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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.”

Complete Article ↪HERE↩!

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How hospice helps patients and families navigate end-of-life care

— Former president Jimmy Carter’s wish to enter hospice care has raised awareness about how families cope with the dying process

By and

The decision by former president Jimmy Carter to stop medical intervention and spend his remaining time at home with his family has brought new attention to hospice care.

Hospice care is a form of medical care given at the end of life, when medical interventions to prolong life are stopped, and the focus shifts to supportive care and helping both patients and their family members cope with the dying process.

By entering hospice, Carter has taken on “one of the most serious decisions anybody can make in their life,” said William Dombi, president of the National Association for Home Care & Hospice. “I think it’s a good thing that people are gaining awareness of hospice through this. Every generation needs to learn about what hospice is, how valuable it is and that it’s an option — a great option — that is available to them.”

We answered common questions about hospice and end-of-life care.

What happens when you go into hospice?

Hospice describes a specific type of supportive care for people near the end of life. A defining principle of hospice care is that it does not include medical interventions focused on curative treatments or prolonging life. Patients may decide to enter hospice care because they have run out of realistic treatment options, or they may decide that want to focus on quality of life and no longer want invasive medical treatments.<

“You need to get good medical care for the stage of illness you’re in,” said Leslie Blackhall, a physician and section head of palliative care at University of Virginia Medical Center. Hospice care doesn’t shorten life, “it’s just a more appropriate form of care,” she said.

Some people who need extensive care may spend their final days in a nursing home or assisted-living facility. But many people “entering hospice” simply go home to be with their families. A patient’s hospice care plan may include a team of nurses and home caregivers, therapists, social workers and religious advisers, Dombi said. The plan likely will include medical equipment, such as a home hospital bed, as well as medications to ease pain, anxiety and ensure comfort.

Most insurance plans cover the costs of hospice care. For those who don’t have insurance, many hospices will provide free care and, state Medicaid systems also may assist with the cost, said Phil Santa-Emma, medical director of hospice and palliative care services at Mount Carmel Health System.

How long do people live in hospice care?

Hospice is set up for patients who are expected to have less than six months to live. But there’s no way to accurately predict how long the dying process may take.

“A significant number of people live less than 15 days and a significant number more than a year,” Dombi said.

Even among very sick patients in intensive care units, doctors’ predictions of the timing of death are only accurate around 20 percent of the time.

“So many people are under the misconception that hospice means I’m dying right now,” Santa-Emma said. “We have to reframe that. Hospice is going to help me live the very best I can, and even though I have the terminal illness, I know I’m mortal, and I know I’m going to pass away. But between now and then, how do I live the best that I can?”

What happens if you live longer than expected?

Sometimes people in hospice care exceed doctor’s predictions for how long they might live. When this happens, the hospice provider will require the patient to be assessed every few months to decide whether the patient remains terminally ill, said Santa-Emma. If patients are stable and the disease is no longer showing signs of progression, “then you graduate from hospice,” he said.

Patients who continue to meet the criteria for hospice are allowed to continue the supportive care.

Margaret Drickamer, the associate medical director of inpatient hospice care at UNC School of Medicine, said it can be upsetting for family members and patients who have prepared for death, only to be told the patient has hit a plateau and is being discharged from hospice care.

“I have the unhappy job of saying this person isn’t dying fast enough,” Drickamer said. “It’s very hard on the families.”

What are the four levels of care for hospice?

Routine care, which is the predominant form of hospice care, is provided in the home — or wherever the patient lives. Several times a week, hospice nurses visit to assess the patient and provide medical services, and an aide visits to help the patients with personal needs such as bathing. Social workers and a chaplain or other spiritual adviser visit as needed.

General in-patient care is for patients whose symptoms are rapidly changing and can no longer be managed at home. These patients are admitted into a facility such a hospital or hospice facility to receive around-the-clock care.

Respite care is to give caregivers a break. The patient is admitted to a hospital or skilled nursing facility for a short period of time so family members and friends can take time for self-care.

Continuous care is for patients who are actively dying and need eight hours or more of continuous care from nurses and aides. Hospice sends a medical professional to the home to provide that care.

What’s the difference between hospice and palliative care?

Hospice care and palliative have a lot in common, but they are also very different.

Palliative care primarily focuses on managing pain and symptoms to ensure a chronically ill patient has a good quality of life. Some patients in palliative care may still be pursuing treatments to cure serious illness or slow decline.

A cancer patient, for instance, may still be receiving chemotherapy or radiation treatments to slow the progression of the disease, but also be given palliative care, such as medications to focus on pain and symptom relief, special equipment to make life at home easier and mental health support.

“When they refer to palliative care, we are primarily on symptom management,” said Jennifer A. Winegarden, a senior associate consultant for hospice and palliative care at Mayo Clinic Health System. “The focus is to truly palliate. That’s the definition – to relieve suffering.”

Someone can be on palliative care for years before they’re transferred to a form of hospice care.

Hospice is the final stage of palliative care in which the person has decided not to seek curative treatment, but is still given a wide range of supportive care for both patients and families.<

When should someone seek hospice care?

The answer depends primarily on the patient’s wishes, but can be influenced by their age, quality of life, prospects for future treatments, input from family members and the advice of doctors. Someone in their 40s with a young family, for instance, may be willing to continue invasive medical treatments longer than someone twice that age.

Drickamer said the answer boils down to this: How do I want to spend the time I have left?

Doctors may suggest hospice care for patients who are frequently returning to the hospital, sleeping more than 12 hours a day, eating less or losing weight or speaking only a few words a day, Winegarden said.

“The biggest issue is that people associate hospice with giving up, and I disagree,” Winegarden said. She said some of her patients have told her they haven’t “lived this well for years.” Hospice care is about bringing patients the greatest support and comfort with “the time they have left,” she said.

It takes courage for anyone to shift gears and focus on pain management and care instead of preventing or treating a chronic condition, Drickamer said. That’s why President Carter’s example is so important, she added.

“He’s gotten to a stage where he wants comfort and dignity,” she said. “He’s demonstrating to people how to do that.”

Complete Article ↪HERE↩!

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It’s not un-Christian to support assisted dying

— Christian beliefs seem to underpin the views of many people opposed to assisted dying in the UK. As Prue Leith appears in an illuminating documentary about the practice for Channel 4, Kate Ng argues that allowing others to experience ‘good death’ is the most Christian thing you can do

Danny Kruger and Prue Leith in ‘Prue and Danny’s Death Road Trip’

My mother and I had a conversation about death recently. It wasn’t awkward or prolonged. In fact, it was a very brief exchange in the middle of a Christmas market in Germany while we waited for our bratwurst. “I think people live too long these days,” she told me. “I don’t want to live till I’m 100. And if I get sick, I don’t want to get to a point where it’s not worth living any more.” I agreed with her, we got our bratwurst, and went about our day.

I know many people will think this is morbid, but I’m glad that my mother and I are able to have casual conversations about death. Not because life isn’t precious, but because it’s too precious to dance around subjects like this. We all deserve a good death, just as we deserve good lives. Why not talk about it?

So when Prue Leith announced her new Channel 4 documentary about assisted dying, I was intrigued. Assisted dying, also known as assisted suicide, is defined by the NHS as the act of “deliberately assisting a person to kill themselves” and is illegal in the UK. The British Medical Journal says it is usually used in the context of “giving assistance to die to people with long-term progressive conditions and other people who are not dying, in addition to patients with a terminal illness”.

In short, if someone with a terminal illness or a condition that gets progressively worse wants to end their life, assisted dying would enable them to do so on their own terms. The alternative is to wait days, weeks, or even months to die. Leith argues that assisted dying is the most humane scenario here. I think she’s absolutely right about this.

However, Leith’s son Danny Kruger, the Tory MP for Devizes, strongly opposes his mother’s views. A staunch Christian, Kruger is the chair of the all-party parliamentary group (APPG) for dying well, which “promotes access to excellent care at end of life” and campaigns for better resources for hospice and palliative care services. This is an important and necessary cause. However, the group also “stands against the legalisation of doctor-assisted suicide in the UK”.

This puts Kruger head to head with his mother. Their documentary, Prue and Danny’s Death Road Trip, tackles this difficult discussion between mother and son, and sees them travelling across Canada – where assisted dying is legal – to speak to people who bolster both sides of their argument. At one point in the show, Leith hits the nail on the head when she asks her son if the root of his objection is because of his faith’s belief that “suffering is good for the soul”. Kruger replies: “I think suffering is part of life, but I don’t think we should suffer unnecessarily.” He doesn’t seem to grasp the irony of what he’s saying.

I would like the option to have a good death of my own choosing

Leith also points out that “a lot” of the APPG for dying well’s membership is made up of Christians, yet the individual members seem to avoid acknowledging the influence of their beliefs. They also seem to decline to admit that assisted dying goes against Christian beliefs. “Nobody would use that as their argument,” Kruger says in response. “We don’t go around saying, ‘God says don’t do this,’ I mean, that would be mad.”

But as long as assisted dying remains illegal in the UK, unnecessary suffering will continue. Perhaps he doesn’t want to believe it, but what Kruger is essentially saying – with all his religious bias – is that even if you’re already dying, you shouldn’t be given the choice to leave this mortal plane unless God decides it’s time for you to go.

As someone who grew up in a born-again Christian household, I know exactly how much Christians think suffering is crucial to the human experience. The idea is that the more you suffer in the name of God, the better your chances are of getting into heaven. So it’s hypocritical of Christians like Kruger to say they don’t think people should suffer unnecessarily.

The argument against assisted dying claims that legalising it would result in a “slippery slope that could lead to widespread abuse and distress” of vulnerable people. Members of the dying well group say that placing restrictions around who can access the service would not work, and the net would become wider and wider, even allowing people with no health conditions to qualify. Certainly, these are questions that need to be answered, and any policy drawn up should consider how vulnerable people will be protected. But, given that three-quarters of Britons support assisted dying for people who are terminally ill, MPs must begin having open and constructive conversations about changing the law.

I think about dying a lot. Not in a morbid or harmful way, but I think about how I want to die and what kind of memories I want to leave behind. And if it turns out that I should wind up with a terminal illness or a progressively chronic condition, then I would like the option to have a good death of my own choosing. I want my loved ones to remember me with joy, not with sadness or trauma at having watched me suffer till the end. It would be far more humane than any of “God’s work”.

Complete Article ↪HERE↩!

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The Good Death Through Time

By Caitlin Mahar, Melbourne University Press, $35.00.

Reviewed by Rama Gaind

How likely is it that our ancestors can help us now to face complex questions of dying?

The Good Death Through Time delves into the history of how people’s responses to dying have changed in western societies. We also get to understand when and why other Australians began to find the notion of a physician-assisted death appealing.

This book also asks how such a death became a ‘thinkable’-even desirable-way to die for so many others in western cultures. In particular, it looks at the radical way in which they changed in the course of the 19th and 20th centuries.

“I have quite a bit of understanding of white man’s ways, but it is difficult for me to understand this one.” ― G Ntjalka Williams, Ntaria Council President, 1997

An Australian Senate committee investigation of the Northern Territory’s Rights of the Terminally Ill Act 1995, the first legislation in the world that allowed doctors to actively assist patients to die, found that for the vast majority of Indigenous Territorians, the idea that a physician ― or anyone else ― should help end a dying, suffering person’s life was so foreign that in some instances it proved almost impossible to translate.

For centuries a good death ― the ‘euthanasia’ ― meant a death blessed by God that might well involve pain, for suffering was seen as ultimately redemptive.

This book explores the modern idea that a good death should be painless, bearing in mind sometimes disturbing developments in palliative medicine, and an increasingly well-organised assisted dying movement. We are able to understand the radical historical shift in western attitudes to managing dying and suffering helps us better grasp the stakes in today’s controversies over what it means to die well.

Through unwavering research, Mahar writes an articulate and well-grounded guide to what people have thought and felt about dying.

Complete Article ↪HERE↩!

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‘The Good Death’: Communications Expert Approaches End-of-Life Discussions With Humor

— Communications Expert Approaches End-of-Life Discussions With Humor

Sitting neatly on Christian Seiter’s desk is a pair of salt and pepper shakers shaped like gravestones, each one with its own inscription: “Here lies salt” and “Here lies pepper.” 

Surrounded by death-inspired trinkets and memorabilia, the assistant professor of human communications at Cal State Fullerton calls himself a “death positive scholar” interested in studying end-of-life communication. His research analyzes how different emotions — such as worry and humor — impact people’s willingness to confront their mortality.

By understanding the power of these communication strategies, Seiter’s goal is to encourage people to talk about death and help them work toward what he calls “the good death.”

“Death comes for us all, as harrowing as that can be. Pretending that it’s not going to happen isn’t going to help anybody. In fact, failing to prepare could make the worst day of your loved one’s life unnecessarily worse,” said Seiter. “When time is running short, the gifts that we give are almost all communication-based — things like communicating clearly about what wishes you would want.”

Using Humor to Face Mortality

According to Seiter, planning for a person’s death includes three main steps: reflecting on one’s values and beliefs about the end-of-life, sharing those wishes with loved ones through conversation and formalizing those wishes with documentation, such as advance directives.

Advance care directives include living wills which outline a person’s decisions for medical treatment if they are no longer able to express informed consent, and designating a health care proxy to make medical decisions if a person is unable.

For many, especially young and healthy people, these steps can seem unnecessary or premature, but Seiter said that preparing for the end of someone’s life is similar to packing a spare tire before a long road trip. It’s better to have it and not need it than need it and not have it.

“It’s pretty easy to convince someone who is elderly or someone who’s very ill that this is relevant, but it’s a lot harder to convince college students that they’re not immortal,” he said.

Since the onset of the COVID-19 pandemic, Seiter said that death anxiety has significantly increased. He explained that the constant reminder of death has deterred people from seeking information about end-of-life care.

In a study he conducted in 2020, Seiter found that worry can be used as a mechanism to influence people to take an active role in planning for the end of their life, but in response to the pandemic and high levels of demotivation, he’s interested in another approach to discussing death — humor.

“Humor has the ability to make conversations about death more accessible for everybody,” said Seiter. 

Christian Seiter
Christian Seiter, assistant professor of human communications

This semester, he is working on a research project that evaluates how different levels of humor in a podcast impact listeners’ ability to talk about death and seek out end-of-life precautions. In three podcasts, the speakers talk about advance care planning, but aside from a control episode, one episode adds humor and the third includes humor with profanity.

He is still analyzing the data, but historically, profanity in the death positive movement has been a popular method of encouraging young people to engage with such topics as last wishes and advance care.

Despite Seiter’s best intentions, he knows that there are a lot of reasons why people postpone thinking about their death. For some people, it’s fear that talking about it will invite death into their lives.

No matter the reason, Seiter said it’s important to think about the bigger picture and the additional heartbreak that loved ones could be spared if these conversations occur before it’s too late.

“I’m always amazed by the stories that I hear of people talking about how some of the best days of their lives were some of the last days of their lives because they don’t have to worry about the next steps. Everything is already in place, and they can focus on saying goodbye and leaving with peace,” said Seiter. “Clarity is maybe the greatest gift you could give your loved ones.”

Not everyone is as fascinated with death as Seiter, but there are ways that they can begin to have these conversations in informal and low-risk settings. He said that the first step is to start thinking about one’s mortality and deciding who they would trust to act on their behalf. After discussing those answers with loved ones, people can fill out an advance care directive online without the help of a lawyer.

“I think it’s important for us to step into places of constructive discomfort,” he said. “I’m a big proponent of approaching it with healthy curiosity. If you are curious about it, don’t stifle that. Don’t let societal taboos or myths stop you, and don’t judge yourself for being curious.”

Becoming Death Positive

Seiter found his niche in end-of-life communication as an actor studying medical humanities and bioethics at the University of Rochester School of Medicine and Dentistry. His original goal was to design a theater-based workshop that taught participants clinical empathy. During his program, his adviser sent him to the palliative care unit, and the experience altered his perception of death permanently.

“When I stepped into the very first patient room, I almost fainted and I had to excuse myself. It’s not something that came easily,” said Seiter. “After I composed myself and received a pep talk from my mentor, I reframed the experience and was able to have some of the most meaningful weeks of my life. That’s where I fell in love with the idea of ‘the good death.’”

From that moment on, he shifted his interest away from theater and began his career in academia, conducting research and engaging students with this topic of death.

He brings his expertise into the classroom at CSUF, teaching classes on health communication, processes of social influence and persuasion as well as interpersonal communication and research methods.

“Many people don’t want to admit that we are all a little curious about this, and yet, you would never know because nobody wants to talk about it,” said Seiter. “Especially with COVID-19, we’ve all been living with death very intimately for several years and giving people an avenue to talk about it is a really valuable thing.”

Complete Article ↪HERE↩!

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Giving the gift of a ‘good death’

By Megan Crotty

It was a normal workday at Patty Burgess’ cosmetic surgery consulting business, then the phone rang.

It was a call for her coworker, Rona, from her doctor that made her visibly upset. The doctor had test results for Rona but would not give them to her over the phone, so Burgess said, “We’re going,” and the two drove to the doctor’s office.

The tests revealed stage 4 lung cancer.

“It was shocking, and it just changed everything on a dime,” said Burgess, who became Rona’s caregiver at the end of her life. “She was a dear friend. She helped introduce me to hospice, and I learned what an unbelievable, valuable benefit it was. The next thing you know, my whole life had changed.”

Serving a need

After being a volunteer, trainer and community educator for hospice, Burgess saw the need for better training of hospice volunteers and caregivers. Fast-forward 20 years, and Burgess is a national trainer, speaker and educator in end-of-life matters, and she has trained more than 15,000 volunteers, staff, end-of-life doulas, caregivers and students thanks to her company, Teaching Transitions.

The course, “Certified End-of-Life Specialist and Hospice Volunteer Designation,” is being offered at North Carolina’s Randolph Community College starting next month.

Patty Burgess

“People plan more for buying a car or going on vacation than they do for their own death,” Burgess said. “One of the things that our course seeks to do is try to help transform the experience of dying, grief and loss from one of only fear or sadness or being overwhelmed into peace, connection, meaning and even a little bit of awe. That’s a good death.”

She continued: “Lots of times the patient is ready, but the family is not. Sometimes, getting the family to come to terms with, and to understand the sacred passage — and all the connection and time and all the beauty that can really be had — can make a huge difference in the death of their loved one.

“I’m not necessarily wrapping death up with a big red bow because sometimes it can be pretty messy, but it’s usually messier when people don’t know what to expect; they’re fearful, and they’re overwhelmed. But if they know what to expect and understand that this is a normal, natural part of life and if we’re seeking a good death, it’s much more likely when people know what’s coming.”

Course details

Burgess said the immersive, self-paced, online course teaches students to cultivate a high level of compassion and empathy, and to eliminate factors that may obstruct the delivery of high-quality care and companionship to whomever they serve.

The course features 10 modules:

  • Welcome, Overview and Purpose of the Course
  • Hospice 101: Introduction to Hospice Philosophy, Benefits, Eligibility, & Team Approach to Care
  • Personal Death Awareness, Exploring Beliefs and Fears, Advance Directives
  • End of Life Communication: Speaking and Listening Differently
  • Clinical Care at End of Life: Signs & Symptoms of Approaching Death, Universal Precautions, Pain & Symptom Management, Safety in the Home, Actions When Death Occurs in Various Settings
  • Spiritual and Cultural Diversity and Inclusion in the Dying and Death Experience
  • Loss, Grief and Bereavement: Understanding, Coping and Healing: Supporting Others through Grief
  • Self Care & Resilience: Managing Personal Stress and Avoiding Burnout
  • Legacy: Last Words, Eulogies and a “Dialogue with Death
  • Putting it All Together: Volunteer Roles, Visit Etiquette, Ethics and Needs of the Dying

The course also meets and exceeds the Medicare regulations for hospices, and the training recommendations by the National Hospice and Palliative Care Organization (NHPCO). It is appropriate for personal or professional caregivers or healthcare staff wishing to enhance skills and credentials.
It is also valuable for various roles and disciplines (as either entry-level training or continuing education), such as nurses, grief counselors and more clergy.

“There are lots of times when we have nurses in the program who have worked in oncology and spent their time trying to keep people alive,” Burgess said. “They never really dealt with death. Initially, this course was designed for hospice volunteers, but it’s for the layperson, students looking to enhance their professional credentials… We’re all going to become a caregiver to someone.”

Burgess was one of seven original founders of the National End-of-Life Doula Alliance (NEDA) in 2018. Today, NEDA has welcomed more than 1,300 members since its formation and continues to grow as this healthcare segment gains popularity and utilization.

Complete Article ↪HERE↩!

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How do you want to die?

— Society doesn’t often talk about dying, but an end-of-life doula in Durango says we should


Christine Pollock, an end-of-life doula, says the quality of one’s dying experience is largely dependent on his or her preparation going into it.

By Reuben Schafir

Years before she received any training to prepare for working with those nearing the end of life, Christine Pollock gathered a small community of supporters as a friend of hers prepared to die.

“As time progressed and she got closer and closer to death, she embodied more and more light,” Pollock said. “Even though she was in so much pain and suffering, she became like this beacon of light.”

It was July 2013. As Pollock’s friend took her final breath, a powerful breeze cut the still heat of the day and poured through the window.

“The veils are very thin between being on this side and being on that side,” Pollock said. “I think our hearts can hold a lot more than we allow them to, especially when it comes to compassion.”

Pollock is an end-of-life doula in Durango. She describes her work as that of a front-line caregiver who provides comfort care and views herself as a conduit – she helps facilitate the dying experience that those passing wish to have.

Just as doulas transition people into the world, end of life doulas transition people out of it.

The work of an end-of-life doula is not medical, at least in Pollock’s case. She does not administer medication or take the place of hospice or palliative care.

In his 1971 elegy for the aged, “Hello in There,” the legendary folk artist John Prine wrote of the solitary old folks to whom he delivered mail during his days as a letter carrier. It’s refrain concludes, “old people just grow lonesome, waiting for someone to say, ‘hello in there, hello.’”

It is this experience that end-of-life doulas hope to prevent.

“The whole thing is about changing a cultural paradigm around how we view death, taking it from a fear-based perspective, a scary experience, into a sacred and beautiful transition,” Pollock said.

As long as people have been living, they have been dying. The experience, in many cases, used to be as much an exercise in mourning as it was a celebration of life. As communities grew, it became easier for people to slip through the expanding gaps in the social web, Pollock says. And as the bonds of community have weakened, the fear of death has increased.

“Everybody rallied around a birth, everybody rallied around a death and honored their life, honored their gifts,” she said.

She views her work as that of a stopgap. It takes the place of a community – or facilitates the creation of one – to celebrate a life as it comes to an end. Doulas see death as a transition of a threshold; the quality of that transition, Pollock said, hinges on ones preparation.

She began this work in an official capacity after a six-month training at the Conscious Dying Institute in Boulder, which she attended in 2019. The extensive training asked participants to read in depth on the topic, come to terms with their own grief and practice creating plans for the final three months of someone’s life.

Pollock leads meditation and wellness retreats as a day job, as her practice as an end-of-life doula is not a full-time occupation. The line between client and companion appears blurred in the cases when she counsels those nearing death for no compensation.

In the last year, she said she had three paying clients, between eight and 10 whom she worked with free of charge, and an additional smattering of telephone consults.

The work of an end-of-life doula is different according to the needs of each client and the person doing the work. Pollock works from a toolbox filled with guided meditations, music, massage therapy, Reiki and an assortment of literature and mantras.

A lack of discussion around death as a society inhibits planning; Pollock’s primary mission is to encourage those approaching death to develop some sort of plan. She works with clients to create “vision maps” that could include anything from exercise in forgiveness to visiting the ocean.

“We fill the care gap,” she says.

The soft-spoken caregiver is mindful of individual religious or spiritual beliefs and seems adept at fitting her own work into the existing understanding of life and death that a client and family maintain. Whatever one’s conception of an afterlife may be, Pollock works to ease the transition into it.

Although working with an endless stream of dying clients could foist an undue weight on an end-of-life doula, she says the work enriches the meaning in her own life.

“It’s truly a calling,” she says. “It’s a life purpose and everything that I have done up until this point in my life has led me to this precipice of the final work that I will do with my life.”

Pollock hopes that eventually, her line of work will be rendered unnecessary by a change in the cultural conception of death.

“We’re headed back to honoring death as a vibrant part of life, to take the fear out of it,” she said.

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