes to those who will be making decisions for you when you cannot.

Complete Article ↪HERE↩!

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Sadness and Loss Are Everywhere. Books Can Help.

By Margaret Renkl

I was 10 when “Brian’s Song” aired in 1971 as an ABC Movie of the Week. It is the story of the abiding friendship that grew as Brian Piccolo, who was white, and Gale Sayers, who was Black, competed for playing time as N.F.L. rookies with the Chicago Bears. It’s also the story of Piccolo’s death of cancer at 26. I was a girl in Birmingham, Ala., then “the most segregated city in America,” when “Brian’s Song” reminded this country that race was not an insurmountable barrier to love.

Of course I read “I Am Third,” the 1970 memoir by Gale Sayers from which the film was adapted, as soon as I could get my hands on it. When the bookmobile librarian suggested that I might also like “Death Be Not Proud,” John Gunther’s heart-wrenching account of his 17-year-old son’s death from a brain tumor, I devoured it too.

I was not a child obsessed with death; I simply wanted to understand how the world works. My friend Mary Laura Philpott read the same kinds of books as a child, and for the same reason.

“The more I saw and heard of the real world, the more I came to suspect there was sadness everywhere, and if I was going to live in this world, I should understand its scale and reach,” she writes in her acclaimed new book, “Bomb Shelter.”

Reading stories is a gentle way for a child to encounter the hardest truth that shadows mortal life: There are no happy endings.

“The first problem love presents us with is how to find it,” writes Kathryn Schulz in her new memoir, “Lost & Found.” “But the most enduring problem of love, which is also the most enduring problem of life, is how to live with the fact that we will lose it.” Many stories solve the first problem. Far fewer admit that the second even exists.

Books about loss tell us something about our own nature. They remind us that we belong to a species capable of carrying on when we think we can’t carry on any longer. Death is just part of how the world works. It’s part of how we ourselves work.

“No part of an embodied life is guaranteed except for death,” writes Tallu Schuyler Quinn in her new essay collection, “What We Wish Were True.” To face it — however haltingly or furiously or tearfully, or on a carousel of all those swirling feelings — is to be fully alive.

Ms. Quinn was the beloved founder of the Nashville Food Project, which addresses food insecurity. Last summer, when I wrote about her life and mission, she was working on a collection of essays drawn in part from her CaringBridge journal about living with a terminal brain cancer. Ms. Quinn died in February. The book will be published on Tuesday.

I did not know Ms. Quinn personally, but even from a distance I know that her life was a bright testament to the power of serving others. I know, too, that she could write like an angel, with poetry and humor and a bone-deep understanding of the way love and grief walk hand in hand through the world together, twinned: “As these tumors hold court in my mind and mix me up in these sad and terrible ways,” she writes, “I find shelter in new thanks and new praise and in another day — and even in how healing these salty tears taste pouring into my open mouth as I wail my thanks for this unexpected, unbelievable, boundless shelter of love.”

There are reasons to worry that a book which confronts the essential inevitability of death, especially the untimely death of a human being in love with the world, someone who never seemed to waste a minute of her one remarkable life and is heartbroken to leave it behind, will be a book many readers will fear to face.

After all, we are still in the midst of a pandemic that has taken millions of people from their loved ones. We are watching in real time as bombs fall from Ukrainian skies and Vladimir Putin’s ground forces slaughter innocent people. The hunger Ms. Quinn fought so hard to alleviate will inevitably worsen as inflation rages. In such a world, who could bear to read a book which the writer herself did not live long enough to see into print?

But the human world has always been just this tragic, just this unbearable, and the literary world has always given us reasons to understand the gifts such books can offer — not in spite of the tragedies we witness and live through, but because of them — if we don’t turn away.

We’ve all had near misses that shook us to the core: when a hydroplaning car skidded to a stop in the nick of time; when a toddler, unwatched for half a second, teetered at the top of a flight of steps but was caught just before stepping over the edge; when the scan showed a shadow that had to be a tumor but turned out to be nothing at all.

And every near miss is almost always followed by a golden time, too brief, when the futile frustrations and pointless irritations of daily life fall away, when all that’s left behind is gratitude. We are here. Our beloveds are here. How remarkable it is to be together. How full of grace the fallen world can be.

“What We Wish Were True,” like so many end-of-life memoirs that came before it, and so many others still to come, is for readers a kind of literary near-miss experience. Its beauty reminds us to linger in the grace. Its wisdom teaches us to treasure the ordinary pleasures we ought to have been treasuring all along.

“I think about everything I will miss, and what I won’t be alive to witness or experience or endure or bounce back from,” writes Ms. Quinn. “No singing show tunes in the minivan. No burnt toast with butter in the mornings. No snuggling up to watch cooking shows. No walks together circling the neighborhood we love so much.”

Whether it comes before or after we turn the last page of a book, we know the ending of every human story. “If an ending could be changed through strategic planning or force of will or the sheer love of life, things would go differently, but this cannot be changed,” Ann Patchett writes in “These Precious Days.”

It cannot be changed. The finality of that truth is breathtaking.

But “What We Wish Were True” is not a book about dying any more than “Brian’s Song” is a movie about dying. It is a book about the life of an extraordinary person. It is a book about love and gratitude and making every day an opportunity to love, a chance to decide, again and again, to keep on loving for as long as we draw breath. And, through the miracle of books, beyond it, too.

Complete Article ↪HERE↩!

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Living Coffin makes sure we continue the Circle of Life even in death

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Very few people are comfortable discussing matters related to death. In some cultures, it’s even taboo to do that. Despite social mores and psychological hurdles, there are businesses that thrive around the passing of family members and friends. The state environment might be the last thing on people’s minds when burying their loved ones, but it might shock them to learn that, even in death, we continue to harm the planet that has given us so much in our life. Since it’s a rather morbid topic that very few probably want to broach, it took vision, courage, and ingenuity to design a product that offers comfort to the bereaved while also giving back something to the environment, making sure that we continue to live on, even if in a completely different form.

Designer: Loop

Unless we have relatives or friends in the funeral business, we probably never give much thought to what pretty much becomes the last bed our body lies in. Presuming, of course, you don’t go for cremation or other practices and traditions. Few might have given any thought to the materials used for coffins, for example, and simply presume that they eventually decompose and disintegrate along with the human body. That, unfortunately, isn’t the case, and most of our funeral practices, be it burial or cremation, actually continue humanity’s crimes against Mother Nature.

The Living Coffin, which also goes by the less morbid name of Living Cocoon, shatters those misconceptions and even offers a way for people to make amends with the planet once they’ve ended their earthly journey. Instead of the typical materials used in coffins, which often use harmful chemicals or non-biodegradable materials, the “box” is actually made of mycelium. Or rather, the coffin is grown from a type of mushroom that is known for being nature’s biggest recycler.

The idea is not only for the coffin itself to return to the soil but also to transform dead organic matter into nutrients needed to grow plants. Yes, it basically turns your dead body into compost that could nurture new life. Instead of a cemetery filled with concrete, dead matter, and pollution, a burial site can actually become the start of a new forest, with each tree forever marking where your loved one was laid to rest. Inside the coffin is a bed of moss, rather than fabric or plastic, which helps the process along without poisoning the soil.

It is admittedly a novel concept that could unsettle some folks, but it is also a simple yet effective way to make sure that we leave behind a good legacy, no matter how we have lived our life. One of the things that people are advised to do in order to live forever is to plant a tree, but few of us are able to do so during our lifetime. The Living Coffin ensures that we’d still be able to do that after our death and could even have a tree to our own name.

Complete Article ↪HERE↩!

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Don’t leave your health decisions to chance

It’s easy to put off making important decisions in life, especially health care decisions. They can be uncomfortable and complex. Yet taking time to discuss and document your health care wishes can bring peace of mind and lead to better health outcomes in the future.

By William Creech

It’s easy to procrastinate

There are so many things to do every day, an almost-limitless amount of “low hanging fruit” items to cross off the list. It’s easy to put off thinking about your health care wishes.

There are many more enjoyable things to plan and ponder, while considering your health care wishes can feel like a chore. When given a choice between planning a vacation or outlining your end-of-life wishes, it’s easy to pick the more fun, less distressing task.

You also may procrastinate because you believe these decisions can wait for a more appropriate time in the future. Unfortunately, the right time and circumstances never seem to line up.

Documentation of your wishes

Thinking through and documenting your health care wishes tells your family and health care team what kind of care you want if you are too ill to express your wishes yourself. This could occur if you’re terminally ill, seriously injured, in a coma, in the late stages of dementia or near the end of life.

Some decisions that you should document include when you want to be resuscitated by CPR, when and for how long you want to be placed on a mechanical ventilator, or if you want to be fed through a feeding tube.

Record your wishes in a legal form called an advance directive. This document isn’t just for older adults. Anyone over 18, regardless of state of health, can complete an advance directive. It’s only activated if or when you are incapacitated and cannot make health care decisions.

One type of advance directive, a power of attorney for health care, is preferred because it makes your care wishes known and designates a person to make decisions for you if you cannot speak for yourself. This person is called a “health care agent.”

When selecting your health care agent, remember this story:

Two leaders pondered a difficult decision and were united in their approach. But soon, the second leader started to second guess the decision. The first leader said to the second, “Now is not the time to be a fence straddler.”

As you select your health care agent, pick a person you trust to follow your wishes and hold firm to the decisions.

You can update an advance health care directive or power of attorney for health care at any time, such as after a new diagnosis, a change in marital status or if your thoughts about end-of-life care evolve.

Get better outcomes

Procrastinating health care decision-making is a serious matter, so the sooner you begin, the better the potential outcome.

In some cases, life can be prolonged using advanced technology like ventilators, vasopressors and surgery. It’s great to be an educated health care consumer and understand the available treatment options, but it’s also important to remain objective, and listen to and heed the advice of your health care team.

If your health care team is unsure of your wishes, they may insist on prolonging care or performing invasive treatments on your behalf. These actions can have serious negative side effects and result in low quality of life.

Documenting your wishes early ensures that you will get the medical care you want and need while avoiding unwanted heroic measures that may be harmful. It also relieves unnecessary suffering, and eases your family and friends of decision-making burdens during moments of crisis or grief. What a gift this is for them.

Tips for difficult decisions

These conversations and decisions are not easy, but they are important.

Here’s my advice on tackling difficult decisions with your family and friends:

Don’t kick the can down the road.

Sometimes getting started is the hardest part. Years ago, I drove a vehicle with a manual three-speed transmission on the column. Unlike the automatic engines found in cars today, you could give this car a small push downhill to start the engine. In the same way, some people just need a little push to get started.

Perhaps you feel the day will never come that you face a serious injury or illness or that you will die in your sleep. But nearly every family is affected by a serious illness or injury at some point. If decisions are put off and not documented, a well-intentioned but uninformed family member could make decisions that don’t align with your wishes. I have found this to be the case on many occasions. A rolling snowball in the form of unmet health care decision-making can lead to a big mess that can become a proverbial avalanche if left unheeded.

Don’t decide to do nothing.

Inaction is still an action. If you refuse to make difficult decisions in health care, you are still deciding, but it’s much riskier. It’s like gambling on a roulette wheel. You don’t know where the ball is going to stop. Instead of taking action to improve your odds, you are just hoping for a good outcome.

You take control by expressing your wishes and choosing a responsible health care agent in an advance directive. These actions guide your roulette ball by adding flappers on the wheel that align with your desires. Doing so can make the difference between comfort or chaos for you, your health care team and your family.

Keep points simple yet specific.

As you complete your advance directive, you will be advised to consider all options. This can feel overwhelming. The key is to keep it simple because there is no way you can cover every possible scenario.

Too often, advance directives are too generic or too detailed. I recommend a happy medium where some key themes are outlined and cover a myriad of scenarios. Keep it simple when you can.

Let professionals guide you.

When you are ready, find a health care professional to guide you through completing an Advance Directive booklet. Social workers and chaplains in health care organizations, along with faith leaders, community service workers in local communities and volunteers, are trained to assist you. Your primary care provider also can assist. These professionals will help you work through the decisions, but they won’t tell you what to do.

Advanced planning and outlining your wishes before you need the care gives you the opportunity to communicate your wishes with your family. Talk with them about your advance directive and health care wishes, along with your rationale behind the decisions. Give a copy to your health care agent and health care team.

It’s prudent to be a well-informed patient as you outline your health care wishes. They are not only life decisions, but also they’re life-altering.

Helpful links:

Complete Article ↪HERE↩!

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A child’s view of death with dignity is the focus of Bill Richardson’s heartfelt book

“As it becomes more common it is going to be something kids are exposed to and that they think about and their parents will talk to them about it. … So that was all I was thinking about. What this might be like for a kid.” — Bill Richardson

By Dana Gee

In 2020, 7,595 cases of medical assistance in dying (MAID) were registered in Canada, up almost 35 per cent from the year before.

As medically assisted death becomes more common it only makes sense that more and more children are going to have to deal with it. That reality is at the heart of former broadcaster Bill Richardson’s new children’s book Last Week. Illustrated by Emilie Leduc, Last Week tells the story of a death with dignity through the eyes of a child.

In this case the child counts down, literally, the last seven days of their grandmother’s life.

“I lay awake. I did the math. In four hundred and thirty-two thousand seconds, this last week will be over,” says the child as they reflect at the end of the second day.

“As it becomes more common it is going to be something kids are exposed to and that they think about and their parents will talk to them about it,” said Richardson during a recent phone interview. “Their grandparents will talk to them or whoever the recipient of the medical assisted death will talk to them. So that was all I was thinking about. What this might be like for a kid.”

While he wasn’t trying to “be comprehensive,” Richardson does deliver a lovely and clear look at what mourning can look like when someone has chosen this route. The book’s afterword is by MAID pioneer Dr. Stefanie Green the co-founder and president of the Canadian Association of MAID Assessors and Providers.“My connection to this is really via my partner, whose name is Bill Pechet. Bill’s mother Judy, in 2016, chose a medically assisted death and she was an amazing person. She was very vibrant,” said Richardson. “She was 92 when she died, and she had great, great, great clarity of mind and her body was giving up and she made this informed decision.”Richardson noticed that friends and family came and stayed and hung out in the days prior to Judy’s death.

“It changes the way we mourn,” said Richardson. “I was deeply, deeply touched by watching Judy receive these people to the very end of her life. She had always been a warm hospitable gregarious, welcoming, social, intelligent, articulate person who really valued contact. Who adored her family and who loved conversation.“So, people sat around, and they talked, and they talked, and they talked, and they laughed, and they laughed, and they laughed and told stories and they eat, and they eat, and they eat. And then it was done. I just thought what a great thing.”This is what the child in Last Week witnesses and clocks. They realize their Flippa — nicknamed so because she walked to the beach for her daily swim in a wetsuit and flippers like a real-life West End neighbour of Richardson’s did — was loved and cherished. Stories were told, hands were squeezed, and hugs were delivered and most importantly there was laughter.

This book is Richardson’s eighth for kids. The former CBC Radio host started out writing for adults but soon found his way into a familiar zone.“I was writing for adult audiences then someone asked me if I wanted to write for children,” said Richardson. “My first job as a grown-up person was back in 1980 working as a children’s librarian. I spent about five or six years kind of immersed in that world. I knew the literature. I kept track of it a little bit after. I know more or less what is going on.”Richardson wrote this book in a single sitting, but he didn’t go in with the plan to use counting as story engine.

“I didn’t know what it was going to be until I came to the end. I wondered why the counting structure. Why has this child settled on this way to kind of frame what’s going on? And then I began to realize in numbers there is a kind of comfort that is something that is quantifiable. It is also relentless and unstoppable,” said Richardson.

While the death of a loved one anchors this story it isn’t depressing. Watching the child watch the things going on around their grandmother’s exit is a reminder of a full life, a life that was shared.

It certainly is a book about coming to terms with grief, but it is also very much a book about love.

Complete Article ↪HERE↩!

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Americans are bad at talking about death, and it’s hurting the environment

The path to more eco-friendly burials starts with uncomfortable conversations about death

By Rachel Ashcroft

How often do you think about your own death? The answer is probably along the lines of “rarely, if ever.” Death denial is commonplace in the United States; indeed, in Western countries, people tend not to die at all, but “pass on” or “slip away” instead. Our own death, in particular, is something we try to avoid thinking about until we really have no choice in the matter.

This is perfectly understandable behavior. Thinking about death can be scary for many reasons, from fears about dying in pain to contemplating what happens after death. Longer lifespans and medical advances have made it easier to delay thinking about mortality. But death denial has many disadvantages, too. Avoidance can actually increase — not lessen — anxiety. We also risk leaving behind grieving loved ones who aren’t clear on our final wishes. Death denial is not just bad for individuals, either: There’s plenty of evidence to show that it is harmful to the environment, too.

Traditional funeral options are less than eco-friendly. In the U.S., some estimates suggest that cremation emits approximately 360,000 metric tons of CO2 each year. According to the Green Burial Council, heating a furnace at 2,000 degrees Fahrenheit for two hours produces roughly the same emissions as driving 500 miles in a car. Burials pose their own set of problems: Caskets and vaults use a large amount of natural resources. Casket wood alone requires the felling of 30 million board feet of wood in the U.S. each year, and thousands of tons of steel and concrete are used to construct vaults. Embalming fluid (which contains carcinogenic chemicals) can contaminate groundwater around cemeteries.

At a time when large corporations are regularly held to account for their green principles, the funeral industry is one of the few players to escape the scrutiny of its practices. A culture of death denial facilitates this situation. In a society where death is considered “morbid,” who wants to build their activism around something that most of us avoid discussing? Prominent figures like Greta Thunberg rarely venture into the murky world of deathcare. On Instagram, eco influencers are far more comfortable snapping pictures of avocado on toast than discussing the perils of embalming fluid.

Things weren’t always this way. In the early 1900s, Americans lived in close proximity to the dead and dying. Bedside vigils, in which the entire family gathered around a dying relative, were extremely common. Most people died in their home, leaving family members to prepare the body. Historians argue that this changed when end-of-life care moved to hospitals and funeral parlors began looking after dead bodies. Death became far less visible. When people today view an open casket, the corpse is altered so as to hide the physical effects of death. This evolution from death in close proximity to death being hidden and painted over has fueled a tendency toward death avoidance which, when compared to many other world cultures, is a complete anomaly.

Fortunately for our planet, change is on the horizon. Several environmentally-friendly deathcare options are springing up across the United States. From water burials to natural organic reduction or “human composting,” the green deathcare industry is taking root. But in order to fast forward the process of offering people legalized, eco-friendly deathcare choices, we have to talk more openly about death and dying to begin with.

In practical terms, avoiding death talk allows myths and assumptions about funeral care to flourish. Just over half of Americans choose cremation each year, partly due to a (false) perception that it’s good for the environment. Caitlin Doughty, a prominent mortician and “death positive” advocate, has also reported instances of bereaved families being informed that embalming is a legal requirement — it isn’t. No state requires embalming or even burial inside a vault. If you’ve lived your whole life trying to reduce your carbon footprint, understanding what is and isn’t legal can help make your death greener, too.

People often say they “want to be a tree” after they die. But when we don’t examine traditional deathcare closely enough, it’s easy to overlook the fact that ash from cremated remains doesn’t enrich soil, while traditional burial prevents bodies from mingling with the earth. Setting aside time to explore other funeral options reveals the different ways that our remains can help plants grow. “Green burial” generally describes an unembalmed body placed in a shroud or biodegradable coffin, which is lowered directly into the ground. This allows the body to decompose into the surrounding earth. No state laws forbid green burial, and a growing number of cemeteries are offering this service. Human composting uses a combination of microbes, oxygen, and organic matter to convert corpses directly into soil. It’s legal in Colorado, Oregon, and Washington, and bills are being considered in several other states.

There are some disadvantages to green deathcare. At the moment, price can be an issue. For society’s poorest, direct cremation (no viewing or visitation) costs as little as $1,000. Human composting, on the other hand, is priced between $7,000 to $10,000. There may also be religious issues pertaining to human remains; Washington’s legalization of human composting was opposed by Catholic groups who argued that composting didn’t show enough respect for the deceased body.

However, green deathcare will only become more affordable and widespread (for those who want it) if we learn how to talk about death in the first place. Of course, it can initially be uncomfortable to think about ourselves turning into ash or soil. But having as much information as possible about a topic is always empowering — even when it comes to your own death.

Complete Article ↪HERE↩!

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Penance and plague

— How the Black Death changed one of Christianity’s most important rituals

Confession, circa 1460/1470. Artist unknown.

By

The 14th century is known for catastrophe. By midcentury, the first wave of plague spread through a Europe already weakened by successive famines and the Hundred Years War between England and France. And crises just kept coming. After the first wave, which has come to be called the Black Death, the disease returned at least four more times before 1400. All the while, fresh conflicts kept erupting, fueled in part by the rising number of soldiers available for hire.

As a medieval historian, I study ways that community leaders used Catholic practices and institutions to respond to war and plague. But amid the uncertainty of the 14th century, some Catholic institutions stopped working the way they were supposed to, fueling frustration. In particular, the unrelenting crises prompted anxiety about the sacrament of penance, often referred to as “confession.”

This uncertainty helped spark critics like Martin Luther to ultimately break from the Catholic Church.

Saints and sacraments

During this era, European Christians experienced their faith predominantly through saints and sacraments.

In art, saints were depicted as standing near God’s throne or even speaking into his ear, illustrating their special relationships with him. Pious Christians considered saints active members of their communities who could help God hear their prayers for healing and protection. Throughout Europe, saints’ feast days were celebrated with processions, displays of candles, and even street theater.

Fourteenth-century Christians also experienced their faith through Catholicism’s most important rituals, the seven sacraments. Some occurred once in most people’s lives, including baptism, confirmation, marriage and extreme unction – a set of rituals for people who are near death.

A medieval manuscript with colorful illustrations depicts rites for people who are dying.
A 15th-century manuscript depicts deathbed scenes: doctor’s visit; confession; Communion; extreme unction; and burial. From the Bedford Hours of John, Duke of Bedford.

There were two sacraments, however, that Catholics could experience multiple times. The first was the Eucharist, also known as Holy Communion – the reenactment of Christ’s Last Supper with his apostles before his crucifixion. The second was penance.

Catholic doctrine taught that priests’ prayers over bread and wine turned those substances into the body and blood of Christ, and that this sacrament creates communion between God and believers. The Eucharist was the core of the Mass, a service which also included processions, singing, prayers and reading from the Scriptures.

Religious Christians also encountered the sacrament of penance throughout their lives. By the 14th century, penance was a private sacrament that each person was supposed to do at least once a year.

The ideal penance was hard work, however. People had to recall all the sins they had committed since the “age of reason,” which started when they were roughly 7 years old. They were supposed to feel sorry that they had offended God, and not just be afraid that they would go to hell for their sins. They had to speak their sins aloud to their parish priest, who had the authority to absolve them. Finally, they had to intend to never commit those sins again.

After confession, they performed the prayers, fasting or pilgrimage that the priest assigned them, which was called “satisfaction.” The whole process was meant to heal the soul as a kind of spiritual medicine.

Broken up by Black Death

Waves of plague and warfare, however, could disrupt every aspect of the ideal confession. Rapid illness could make it impossible to travel to one’s parish priest, remember one’s sins or speak them aloud. When parish priests died and were not immediately replaced, people had to seek out other confessors. Some people had to confess without anyone to absolve them.

A manuscript depicts people burying victims of the Black Death plague.
An illustration in the Annales of Gilles de Muisit, from the 14th century, depicts people burying victims of the Black Death.

Meanwhile, Europe’s frequent wars posed other spiritual dangers. Soldiers, for example, were hired to fight wherever war took them and were often paid with the spoils of war. They lived with the constant weight of the commandments not to kill or steal. They could never perform a complete confession, because they could never intend not to sin this way again.

These problems caused despair and anxiety. In response, people turned to doctors and saints for help and healing. For example, some Christians in Provence, in present-day France, turned to a local holy woman, Countess Delphine de Puimichel, to help them remember their sins, protect them from sudden death, and even leave warfare to become penitents. So many people described feeling consoled by her voice that a medical doctor who lived near the holy woman set up meetings so people could hear her speak.

But most people in Europe did not have a local saint like Delphine to turn to. They looked for other solutions to their uncertainties about the sacrament of penance.

Indulgences and Masses for the dead proved the most popular, but also problematic. Indulgences were papal documents that could forgive the sins of the holder. They were supposed to be given out only by the pope, and in very specific situations, such as completing certain pilgrimages, serving in a crusade, or doing particularly pious acts.

During the 15th century, however, demand for indulgences was high, and they became common. Some traveling confessors who had received religious authorities’ approval to hear confessions sold indulgences – some authentic, some fake – to anyone with money.

Catholics also believed that Masses conducted in their name could absolve their sins after their death. By the 14th century, most Christians understood the afterlife as a journey that started in a place called Purgatory, where residual sins would be burned away through suffering before souls entered heaven. In their wills, Christians left money for Masses for their souls, so that they could spend less time in Purgatory. There were so many requests that some churches performed multiple Masses per day, sometimes for many souls at a time, which became an unsustainable burden on the clergy.

An eagle's-eye photograph shows a graveyard being exhumed.
A Black Death burial trench under excavation between rows of individual graves and the later concrete foundations of the Royal Mint in East Smithfield, London.

The popularity of indulgences and Masses for the dead helps scholars today understand people’s challenges during the Black Death. But both practices were ripe for corruption, and frustration mounted as a sacrament meant to console and prepare the faithful for the afterlife left them anxious and uncertain.

Criticisms of indulgences and penance were a focus of reformer Martin Luther’s famous “95 Theses,” written in 1517. Though the young priest did not originally intend to separate from the Catholic Church, his critiques launched the Protestant Reformation.

But Luther’s challenges to the papacy were not ultimately about money, but theology. Despair over the idea of never being able to perform an ideal confession led him and others to redefine the sacrament. In Luther’s view, a penitent could do nothing to make satisfaction for sin, but had to rely on God’s grace alone.

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