People come and go in our lives for a variety of reasons. Sometimes it’s because we meet a new friend, or a relationship ends. Maybe we’re the one coming and going as we change jobs or move to a new city. At some point, our entrances and exits are more substantial…we are born and we die. That’s the circle of life.
In the Not So Distant Past
While both birth and death are an unavoidable part of the human experience, I suggest that as a modern culture, we treat each of them very differently. However, this hasn’t always been the case.
As a big fan of Call the Midwife, I never tire of watching the sanitized TV version of babies being born. The series takes place in an East-London neighbourhood, during the 1950’s and early 1960’s. Among other things, it chronicles the progression from the norm of home births to hospital births; and the resulting changes in the expectations of everyone involved. I’m not advocating one birth experience over another, just noting the shift of birth taking place at home vs. taking place in a medical setting.
Like birth, death has also moved locations. In the past, the common practice was that we died at home–circumstances allowing. Ideally, the dying person was surrounded by family and/or friends who were there to offer comfort to the individual and each other. Family members shared the final tasks of preparing their loved-one for burial. Visitation was held in the family home. Birth and death were very personal, yet community, experiences. Now, most of us can expect to die in a hospital, and prepared for our final resting place by funeral home staff.
A Semi-Current Picture
According to Statistics Canada, in 2014 approximately 259,000 Canadians died. The Fact Sheet published about Hospice and Palliative Care in Canada reported that 70% of those deaths occurred in hospitals.
On the flip side, 2014 saw approximately 384,000 Canadian births (142,000 in Ontario). A December 2015 Toronto Star article outlined a three-year McMaster University study that noted midwives attended 10% of all births in Ontario (2014 is included in their data). Of this 10%, 20% of these births occurred at home.
The bottom line…most of us will come and go in a hospital. However, the picture may be changing.
Thoughts on Current Practices of Life…
Midwifery, was regulated in Ontario in 1994, as a publicly funded service. Currently there are more than 700 registered midwives in Ontario who provide neonatal care to pregnant women, attend their deliveries and look after the mother and baby following birth. With the 1994 law, midwives have hospital privileges (including access to hospital staff and resources). The blending of the two options gives expectant parents more choice of where to deliver their babies. It is no longer a binary decision of at home with a midwife vs in hospital with a obstetrician (most family doctors no longer deliver babies).
According to the McMaster study, for women with low-risk pregnancies, babies delivered at home were at no greater risk than those in hospitals. We can have the best of both worlds.
The same choice has begun around end of life decisions as well. The number of hospice centers and palliative care support is growing steadily. According to an Ontario Ministry of Health and Long-term Care position paper:
“Ontario is working to provide patients with more choices for palliative and end-of-life care.
This includes investing in more hospice care across the province and expanding caregiver supports that help families and loved ones support palliative patients at home and in their communities. Ontario will also support more public education about advanced care planning so that patients’ wishes for end-of-life care are understood. The province is establishing clear oversight and accountability for Ontario’s palliative care services, to further advance patient-centred care.”
It will be interesting to see the effects of assisted death legislation on end-of-life location options.
Speaking of options, there are now death doula’s or midwives who spiritually help individuals and their families through the death process. Training programs to become a death doula are now available throughout Canada and the US. Both MacLeans magazine and Global News have covered this subject.
Death is Making an Appearance
While our culture tends to hide death–even in the language we use to describe death (“passed away” or “passed on”); I have started to notice some changes. Besides the increased visibility of hospice and palliative care and debates on assisted death, end-of-life has started to take up space in our current frame of reference.
At first it was something I glimpsed out of the corner of my eye. A colleague had mentioned that he had attended a weekend workshop on “home funerals”. The event took place in a private home, and included information about the rules and some basic skills for taking care of your deceased loved from death until burial. While not for everyone, this is a fascinating alternative to the current practice.
Next, over the six-month period, numerous articles appeared in the local paper:
- A story about a Romanian cemetery (called the Merry Cemetery) where the crosses are etched with colourful epitaphs and drawings describing the deceased’s life and/or personality;
- A helpful article about “tying up the loose ends of life”;
- Another article assuring readers that “death doesn’t have be so frightening”;
- A commentary of the Mexican tradition of the Day of the Dead–a family celebration that sees family members and friends having parties in local cemeteries as they visit their loved ones;
- And finally, a review of the book “The Gentle Art of Swedish Death Cleaning: How to free yourself and your family from a lifetime of clutter.” A new reason to declutter.
I came across information about the Good Green Death Forum (an event organized by the Green Burial Society of Canada) and DeathCafe.com (a social event where people talk about death with the goal of increasing their awareness of life).
Ideas about death appear to be popping up in popular culture.
Why Does This Matter?
As a therapist, I tend to look at things through the lens of mental health. While birth is usually a happy event (no matter where it takes place), I have concerns about how we deal with the end of life. With the movement of death from plain sight over the past decades, it has become scary. Combined with our culture’s fixation on youth, this fear has escalated. As with most things in life that we don’t understand, when we push them away they become something mysterious, and to be feared.
But do we have to continue to treat death this way? Instead can we use a familiarity with death as a tool to help us live more aware and fulfilling lives?
Another Way to Look at Death
In many Buddhist traditions, a purposeful contemplation of death is one practice that is used to help individuals become aware of the constancy of change and life’s fragility. The concept is that when we realize that nothing in life is permanent and everything is easily broken, we look at events in our lives differently. We may appreciate to a greater level not only what we have (including health, relationships, and things), but also the people we love. From this perspective, while we may grief loss (from the breaking of a favourite cup to the loss of something greater), we understand it to be part of a greater whole. As well, to quote a best-selling book title, we “Don’t sweat the small stuff…and it’s all small stuff”.
Death as an Exercise
I’ve come across a few books over the years (The 7 Habits of Highly Successful People and She Means Business (to name a few) that advise readers to become comfortable with their own death as a way to add focus to their lives.
These authors lead a guided exercise in which the reader imagines, in detail, their own funeral or memorial service–paying particular attention to what their family and friends are saying about them. These imaginary statements become nuggets to be mined as you set life goals. I’m not sure if it works, but could be an interesting exercise.
We can’t hide from the comings and goings in our lives…whether it’s us or someone else. However, we can become less fearful and more mindful.
And now…somewhat predictably, but none the less still moving after all these years (movie came out in 1994)…The Lion King – Circle of Life. Enjoy!