Tag: After Death

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The Various Costs of Dying

— A new report breaks down what it costs to die, giving further reason to make clear final arrangements

By Emma Suttie

As a culture, we don’t like to talk about death. Even though it’s the destination we all share, regardless of our beliefs, most of us prefer not to think about it. Unfortunately, this aversion leaves most of us unprepared for death when it arrives, making things harder for the loved ones left to manage our affairs.

A new report looks at the cost of dying in the United States, from the material costs to the emotional and physical toll it takes on those left behind.

The report was created by Empathy–a company that helps people manage the logistics and emotional hardships associated with death. The company surveyed almost 1,500 people who had experienced the loss of a close family member in the last five years. Their goal was to try to quantify and better understand what they went through.

Here are some interesting findings from the report:

  • 3 million people die in the U.S. every year
  • 68 percent of Americans who are grieving suffer physical symptoms
  • An average of 540 hours of work are spent settling a loved one’s affairs
  • It takes families an average of 12.5 months to resolve all financial matters after the death of a loved one
  • 20 percent of the workforce is grieving a recent loss at any given moment

The Financial Cost

Perhaps the most astonishing figure from the report was that the average direct financial costs related to the death of a loved one can reach $20,000. This includes things like the cost of the funeral and financial and legal matters that must be dealt with when a person dies.

The report found that the average cost of a funeral is $7,848, the cost of financial matters averages $4,384, and legal matters cost an average of $4,967. Using these numbers, it’s easy to see how the cost can easily climb to $20,000 and beyond. And these are only part of the financial costs associated with dying.

Other financial costs the report included in their analysis are those associated with the total funeral costs, like payments to the funeral home ($3,584), the burial plot ($1,841), catering and refreshments ($602), hiring officiants, priests or other clergy ($472), music ($136), and invitations ($111).

How Loss Affects the Mind & Body

There are other, less tangible consequences as well—like grief—which is a highly personal experience that people are grappling with while having to contend with all the tasks associated with the death of someone they love, which only complicates the process further.

The stress and emotional strain associated with a loved one’s death often lead to physical symptoms. The report found that 93 percent of those surveyed suffered from at least one physical or mental symptom after their loss, 83 percent suffered anxiety, with 46 percent suffering for a few months or more. None of this seems surprising, considering that grief can be an overpowering emotion, and after the loss of someone close to us, we have an immediate increase in tasks and responsibilities to manage the affairs of the one we’ve lost.

Other physical and mental symptoms that lasted more than a few months reported in the study were:

  • Memory problems (30 percent)
  • Unusual anger or irritability (30 percent)
  • Weight loss or gain (33 percent)
  • Irregular sleep patterns (38 percent)

And the above numbers increased significantly if the person happened to be the executor of the deceased person’s estate–a job that comes with considerable responsibility and its own unique stresses.

How to Prepare–for Peace of Mind

Although our views about death are highly individual, there are things that we can all do to help prepare for it when the time comes. Preparation can help us relieve some anxiety, think about what we want, as well as think through some of the logistics, which will help others have a clear roadmap of what we desire and how to make it happen.

There are a lot of things to consider when we begin thinking about our own death. And although this can initially seem an anxiety-producing activity, it can actually be very grounding and help give one a sense of peace.

Here are some things to think about, broken into different categories:

If you are diagnosed with an illness and need healthcare, here are some considerations:

  • Do my loved ones fully understand my condition and what to expect?
  • Have I expressed exactly what medical interventions I want and ones I don’t?
  • At what stage do I want to waive further medical interventions or procedures?
  • Do I have a do not resuscitate (DNR) order that would be enacted after certain procedures or surgeries?
  • Have you chosen someone who can make your healthcare decisions when you can no longer make them yourself? Do they know your wishes?
  • If the healthcare system can no longer help with your condition, what would you like to happen? For example, would you like to be at home?

Personal Considerations

  • What are my beliefs about death? Do I need to make peace with any aspect of this process?
  • Are there any family or friends I want to talk to, and share love and gratitude with so they know how I feel about them?
  • Is there anyone I may have had difficulties with and want to make peace with before I die? Perhaps there is someone who may need my forgiveness or a broken relationship I want to repair.
  • Who would you like to leave your personal belongings to? Make notes as to who should have what so you can make sure people get what you want them to have.
  • If you are a single parent with young children, who will care for them after you are gone?
  • If you have pets, who will look after them?
  • Where are all your personal photos/videos? Are they on a computer? If so, does someone else know how to access them?
  • Have you labeled people in your photos? And where do these personal treasures go when you die? Will they go to children or other family? Having personal effects like photos well labeled is important so your family can identify others later on.

Funeral/Memorial/Celebration of Life Planning

  • What would you like to happen to your body after you die? Do you want to be embalmed? Buried? Cremated? Or do you want a green, or natural burial?
  • Do you have a preference for what casket you would like or how you would like to be buried? If you would like to be buried, where will it be?
  • Would you like a burial plot, headstone or grave marker? If cremated, where would you like your ashes scattered, or who would you like to keep them?
  • Do you want a ceremony of some kind? If so, what kind of ceremony would you like, and how would you like people to celebrate you?
  • Would you like flowers, and if so, what type? Or would you like people to donate to a charity you believe in instead?
  • Would you like someone to deliver a eulogy or have several people speak about your life? If so, speak to them ahead of time.
  • Should you pre-pay for funeral/burial/cremation services ahead of time? It can often be less expensive when done in advance.

Legal Considerations

  • Consider writing a will to make your wishes known and have them carried out legally.
  • Do you want someone to be your power of attorney?
  • Make a list of your assets so you can decide who you would like to have them.
  • Organize and store important documents and passwords so they can be easily found and accessed.
  • Talk to your loved ones about your wishes.

If you need a little inspiration, BJ Miller, a practicing hospice and palliative care physician, gives a moving TED talk about what really matters at the end of life.

Here are some resources to help guide you through the process and keep you organized as you go:

Final Thoughts

Although this all might seem a bit daunting initially, you can do what is comfortable and take your time. Choose which tasks are important to you, and work your way through them at your own pace.

Although some people are blessed to know that they are coming to the end of their lives and can prepare, many of us will not know in advance.

Thankfully, we can choose to do any of the things above at any time. Perhaps more important than anything is the way contemplating death can remind us of how precious life is and how important it is to cherish every moment and let the people in our lives know what they really mean to us.

Complete Article ↪HERE↩!

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Rest in … compost?

— These ‘green funerals’ offer an eco-friendly afterlife.

A shrouded mannequin demonstrates the “laying in” ceremony at Recompose, a human composting facility in Seattle. Human composting, water cremation, and green burials are gaining traction as people seek to minimize their environmental impact in death.

Traditional burial and cremation pollute the ground and emit carbon dioxide. People are looking for new options.

By Allie Yang

You may have seen the headlines: Earlier this year, New York State became the sixth in the nation to legalize something called human composting. In 2022, Archbishop Desmond Tutu chose to be cremated not by flame, but by water, in a process called alkaline hydrolysis. In 2019, actor Luke Perry was buried in a “mushroom suit” made of cotton and seeded with mushroom spores. All were part of a push to make the afterlife more eco-friendly.

Death care has remained largely unchanged in the United States ever since embalming and burial became the de facto method as far back as the Civil War, says Caitlin Doughty, mortician and founder of death care advocacy nonprofit Order of the Good Death. Most people don’t even have access to other options: burials and cremation are the only methods that are legal in all 50 states. 

Traditional burial methods harm the planet in various ways. Embalming slows the decay of a person’s body so that it’s presentable at a funeral—but after burial, the chemicals used for embalming leach into the ground. Caskets require enormous amounts of wood and metal, and cemeteries often build concrete vaults in the ground to protect them. Even cremation requires a lot of fuel, and generates millions of tons of carbon dioxide emissions a year.

Now, however, a variety of theoretically more sustainable death care alternatives are increasingly being offered around the country. Here’s what you need to know.

Green or natural burial

Green burials have been used as long as humans have been burying bodies. Both Native American and Jewish communities traditionally use green burials. But in recent generations, they have fallen out of fashion as people opted for more elaborate burials. Green or “simple” burials became more commonly used for the poor and wards of the state.

These are generally defined as burials using materials that are both nontoxic and biodegradable. In a typical green burial, the deceased is dressed in a 100 percent cotton shroud and buried in a plain pine box.

In some cases people choose to “become” a tree in death by having a tree planted over their plot. (However, the tree burial pods that kicked off this trend—in which bodies are wrapped in an egg-shaped pod that supposedly feeds the roots of a young tree—are not available for commercial use and it’s unclear if they are even viable.)

(In these cemeteries, nature also rests in peace.)

Almost every cemetery in the U.S. has an area reserved for green, or “simple” burials, according to Ed Bixby, president of the Green Burial Council (GBC), which helps educate and certify burial grounds meeting sustainability standards. On some burial properties, plots are marked via GPS and a natural stone marker—otherwise, the area is left to grow wild, becoming less like a cemetery and more like a nature preserve full of life.

Most families who choose natural burial also forgo embalming, often seeing the process as overly invasive, when refrigeration alone adequately preserves the body. Others opt for gentler embalming fluids made without formaldehyde, which are becoming increasingly available.

But could these simple burials contribute to the spread of disease or pollution of the land? The data from existing research on traditional cemeteries “doesn’t indicate that bodies are dangerous in and of themselves,” says Lee Webster, director of New Hampshire Funeral Resources and Education and former director of GBC, adding that vaults, chemicals, and non-organic containers used in traditional burial do contribute to pollution. 

Further, the WHO has found “no evidence that corpses pose a risk of epidemic disease—most agents do not survive long in the human body after death.”

Still, it’s unclear if some of the newer variations of green burials are effective. For example, the brand responsible for Luke Perry’s mushroom suit claimed it would neutralize toxins and give nutrients back to the earth. Years earlier, however, the suit’s maker had hired mortician Melissa Unfred to study the suit—Unfred found there was no evidence the suit had any real effect.

Water cremation

One cremation creates an average of 534 pounds of carbon dioxide, one scientist told Nat Geo in 2016. Toxins from embalming fluid and nonorganic implants like pacemakers or tooth fillings also go up in smoke. Water cremation—also known as aquamation or alkaline hydrolysis—produces the same result with significantly less environmental impact and for some, a spiritual benefit.

(Greenhouse gases, explained.)

Native Hawaiians practiced a form of water cremation for thousands of years. They would use heated volcanic water to break down the bodies of their loved ones, says Dean Fisher, water cremation consultant and former director of Mayo Clinic’s donated body program. Then they would bury the remaining bones, where they believed the soul’s spiritual essence was stored.

The tradition has fallen out of practice in recent years—but in July 2022 Hawaii legalized water cremation, putting the tradition back within reach.

Water cremation machines work by pumping a heated alkaline fluid around a body for four to six hours, exponentially accelerating the natural decomposition process. Bodies can be embalmed or unembalmed and dressed in any material that is 100 percent natural. After the body breaks down, only bones and non-organic implants remain. The bones are dried, crushed, and returned to the family.

The only byproduct of water cremation is nontoxic, sterile water that can be recycled into the local water supply—270 gallons of it, or slightly less than what the average American household uses in a day. There are no emissions into the ground or air.

But water cremation does have its drawbacks. For one, traditional cremations are more readily available, faster, and usually less expensive. Water cremation also requires energy to heat the water and run the pump, although a Dutch study from 2011 showed that’s only 10 percent of the energy used in flame cremation.

Further, some critics of water cremation argue it is immoral or disrespectful to the deceased, akin to flushing your loved one down the drain. However, advocates counter that water cremation simply accelerates the natural decomposition process and is no different from the blood from routine embalming that also goes through water treatment to be neutralized.

Either way, water cremation appears to be gaining steam in the U.S. It is currently legal in 28 states—and 15 of them approved it within the last decade.

Human composting

Human composting turns bodily remains to soil through a highly controlled process—very different from food composting that can be done in your backyard. In a sealed container, a body is cocooned in a mix of natural materials like wood chips and straw. Over a month or more, the vessel heats up from active microbes that start to break the body down. Fans blow oxygen into the container, which is regularly rotated to reactivate the microbes.

(How composting works.)

After 30 to 50 days, bone and any non-organic matter are taken out. The bones are then ground down and returned to the material. It takes another few weeks to “cure,” as microbes finish their work and the soil dries out. The end result is a cubic yard of compost that families can use or donate to environmental causes.

There are environmental costs to human composting, also called natural organic reduction (NOR). Fuel is needed to transport elements like wood chips, and electricity is used to power air pumps, fans, and the vessel rotation.

“We’re just getting started as a company tightening [those elements] up,” says Katrina Spade, founder of Recompose, the first NOR facility in the country located in Seattle, Washington. Still, she says the company’s own assessment of the process showed just over a metric ton of carbon savings per person over traditional cremation or burial.

Human composting is rare. It’s only legal in six states—most recently in New York in January. But a Massachusetts lawmaker has also proposed a bill to allow human composting, and advocates like Spade believe that a number of states will legalize it in 2023.

But even if you’re not interested in an eco-friendly afterlife, advocates say that these burial alternatives come with another advantage: Families can be more involved in the death care of their loved ones, from bathing and dressing them at home to lowering their body into the grave if they choose a green burial.

“It’s not required. But it’s always encouraged to do what you can, if you wish,” Bixby says, adding that most families embrace being part of the process. “You’ll watch them go through the gamut of emotions… then when they’re done, they’ll have this genuinely serene smile on their face. They found a greater sense of acceptance of that passing through the process.”

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From cradle to compost

— The disruptors who want to make death greener

Startups rush to gain foothold in a burgeoning industry as New York and California move to legalize human composting

By

Americans are looking for greener ways to die, and a new wave of deathcare startups are rising to the occasion.

After death, bodies are typically handled in one of two ways: embalmed and buried in a casket, or incinerated and turned into ashes. But both of these options have contributed to the environmental crisis – with fossil fuel-intensive cremation emitting chemicals such as carbon monoxide into the air, and burials taking up large swathes of land.

As interest in alternatives rises, startups aiming to disrupt these practices are gaining steam. New York in January became the sixth state in the US to legalize human composting, also known as “natural organic reduction”, which uses heat and oxygen to speed up the microbial process that converts bodies into soil.

The growth in demand comes in part due to Covid-19, experts say. The pandemic brought death to the forefront of the public consciousness and exposed concerns about its environmental destruction, as places like Los Angeles had to suspend air pollution rules to allow an influx of bodies to be processed.

Human composters are pitching themselves as part of the solution – and trying to dismantle the funeral industry in the process. The potential to alter an age-old practice has brought together former Silicon Valley types, celebrity investors and mission-driven entrepreneurs as interested in lofty green goals as they are in changing our relationship to death.

Katrina Spade, founder and CEO of Recompose, poses with a shrouded mannequin in front of an array of human composting vessels.
Katrina Spade, founder and CEO of Recompose, poses with a shrouded mannequin in front of an array of human composting vessels, in Seattle.

Providers say they are seeing unprecedented demand. The human composting startup Return Home has seen 20 people from California, where human composting is not yet legal, transport loved ones to the company facilities in Washington state – including five who drove with bodies in tow.

“The fact that we are now seeing so many Californians flocking to Return Home in order to pre-purchase services for themselves and their loved ones is proof-positive that [our technology] is the future of funeral services,” said Micah Truman, the company’s CEO and founder.

Founders paint a picture of an industry that is both collegial and competitive, where entrepreneurs connect at meetups and through group chats but often find themselves looking over their shoulders for people entering the industry with less altruistic views. This is especially true as old guards of the funeral industry seek to cash in on the new trend, Truman said.

“It’s interesting because to create disruption, we are going to have to have outsiders coming in,” he said. “Because everyone in the funeral industry is so invested in existing technologies, you need outsiders to help with thinking outside the box – no pun intended.”

An industry poised to explode

Natural organic reduction is a relatively new process, recognized throughout the industry as having been pioneered by a woman named Katrina Spade. In her graduate thesis in 2013, Spade investigated methods farmers had been using to compost animals and found they could be applied to human bodies. When remains are placed in a container with natural materials like straw and wood chips, the microbial process that converts bodies into soil can be accelerated. Composting a human currently takes eight to 12 weeks, and is estimated to use just one-eighth the energy required for cremation.

In the ensuing years, Spade worked with lobbyists, lawmakers and investors to legalize natural organic reduction in Washington in 2019. By December 2020, her company Recompose had made it available to consumers for $7,000 – in line with the median cost of cremation, at $6,971, and the median cost of a funeral with burial, at $7,848, not including cemetery plot costs, which can run upwards of several thousand dollars.

In the years since, at least three companies have sprung up in Washington alone, some of which have secured millions in funding from venture capital firms. And with more states catching on, entrepreneurs say the industry is livelier than ever.

At least six states have legalized the process so far, and California, the most populous US state, will allow human composting in 2027 after a law passed last year goes into effect, opening up the potential for millions of new customers.

“In Washington, where human composting has been legal for some time, the industry is concentrated and hyper-competitive,” Truman said. “But I’m sure everyone is going to be doing pushups and getting ready to go to California as soon as it opens.”

US-DEATH-ENVIRONMENT-RETURN HOMEReturn Home CEO Micah Truman shows a demonstration “vessel” for the deceased, which has been decorated by Return Home with flowers and family photos, during a tour of the funeral home which specializes in human composting in Auburn, Washington on March 14, 2022. - Washington in 2019 became the first in the United States to make it a legal alternative to cremation. (Photo by Jason Redmond / AFP) (Photo by JASON REDMOND/AFP via Getty Images)
Micah Truman shows a demonstration vessel for the deceased, decorated by Return Home with flowers and family photos, in Auburn, Washington.
Truman holds a sample bag containing composted animal remains.
Truman holds a sample bag containing composted animal remains.

The commercialization of alternative deathcare is already creating tension in an industry built on a fraught product. It’s difficult to get people to talk about death, much less invest in it. This has left deathcare entrepreneurs and advocates for greener death grappling to balance altruistic goals with the demands of startup culture, according to Caitlin Doughty, a mortician and author of several books about death and the funeral industry.

“There is a newer disconnect between the fundamental idea of ritual around death in human composting versus a bizarre appeal to Silicon Valley that is emerging,” she said. “It is a fascinating development.”

With the traditional funeral market worth $20bn, it is no surprise new technologies have piqued the interest of tech investors. A 2019 survey from the funeral directors’ association found that nearly 52% of Americans expressed interest in green-burial options, and experts have estimated that the emerging market opened by legalization efforts in Massachusetts, Illinois, California and New York could create a market value in the $1bn range.

There is also a growing market in Gen Z and millennials, who have been called the “death positive” generation – more willing to discuss after-life plans at younger ages and try green alternatives. Startups are rising to the occasion with social media outreach: Return Home has more than 617,000 followers on TikTok, where its employees answer questions like “what happens to hip replacements in the human composting process?” and “how does it smell during the process?”

Human composting is not the only alternative deathcare option that is seeing increased interest. Others include aquamation, a process legal in 28 states by which the body is turned into liquid and then powder. Green burial, in which bodies are interred without embalming or a casket and allowed to decompose naturally over time, is legal in almost all states, but laws vary as to where the body can be buried.

portrait
Darren Aronofsky is one of the more high profile supporters of human composting startups.

But of all the alternative options, human composting seems to have gotten the most attention, said Doughty.

“I do see the composting space as being uniquely competitive in a way that I haven’t seen with [other processes] like aquamation or even cremation,” she said. “It seems uniquely positioned at a nexus of climate change policy and new technology that appeals to the Silicon Valley ethos.”

A focus on ethics

The environmental benefits of alternative deathcare have become a large selling point for companies as green investments trend upwards. Transcend, a New York-based green burial startup that promises to turn human bodies into trees after death, highlights its goal of mass reforestation and eco-friendly burial in its advertising, stating on its website: “Every Tree Burial creates a healthier foundation for all life on Earth.”

Its founder and CEO, Matthew Kochmann, has a Silicon Valley background, counting himself as one of the first employees at Uber. He came to the deathcare industry after meditating on the spiritual nature of burial options, he says.

“I was thinking about how I personally would like to become a tree after death, and I realized that there weren’t any options out there to make that happen – I’d have to do it myself,” he said. “I am a huge advocate of helping heal humanity’s relationship and fear around mortality.”

Through Transcend’s process, the body is buried in organic biodegradable flax linen along with a unique blend of fungi-enriched soil, and a young tree is planted in the ground above it. The company says the mushrooms then “work their magic” to ensure “a direct connection between the nutrient-rich body and the tree’s root system so that the body can literally become the tree”.

wood chips in a tray inside a circular module
A Recompose cradle in Seattle.

The company has piqued the interest of investors and celebrities, with Darren Aronofsky, director of Black Swan and Requiem for a Dream, counting himself among the company’s advisers. Still, fundraising hadn’t always been easy, Kochmann said, adding that some investors had told him: “We don’t invest in taboo areas like pornography or death.”

“Putting death on par with pornography just shows that there’s still a lot of work to do in our culture and our society to get people more comfortable with it,” he said.

Recompose, the original human composting startup, has raised nearly $18m – none of which, its founder is quick to point out, came from traditional venture capital funds, but instead from accredited “values-aligned investors”, Spade said – investors who “are first and foremost investing for the mission and the vision” of Recompose.

Spade said the company had prioritized fundraising models that allow it to stay true to its roots as an advocacy group while still creating sustainable funding. It has also launched a “community fund” to help subsidize its services for clients who cannot afford to pay full price.

The company has worked directly with legislators to pass laws that allow for human composting while creating a framework that supports strong ethics in the burgeoning industry.

“We want to be sure that any kind of human composting operator that’s working with grieving families is doing so within the utmost ethical practices,” she said. “It is not only about how to decompose, operate, and care for our clients – but also, how can we support an industry that always has the most ethical, rigorous operations?”

Spade said although her company had been the first to pioneer human composting, she was “thrilled” to see the movement grow. And although the new frontier of deathcare is getting increasingly crowded in some places, those involved say there is an environment of camaraderie and support as they work towards a common goal: taking down the monopoly that the traditional funeral industry has on death.

“This is a community that has to prioritize solidarity,” said Kochmann. “You are fighting for legislation, you are fighting regulatory battles, and you are fighting an uphill consumer battle because people don’t want to think about death.”

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An Indonesian Tradition Of Digging Up Dead Relatives For A Spirited Afterlife Ritual

Men carefully remove a coffin from a intricately carved burial chamber cut into a massive boulder in the village of Pangala, Toraja district of Indonesia, South Sulawesi Province.

By Vishal Arora

An ethnic community in Indonesia engages in a unique funerary ritual where the deceased are brought back to their families, some of them for a final smoke.

Photojournalist Garry Lotulung traveled to a mountainous region on the island of South Sulawesi, one of the more than 17,000 islands that form this archipelago, to capture the emotions that surround this ancient practice that a largely Christian community is still holding on to, and their perspective on life and death. This exclusive photo essay and video offers ReligionUnplugged.com readers a first hand glimpse of this unique religious and cultural ceremony.

Lotulung, who is a consultant photographer for the International Federation of Red Cross and Red Crescent Societies, has 10 photos to transport us to the archipelago’s Tana Toraja region, where the Ma’nene tradition, pronounced “ma-NAY-nay,” is practiced.

The word “Tana” in the region’s name means “land.” And the people of this region are called Toraja, pronounced as “to-RRAH-jah,” which means those who are from mountains.

(Warning: The following photos show human remains that may be disturbing to some viewers.)

Preserved bodies are placed in the Sun to dry, allowing for the old clothes that had wrapped the body to be removed before continuing with the Ma’nene ritual. Pangala Village, Toraja district.

The Ma’nene ritual involves exhuming the corpses of deceased family members periodically, cleaning and re-dressing them. Some even place cigarettes in their mouths before returning them to their graves. They also take the opportunity to clean their relatives’ crypts while the bodies are out. It is a ritual that happens every three or even five years in August.

Partly premised on the belief that death is not the end, the ritual is held every three to five years in August, depending on what a family decided after the death of a relative. Lotulung was there last summer, but his excitement about documenting this ritual, which might be “the only one in the world,” has not faded away.

Out of those 10 photos, the following is what Lotulung called his favorite, capturing a moment at a cemetery where a family is gathered, full of emotion as they are “reunited” with their loved one, changing clothes of their deceased relative with great respect and care.

Relatives lovingly place new clothes on the body of a deceased relative. Pangala Village, Toraja district.

According to a post on the site Authentic Indonesia:

The procession of the Ma’Nene ritual begins with family members coming to Patane (a building that has some room to store several bodies) to retrieve the bodies of their deceased family members. Patane is a family grave that looks like a house. Then, after the body is removed from the grave, the body is cleaned. The clothes worn by the bodies of the ancestors were replaced with new cloth or clothes. Usually this ritual is carried out simultaneously by one family or even one village, so that the event is quite long. After the new clothes were put on, then the body was wrapped and put back in Patane. The Ma’Nene procession was closed by gathering family members at the Tongkonan traditional house to worship together.

Lotulung said the community holds lavish funerals, based on their age-old belief that keeping one’s ancestors happy may result in a good rice harvest. The spirit of the dead is believed to linger in the world until the death ceremony is held, and afterward, the soul begins its journey to Puya, the land of spirits, as per local beliefs, he explained.

At times, bodies remain in homes for extended periods after death as families save for funerals, which in some cases can cost hundreds of thousands of dollars.

Relatives reverently place money in the coffin next to a mummified body. Pangala Village, Toraja district.

Torajans spend a lot of time and money on funerals and subsequent rites, believing that death is not the end and that not keeping ones ancestors happy may result in a poor rice harvest. It is also not unusual for bodies to remain in homes for long periods of time after death while families save for lavish funerals.

Fellow photographer Puta Sayoga wrote in The New York Times a few years ago:

For Torajans, death is a gradual and social process. The bodies of people who have recently died are kept at home and preserved by their families, sometimes for years, until the family has enough money to pay for a funeral. The spirit of the dead is believed to linger in the world before the death ceremony is held. Afterward, the soul will begin its journey to Puya, the land of the spirits. The longer the deceased person remains at home, the more the family can save for the funeral and the bigger and more expensive the ceremony can be. Elaborate funeral ceremonies can last for 12 days and include the sacrifices of dozens of buffalos and hundreds of pigs. Such ceremonies can cost as much as hundreds of thousands of dollars.

A report in The Guardian in Nigeria says that Toranjans believe the spirit of the person lingers and only finds peace in Puya, the land of the spirits, when a funeral ceremony has occurred. The practice dates back to a hunter named Pong Rumasek who was walking in the mountains and found a dead body in the Trojan mountains. The legend holds that the hunter cared for the body and dressed it with his own clothes — an act they believed brought him good fortune.

These views are certainly not compatible with Christianity, according to which death is a passage from physical life to eternal life in heaven or eternal separation from God in hell.

Even Islam – Indonesia is home to the world’s largest Muslim population – does not approve of what might be seen as ancestor worship. Muslims believe in the concept of qiyamah, or Judgment, that the soul will be judged by Allah according to one’s deeds and actions in life.

Family members surround the preserved body of a relative placed in the Sun to dry. Pangala Village, Toraja district.

“Today, Torajans are largely Christian, but their age-old funeral practices — which predate their conversion to Christianity — persist,” Sayoga writes in the Times. “Ma’nene’, for example, which is carried out three years (or more, depending on the family’s agreement), is meant to be a way to honor deceased relative. According to the belief, performing the rite will result in a better harvest in the following year.”

For Toraja Christians, both Protestant and Catholic, the retention of the ritual can be mostly about preserving an important part of their culture.

However, critics argue that the Ma’nene ritual is a form of cultural appropriation, as it is being commercialized and used as a tourist attraction, apart from involving animal sacrifice. They argue that the ritual has lost its sacred meaning and has become a way for the Toraja people to make money.

An elderly man poses for a photo with the bodies of his brothers and sisters. Pangala Village, Toraja district.

However, Lotulung disagrees with such criticism, responding to the complexity of the practice with empathy.

“I have a deep empathy for the Toraja people, as they still provide a proper place and show respect to their ancestors,” said Lotulung, whose work focuses on documenting social issues and environmental crises in Indonesia.

Every family buries their loved ones with as much honor as possible, and sometimes in ways that only they can fully understand, he argued.

A woman covers the body of her sister with new clothes. Pangala Village, Toraja district.

Lotulung could also connect and relate with the Toraja people. He said he couldn’t help but feel emotional while making these photos.

When the photojournalist saw a family pull a body out of a casket, he was “silent for a moment,” wondering whether anyone would ever get a chance to see or meet family members after their death.

“I felt emotional being around the graves. In that atmosphere, I could sense the sadness that follows the loss of a loved one,” he said. “For example, I saw a young woman standing in front of a cemetery and looking at a picture of her deceased mother with tears in her eyes.”

A woman covers the body of her sister with new clothes. Pangala Village, Toraja district.

As a photojournalist, Lotulung said he was careful about giving space to grieving families during the shoot. They appeared to be unaware of the fact that they were occasionally the object of tourists’ attention, he said.

He added that he witnessed a grandson who finally got to hug his grandfather’s body after changing his clothes. Amazed by what he saw, Lotulung thought, “Death helps us understand the reality of life.”

Family members carefully clean a mummified body before dressing it in new clothes. Pangala Village, Toraja district.

Lotulung stated that during his time in Toraja, he never received any information from the villagers about any call for a ban on the practice. He believes the Toraja people do not need attention from international media or tourists, and that they do this sincerely out of respect for their ancestors.

A man holds a traditional lamp inside a cave used as a tomb. Sandan Uai Village, Toraja district. Toraja district.

He also thinks this ritual will continue for much longer as it has been passed down from generation to generation and is deeply ingrained in their culture.

While tourists from Western countries may provide an impetus for such “unique” customs to carry on, members of the community will continue to cling to these rituals to show their respect for their ancestors, and also for fear of drawing their wrath, Lotulung concluded.

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Quebec organ donors increase threefold after ‘steep rise’ in donations from MAID patients

— The proportion of donors who chose MAiD increased by nearly 15 per cent last year, according to Transplant Québec.

The proportion of donors who chose MAiD increased by nearly 15 per cent last year, according to Transplant Québec.

By La Presse Canadienne

Quebec saw a record number of referrals for organ donations in 2022, including a significant increase in donations made in the context of “medical aid in dying” (MAiD) cases, according to the latest annual report from Transplant Québec.

The organization announced Wednesday that the proportion of donors who chose MAiD increased by nearly 15 per cent last year. Most of the cases involved patients who had a neurological or neurodegenerative disease.

Transplant Québec noted that the number of donations made in the context of MAiD has tripled over the past five years. About 10 per cent of cases of MAiD in Quebec represent potential donors, a proportion based on diagnoses compatible with organ donations, which translates to the equivalent of 366 donors.

“This is not only an opportunity to increase the number of organ donors in Quebec, but also an incredible opportunity to see more people benefit from a transplant,” Transplant Québec director Martine Bouchard said in a statement. “In addition to increasing the number of transplant recipients through the generosity of their gesture, these (donors) also gave meaning to their condition by allowing other lives to be saved.”

In total, Transplant Québec received 854 organ donation referrals in 2022 and 483 people received organ transplants. The organization noted that 78 lung transplants were carried, an “unmatched” number, for the second consecutive year.

More than 170 donors in Quebec allowed 584 transplants to be carried out.

The waiting times for lung or kidney transplants has shortened considerably over the past 10 years, according to the report. As of Dec. 31, 2022, 913 people were on Transplant Québec’s waiting list.

In proportion to their population, Montreal, Saguenay—Lac-St-Jean and the Eastern Townships are the regions with the highest number of potential donors, according to Transplant Québec.

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She was presumed dead.

— Then she woke up in a body bag gasping for air.

This Iowa hospice care facility was fined $10,000 for mistakenly pronouncing a woman dead when she was still alive.

By

As the nurse at the hospice care facility in Iowa checked on the 66-year-old woman, it was clear to the caregiver the patient was dead.

The nurse found no pulse, movement or signs of life in the woman, who had been admitted to Glen Oaks Alzheimer’s Special Care Center in Urbandale, Iowa, for early onset dementia in late December, and “felt the resident had passed away,” according to a report from the Iowa Department of Inspections and Appeals this week.

But after the patient was placed in a body bag and transferred to a funeral home, there was one problem: The woman woke up. And she was desperately trying to breathe. “Funeral home staff unzipped the bag and observed Resident #1’s chest was moving and she was gasping for air,” the report said of the woman, who was not identified by the agency. “The funeral home then called 911 and hospice.”

After EMS personnel recorded her pulse but no other movement or motor response, the patient was transferred to a hospital. Two days after returning to the hospice facility that had mistakenly presumed she was dead, the woman died with her family by her side on Jan. 5, according to the state report published Wednesday.

Now, the hospice facility has been fined $10,000, the maximum allowed under state law, for mistakenly pronouncing the woman dead. The state cited in its report the facility “failed to provide adequate direction to ensure appropriate cares and services were provided.” The agency added the hospice facility failed to ensure the patient received “dignified treatment and care at end of life.”

Lisa Eastman, executive director of Glen Oaks Alzheimer’s Special Care Center, did not immediately respond to a request for comment Friday. Eastman said in a statement to the local CBS station in Des Moines the hospice facility cooperated and completed the investigation from the Iowa Department of Inspections and Appeals. She noted the facility has also been in “close communication with the family of the resident.”

“We care deeply for our residents and remain fully committed to supporting their end-of-life care,” Eastman said. “All employees undergo regular training so they can best support end-of-life care and the death of our residents.”

While it is rare for people to be incorrectly declared dead, it has happened before. In 2018, a Spanish prisoner was certified dead by three doctors before waking up in a mortuary. Later that year, a car crash victim in South Africa was covered in a silver sheet and taken to a morgue when a forensic officer noticed the person was still breathing. In 2020, a Michigan woman was about to be embalmed after she was pronounced dead from a heart attack until employees at a funeral home saw her breathing.

Glen Oaks, a state-licensed residential care facility, is not a skilled nursing facility, meaning it is not subject to the same oversight and federal regulations as nursing homes, according to the Iowa Capital Dispatch. The facility was fined $500 last year for failing to perform required background checks on employees after five workers did not have the mandated training.

The outlet reported that while the Iowa Department of Inspections and Appeals believes people living in a state residential care facility are unable to properly care for themselves, those residents “do not require the services of a registered or licensed practical nurse except for emergencies.”

If Glen Oaks does not contest the citation and pays the $10,000 fine within 30 days, then it will be reduced by 35 percent, according to the state administrative code. The patient was admitted to the facility on Dec. 20, 2021, after she was diagnosed with early onset dementia, anxiety and depression, according to the state report. She was admitted to hospice care about a year later, on Dec. 28, 2022, because of “senile degeneration of the brain,” the report said.

It was 6 a.m. on Jan. 3 when a nurse found no signs of life while checking on the patient, who is referred to by the state agency as “Resident #1,” the report said. “Resident #1’s mouth was open, her eyes were fixed and there were no breath sounds,” the report said. “She was unable to locate Resident #1’s apical pulse using her stethoscope. She placed her hand on Resident #1’s abdomen and noted no movement.”

After a few minutes, the nurse “felt the resident had passed away” and presumed the patient was dead, according to the report. The nurse then notified a family member and the on-call hospice nurse. “Hospice agreed to call the funeral home and did so,” the report said.

At 7:38 a.m., a funeral director arrived to retrieve the patient’s body and place it “on the gurney inside a cloth bag and zipped it shut,” according to the state report. Almost an hour later, staff members at the funeral home realized the woman was still very much alive when they saw her chest moving.

She was transported to an emergency room where officials noted that her breathing was shallow, according to the report. The woman was released that same day and returned to the hospice facility “with continued hospice care around the clock,” the agency said in the report. Two days later, she died surrounded by loved ones. This time, it was real.

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Dying Can Cost Loved Ones $20,000 Before Lost Wages And Worse Health, New Report Says

By Deb Gordon

If you think the cost of living in the United States healthcare system is high, wait till you see the cost of dying.

A new report details the direct financial impact of a loved one’s death, as well as the less tangible costs of loss.

The 2023 report on The Cost of Dying was released today from Empathy, a company that helps people manage the logistics and emotional burdens of death. The report includes results from a survey conducted with nearly 1,500 people who had lost an immediate family member in the prior five years.

Overall, the average direct costs related to the death of a loved one can reach $20,000. That’s before factoring lost income from taking time off or healthcare costs required to manage health and mental health symptoms.

On average, survey respondents reported that they paid $3,584 to the funeral home (lower than the 2021 national median cost of $7,848 reported by the National Funeral Directors Association). Burial plots cost respondents an average of $1,841. Smaller expenses, such as catering, officiants, flowers, music, and invitations can add more than $1,700 combined, making the funeral the single biggest expense associated with a loved one’s death.

But the costs don’t end with the funeral. Survey respondents reported paying an average of $4,384 to deal with financial matters, such as hiring accountants and paying bills.

Respondents spent nearly $5,000 on legal matters, including lawyer fees and costs associated with selling off assets. Disposing of real estate can add another $4,000.

Many respondents reported using their own financial resources to pay death-related bills; 42% used their own credit cards or checking accounts and 36% used their savings. Just 14% were able to tap into funds specifically designed for these purposes, such as life insurance or last arrangements insurance.

Rinal Patel, founder of Pennsylvania-based Suburbrealtor, experienced firsthand the costs associated with the death of a loved one.

In February 2022, her 35-year old brother died of a heart attack while he was in Dubai for work. Patel spent more than $4,000 to fly his body back from Dubai and footed the entire bill for his funeral, about $10,000.

“He was my only brother, and I couldn’t let him be buried in a foreign country,” she said.

In addition to direct costs, Patel’s brother’s death also cost her income. As a business owner, Patel missed out on deals while she was away mourning her brother.

“His death cost me a lot financially, emotionally, and psychologically,” Patel said.

Lost work

Death-related costs hit at a time when many people can least afford them.

Nearly all (92%) employed respondents reported taking time off or adjusting their work commitments to manage the experience. For many workers, that costs them money indirectly.

Nearly one-quarter (23%) of respondents reported taking unpaid time off, while about half (51%) took paid time off. Women were more likely to take unpaid time off than men, and half as likely as men (9% vs. 19%) to report feeling satisfied with their employer’s bereavement leave policy.

Empathy’s report says that most U.S. companies offer one to five days of bereavement leave. But most people need more time than that to manage logistics of death, let alone to properly grief.

Jasmine Cobb, a licensed grief and trauma therapist from Texas, was lucky that she could use accrued paid time off when her mother died in 2020 from complications with metastatic breast cancer.

Though her employer at the time was supportive, Cobb noted the mismatch between most employer bereavement policies and employee needs.

“Generous bereavement is an oxymoron and is generally non-existent,” she said. “The most I’ve heard of companies extending is about two to three days max, which tends to be incongruent when experiencing a profound and significant loss.”

The health costs of death

In addition to significant financial impact, 93% of survey respondents reported having experienced at least one health symptom as a consequence of their loss. A majority of respondents experienced at least two symptoms and 34% had four or more symptoms for more than a few months.

Persistent symptoms included anxiety, reported by nearly half (46%) of respondents. Other symptoms included disrupted sleep (38%), weight loss or gain (33%), irritability or anger (30%), and memory impairment (30%).

Women were more likely than men to experience symptoms for a year or longer. For example, 23% of women and just 12% of men reported experiencing anxiety for more than a year. Women were twice as likely as men to experience prolonged sleep disruptions (16% compared to 8%) and weight gain or loss (14% vs. 7%). One in ten (11%) women reported persistent panic attacks compared with 6% of men.

Tennessee-based Brittany Nicole Mendez, 27, a marketing officer at FloridaPanhandle.com, still experiences symptoms associated with loss, seven years after the death of her brother.

Mendez, then 20, was visiting her family in San Francisco for Christmas when she learned her 22-year old brother had been hit by a car while walking on a pedestrian crosswalk. He died the next day.

Though the direct financial burden fell to her parents, who started a GoFundMe to help with the unexpected funeral costs, Mendez didn’t get paid for the extra weeks she spent in California with her family.

The real cost to Mendez has come in the form of lasting mental health challenges.

“I never experienced true anxiety, panic attacks, or depression until after he passed away,” she said.

After her brother’s death, Mendez had difficulty eating and sleeping. She still suffers from extreme panic attacks caused by the fear that she or a loved one will lose their life unexpectedly.

Danielle Jones, 38, of Tampa, Florida, also experiences lingering health impacts of her mother’s death from heart failure in 2021. Jones’ mother died on her 57th birthday.

Jones paid for everything out of pocket, including travel and the process to clear out her mother’s house. She minimized expenses by replacing a funeral with visitation with specific friends and family. Her cousin, who worked for a funeral home, helped out by paying for her mother to be cremated.

But the nonmonetary costs have taken a toll on Jones.

“Her death rocked my world,” she said. “It was hard to go back to work. I cried between work calls.”

Jones started seeing a therapist, but the therapist was disorganized because she herself had just had a death in her own family.

“I quit seeing her,” Jones said. “I couldn’t handle the missed appointments.”

Jones said there were many nights when she could not sleep through the night. She said she only ate if someone reminded her to. Cooking, grocery shopping, and taking walks all reminded Jones of her mother. They would speak daily during these routine activities.

“I couldn’t walk int my kitchen because it made me think of her,” she said. “It was hard to get back to my life as I once knew it.”

Though Jones is a certified nutritionist and wellness strategist who writes about her experience with grief, she said she’s gained 20 pounds since her mother’s death. She blames the emotional stress of her grief.

It may be no wonder that the effects of death can last so long. The process of managing a death can take a lot longer than expected. Resolving all the financial matters associated with a loved one’s death took respondents about a year on average. They spent an average of 20 hours per week dealing with these issues. More than half (62%) said that these issues took longer to complete than they had expected.

Planning can offset the direct and indirect costs of death. Not only does it relieve financial burdens if some expenses have been prepaid, but people whose loved ones pre-planned their funerals reported missing less work and experiencing less anxiety, sleep disruption, and memory impairment. Pre-planning also reduced the likelihood that people would have trouble enjoying everyday activities after they lost their loved one.

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