Today is my birthday, so it feels like an appropriate time to do one of my favorite things - start conversations about death. Today on the blog I’m sharing about one of the aspects of the Creative Dying project that I’m most passionate about: Green burials.

Have you ever wondered about a green burial? Establishing a green burial sanctuary is a big part of the Creative Dying vision, and I’ve recently started volunteering at the Farley Center for Peace Justice and Sustainability Natural Path Sanctuary, so I thought this could be a perfect time to talk a bit more about what green burials are, and why they’re so wonderful.

Green burials are a way to care for our bodies after death that involves intentional choices, little intervention, and an honoring of the natural decomposition process. With minimal environmental impact, green burials aid in the conservation of natural resources, reduction of carbon emissions, protection of worker health, and they support restoration ​and/or preservation of habitats. Choices can be made at each step of the death care process to limit waste, reduce the carbon footprint, and even nourish the local ecosystem.

For most of human history, what we now call a green burial was just called “burial.” When conducting a green burial, there is no embalming, and only use of natural materials that can easily decompose. Bodies are often transported and buried in shrouds made of natural fabric, baskets, or simple wooden boxes. Gravesites are often dug by hand, and burials occur ~3.5 feet under the ground. Burial sites are often decorated with native flowers and plants, simple wooden or engraved stone markers.

There are three levels of green burial - hybrid, natural, and conservation. Hybrid burial grounds offer space for green burials, as well as burials with embalming, vaults, and caskets. Natural burial grounds allow burials directly into the Earth, without embalming, using a biodegradable container, and without a grave liner or vault. These are definitely better alternatives than hybrid sites if you’re concerned about environmental impact. And conservation burials are especially wonderful - This type of natural cemetery  is established in partnership with a conservation organization and it includes a conservation management plan that upholds best practices, in addition to providing perpetual protection of the land. In a conservation burial, burial fees are often used to cover land acquisition, protection, restoration, and management. Not only does conservation burial help protect land, but the burial area becomes hallowed ground, restored to its natural condition and protected for generations to come with a conservation easement.

According to the Green Burial Council and the Order of the Good Death, each year Americans are estimated to put 30 million feet of wood, 800,000 gallons of embalming fluids, 1.6 million tons of reinforced concrete, 17,000 tons of copper and bronze, and 90,000 tons of steel into the Earth during burials. Green burials eliminate much of this waste by leaving out almost all of those materials; simply wrapping a body in a shroud made from a biodegradable material like cotton, or laying a body in a natural fiber basket / box, and and placing it directly in the ground.

While cremations are becoming more popular, it is important to note that the practice of burning bodies releases toxic emissions and pollutants into the air. And spreading ashes in natural environments can harm soil and water quality. So, while cremation may be a useful option when considering financial cost and current accessibility, green burials are the clear winner in sustainable post-death care practices.

So we’ve established that green burials more environmentally friendly and cost saving, but those aren’t the only reasons one might be drawn to a green burial. There is also some sort of magic in the direct process of returning to nature, an embodiment of the decomposition process, and honoring of the natural cycles of birth, life, death, decomposition… It can be an especially meaningful final act to nourish the Earth with our sacred bodies.

Talking about green burials and engaging with the Farley Center Natural Path Sanctuary, common questions have included “will animals dig up the gravesite?” and “will water / soil quality be impacted?” The simple answers are “no.” Thanks to thoughtful green burial sites across the U.S. and the world, data has been collected to show that these are not issues associated with green burials.

If you’re in the U.S., here is a map of green burial grounds that can be useful to explore options near you. Here is also a frequently updated master list of Green Burial Cemeteries in the U.S. and Canada that can be useful to start a search. And of course, feel free to reach out if you’d like to talk more about green burials. I’d love to connect.

References

Aruomero, A, Afolabi, O. (2014). Comparative assessment of trace metals in soils associated with casket burials: Towards implementing green burials. Eurasian Journal of Soil Science. Retrieved from https://dergipark.org.tr/tr/pub/ejss/issue/5424/73448

Bouverette, A. (2017). Green Burials: The Deinstitutionalization of Death. The Hilltop Review. Retrieved from https://scholarworks.wmich.edu/hilltopreview/vol10/iss1/14/

Green Burial Council (2022). About. Retrieved from https://www.greenburialcouncil.org/

Green Burial Council (2022). Natural Burial FAQ. Retrieved from https://www.greenburialcouncil.org/green_burial_defined.html

National Geographic . The environmental toll of cremating the dead. Retrieved from https://www.nationalgeographic.co.uk/environment-and-conservation/2019/11/environmental-toll-cremating-dead

Order of the Good Death (2022). Green Burials. Retrieved from https://www.orderofthegooddeath.com/resources/green-burial/

Hey friends,

As we reach the end of the Creative Dying Card Game Crowd Sale, I thought it might be nice to share a bit more about the “why” and the “how” behind the game. It is truly an honor to share this game and I am so grateful for everyone who has supported this work.

This Creative Dying Card Game is a collaboration with Casey and Figgins at Affinity Games. We linked up through The Fledge (thanks Jerry!) and we each recognized the value of having authentic conversations about death. We were inspired by the Death Cafe model, and we wanted to create a helpful tool to support folks in having conversations - not only to address the practical aspects of illness and dying, but also to help us consider how we really want to use this precious time that we have.

We met regularly over Zoom to brainstorm what the game could look like. After a few iterations, we decided to start with the Creative Dying logo, add colors and make each petal a different category. We used color theory, a Western perspective on the Chakra system, and a modified version of the Stages of Grief to develop the categories.

Next, we started writing the prompts. We did this with a color-coded spreadsheet and careful attention to word choice and topics. We wanted to inspire rich conversations about the complexities of life, death, and grief, but we also wanted the game to help with discussing and planning practical matters. We regularly re-visited the “why” behind the game and often spent significant time selecting a word or phrase that felt just right.

And next was play testing! (Shout out to each of the wonderful folks who dedicated time and energy to this process 🖤). We played the first version of the game together and gathered feedback on how it went, what worked well, and what we could change. We carefully considered all of the comments and edited the game accordingly.

Finally, we launched the updated virtual card browser so anyone can play online for free, and we began printing copies of the card decks to share.

"You know you have a certain time left, and then the question is, ‘What is important for me to do in that time?’ - That's different for everyone, so talking about death, for me at least, is the ultimate prioritization exercise."

- Jon Underwood, Founder of Death Cafe Movement

Thank you for being on this journey together and for supporting this project 🖤

Why Psychedelics & Dying?

August 1, 2021

A central part of our mission at Creative Dying is to establish a dying center that is inclusive, community-based and psychedelic friendly. We care deeply about sharing knowledge and expanding access to psychedelic-assisted therapy. But why include psychedelics in end-of-life care?

I work in a number of spaces focused on psychedelic-assisted therapy - I regularly talk with psychedelic researchers here at the University of Wisconsin-Madison, I join psychedelic society meetings and I’m even completing a training program in psychedelic-assisted therapy. So I was surprised when a new friend, a hospice nurse, was not familiar with the use of psychedelics for facing death and grief. In our recent conversation about psychedelic-assisted therapy, she asked questions like “Is this similar to taking Vicodin after a surgery?” and “Do people commonly get addicted?”

This recent conversation inspired me share more about the unique nature of psychedelics and how, when ingested in a safe setting with intention, they can profoundly support folks who are facing the end of their lives.

So today, let’s talk a bit about why psychedelics can be helpful when facing serious illness and death.

First, despite our best treatments, folks with advanced diseases are suffering from significant mental health concerns (like anxiety, depression, and demoralization).

And humans have been using psychedelic medicines (like psilocybin from “magic mushrooms”) for many years in ritualistic healing contexts. Sometimes called “entheogens”, these plants and fungi can facilitate experiences self-transcendence, reductions in egocentric concerns and broadened perspectives about life and death.

Recent studies have shown that one session of psilocybin-assisted therapy (in a clinical setting with support from trained therapists) can yield large decreases in measures of depressed mood, general anxiety, and death anxiety, while increasing quality of life, meaning and optimism among people with cancer. And having a mystical-type experience on session day was the strongest predictor of experiencing the most positive outcomes from the session.

In most studies of psychedelic-assisted therapy, each psychedelic session is preceded by a number of therapy sessions to help folks sort out their feelings, past traumas and intentions for participating. And after a psychedelic session, participants continue to meet with therapy team to process their experience and practice incorporating their new insights into everyday life (termed “integration”).

When researchers interviewed people with cancer after their psilocybin-assisted therapy experiences, typical themes included: exalted feelings of joy, bliss, and love; embodiment; inability to describe the experience in words; alterations to identity; movement from feelings of separateness to interconnectedness; experiences of moving through psychological distress; the appearance of loved ones as guiding spirits; catharsis of powerful emotion; surrender or “letting go”; forgiveness; improved relationships; and continued challenges to integrate the experience into their everyday lives.

Among people with cancer who received psilocybin-assisted therapy, a long-term follow up study showed sustained reductions in anxiety, depression, hopelessness, demoralization, and death anxiety even 3 - 4.5 years after the session. Participants overwhelmingly attributed positive life changes to the psilocybin-assisted therapy experience and rated it among the “most personally meaningful and spiritually significant experiences of their lives”.

There is no evidence that participants in psychedelic-assisted therapy research have developed addictions to the psychedelic medicines. In fact, psychedelic-assisted therapy may even be a viable option for treating addictions.

Although these results are pretty incredible, most of the modern research on psychedelic-assisted therapy includes participants who are White, cisgender, able bodied, have high levels of education and higher socioeconomic status. So it’s not yet clear how these results would hold up across different samples, or how the therapeutic protocol would need to be adjusted to serve more diverse groups of people. We definitely need to do more research to support expanding access to psychedelic-assisted therapy, especially among people who are most often excluded and marginalized. Establishing cross-cultural partnerships and engaging in community-based participatory methods for future research may help address this disparity.

Overall, psychedelic-assisted therapy has the potential to help ease suffering for folks who are facing serious illness and death (which really, will be all of us!… Yet careful screening is needed because psychedelic-assisted therapy may not be suitable for everyone).

And finally, if you’d like to continue exploring this topic, Horizons Media recently shared an insightful mini-documentary (39 minutes) on Death, Dying, & Psychedelics and it’s available for free online.

If you have any questions about psychedelic-assisted therapy or would like to share your thoughts/experiences, please reach out.

What are Palliative Care & Hospice?

January 8, 2021

If you’re interested in learning more about palliative care & hospice, I commend you! These can be tricky concepts, and even tougher when you’re faced with decisions for yourself or a loved one.

The purpose of this post is to…

• Provide a basic overview of palliative care & hospice;

• Pose some questions which may help you with making decisions;

• Provide some tips for talking with your health care providers about palliative care & hospice.

1.  What are palliative care & hospice? 

The main focus of both these services are to enhance our comfort and quality of life. Palliative care and hospice care have much in common, but there are also some important differences. Palliative care is comfort care that is provided along with curative treatment (any care intended to cure a disease or condition, or intended to prolong life). When choosing to receive hospice care, curative treatment is no longer provided, but you may receive additional benefits and services such as extra comfort care, supplies and people to help. See the images below for some additional info.

2. Questions to consider…

Here are some things you might want to consider when making decisions about palliative care or hospice. These questions may be difficult to think about, but they can also help ensure you and your loved ones are provided with the best care possible. Take your time with these. Think about your answers, write them down, and/or discuss them with a loved one.

• What is most important to me?

• Are the symptoms of my disease or condition well-controlled?

• Am I in pain?

• What makes my life meaningful?

• Do I feel comfortable with my spirituality?

• Could my family/caregiver(s) use additional support?

• Can I expect my illness/condition to be cured?

• If I became too sick to speak for myself, who should make decisions for me?

• Do I have advanced directives and/or a will?

• How well do I feel I am coping with my illness/condition?

3. Tips for talking with your health care provider about palliative care or hospice…

• Focus on what is important and meaningful to you. Share what you see as ‘quality of life’.

• Bring a pen and paper in case you want to write anything down to take home.

• Bring a friend or loved one for support.

• Take your time. Take some deep breaths. This is an important conversation and it doesn’t need to be rushed.

• Ask questions about your diagnosis, treatment options, etc.

• Share your concerns and talk about anything you may or may not want.

• Ask about palliative care and hospice options in your area.

• Remember that you’re never “giving up”. Whichever choices you make, there will be a caring team to support you.

• Decisions don’t need to happen in one visit. Mention that you’d like some time, continued communication and planning.

Taking the time to begin planning for the end of your life, or that of a loved one, is truly a gift. Sending love as you move through this important journey. Feel free to reach out if you have any questions about end-of-life planning. We would love to connect.

During this time of rapid change, some of us will be hospitalized and some of us may die, whether from COVID-19 or something else. It is important that we support community members in preparing for hospitalization, which may also include end of life planning. 

End of life planning encompasses advanced care planning (completing documents to select someone to make decisions for you, if needed, and stating your treatment preferences), along with funeral planning (assisting with selecting and booking funeral services). Although we hope these are not needed at this time, it is always better to have a plan in place.

If you or someone you know would like support in preparing for potential hospitalization and completing end of life planning activities, please reach out through https://www.creativedying.org/contact or email MegRaeMiller@gmail.com. Advanced care planning documents can be sent via mail and completed together through video conference or phone call. Funeral planning can be done through video conference or phone call. Creative Dying is also available to provide grief support for anyone affected by COVID-19. 

The intention of this post is to provide recommendations on how you might prepare for potential hospitalization from COVID-19.

Pre-Planning

Pre-planning in case of a potential hospitalization doesn't have to take much time or effort, and it can be a great way to feel more well prepared amidst uncertainty. Of course, we hope you will not be hospitalized, and if you are, we hope that you will make a full recovery. In general, it is best to address end of life planning well before it is needed.

Here are some ideas for pre-planning in case of hospitalization...

• Write out your end of life wishes as soon as you are able. Hopefully these will not be needed right now, but it’s always better to have a plan in place. You can write your wishes in an informal way (like a journal entry) or a more formal way (like an official end of life planning document, see https://fivewishes.org/). Many formal end of life planning documents are legally binding, which may be helpful in situations where there is conflict about what to do. 

• Some of your end of life wishes may include...

  • Who you want to be in contact with in your last days/moments

  • Who you would want to make medical decisions for you if you cannot make decisions for yourself

  • Any medications you do/do not want to be given

  • What you would like your loved ones to know

  • What you would like done with your body when you die. Some options are: Cremation, Green (natural) burial, Traditional Burial, Infinity burial suit.

• If you would like to pre-plan your funeral, this link will take you to a general price list for providers across Michigan counties (This document covers funeral providers in Ingham, Eaton, Shiawassee, Livingston, Calhoun, Clinton, Wayne, Jackson, Saginaw, Washtenaw counties). It is recommended that you pre-plan your funeral, but do not pre-pay! If you are a veteran, you are entitled to a burial, headstone marker, burial flag and veteran ceremony, see https://www.cem.va.gov/ for details.

• Record your passwords in a secure place and let a loved one know where the information is stored. Make sure all of your accounts have beneficiaries. Put together a file with important documents like your birth certificate, marriage certificate, social security card, titles to cars, bank information, etc. Let a loved one know where this is stored.

• Plan a way to connect with loved ones during this time. FaceTime or Facebook Messenger video may be helpful resources to connect with your loved ones when you cannot be together in person. Consider setting up a standing Skype or Zoom meeting and share the link with any loved ones who you would want to connect with (with a free account, Zoom meetings are limited to 40 minutes). 

If You Think You May be Sick

• If you think you have been exposed to COVID‑19 and you develop a fever and other symptoms (such as cough or difficulty breathing), call your healthcare provider for advice as soon as possible.

• Notify loved ones that you may be sick. Put plans in place to care for children or pets, as needed.

• Begin preparing for potential hospitalization (see "If you have to go to the hospital", below).

If You Have to Go to the Hospital

Some of us will have to go to the hospital to be treated for COVID-19 during this time. While going to the hospital usually isn't a wonderful experience, there are some things you can do to make your stay more comfortable.

• Let your loved ones know as soon as possible.

• Try to stay calm. This may not be easy, especially under these circumstances, but do your best. Take some deep breaths, if possible, and remind yourself that there are healthcare professionals here to care for you.

• Prepare yourself a bit. Here are some things that could be helpful to bring with you…

  • A phone/charger and computer/charger so you can stay connected with loved ones. You may or may not be able to use these things depending on the treatment you receive, but it can be good to have them available.

  • Any medications that you take on a regular basis.

• • Your ID and insurance cards.

• • Your end of life planning documents (these can be informal, like a journal entry of what you might like near the end of your life. Or they could be more formal, like an advanced directive form). Hopefully, these will not be needed, but it is better to be prepared.

• • Things that may make your stay a bit more comfortable. These could include: A favorite blanket, a book you enjoy, a journal, headphones & music, etc.

Hospital Checklist

• Phone & charger

• Computer/tablet & charger

• Any medications you take on a regular basis

• Insurance card & identification 

• End of life planning documents 

• Things to make your stay a bit more comfortable. Some examples include…

  • A favorite blanket

  • A book you enjoy

  • A journal

  • Music & headphones, etc.

This content was created in partnership with Organize Together (http://organizetogether.com/).

Many people believe that they have few options when it comes to funeral and burial decisions – this is just not true! What you and your family decide to do with your body after death is a sacred decision, and there are many things to consider. There are a surprising number of options available, and new ones are becoming available quite frequently. Aside from the burial method itself, cost can be an important factor for many families. There are online resources (such as the Funeral Consumers Alliance, https://funerals.org/) which list the current prices for common burials in your area.

    Here we will provide an overview of some commonly used burial methods, in hopes that you may start considering which of these is right for you. It is never too early to start planning. 

Green burial:  Green (or natural) burials emphasize simplicity. The body is placed in a shroud and/or a biodegradable coffin made of plain wood, cardboard or wicker. Green burials are environmentally friendly, and do not use chemicals to prepare the body. The goal is complete decomposition of the body and its natural return to the soil. These burials are significantly less costly than the other options, and they also contribute to preservation of natural areas. Depending on your state, burying a body on private land may be an option, but be sure to check your state’s regulations.

Infinity Burial Suit: Another option is an Infinity Burial Suit. This one is quite unconventional – it is a jumpsuit woven from mushroom-spore-infused thread. Mushrooms grow around the body once it’s been buried, breaking it down. Mushrooms can also neutralize any environmental contaminants in this area, yielding fertile soil. This is a very environmentally friendly option. A recent Ted Talk covers more on the Infinity Burial Suit (https://www.ted.com/talks/jae_rhim_lee?language=en).

Casket burial: Casket burials continue to be very common in the U.S., but popularity is steadily declining. Many people are familiar with this method and some prefer this tradition. Casket burials can happen above ground (such as in a mausoleum), or below ground. With this option, you can choose to be embalmed, or not. Casket burials are not an environmentally-friendly approach, as embalming and other chemicals can leech into the soil. With this kind of burial, bodies are prevented from breaking down in a natural manner. Overall, this can be one of the most costly types of burials.

Cremation: Cremation is the burning of a body to yield ashes. There are several options for cremation, including scattering cremated remains, keeping them in an urn (various different urns are available) or burying them. This can be a lower cost option. Cremation is becoming much more popular, and has surpassed casket burial as the most commonly used method in the U.S. Unfortunately, the cremation process can result in significant air pollution, so it is not considered to be an environmentally-friendly option.

Other types: Various other options exist to care for your body after death, but most are not yet mainstream.  Some include dissolution, Living Urn burials (https://www.thelivingurn.com), memorial diamonds (https://mymemorialdiamond.com), Resomation (http://resomation.com) , space burials (https://www.celestis.com),  coral reef burials (http://www.eternalreefs.com) and body donation. Each of these greatly vary in price and process.

If you are interested in one of these types of burials (or something else we didn’t include), don’t forget to share this information with a loved one to let them know. If you have questions or would like to talk more about burial options, please do reach out. Taking the time to begin planning for the end of your life, or that of a loved one, is truly a gift.

References 

Burial Planning. (2019). Burial Options: Which is Right for You and Your Family? Retrieved from https://www.burialplanning.com/burial-types/burial-types/

Funeral Consumers Alliance (2019). Green Burial, An Environmentally Friendly Choice. Retrieved from https://funerals.org/?consumers=green-burial

Lexikin. (2016). Burial Alternatives. Retrieved from https://www.lexikin.com/funerals/burial-alternatives/

TED. (2011). My Mushroom Burial Suit. Retrieved from https://www.ted.com/talks/jae_rhim_lee?language=en

Although death has always been an inevitable part of the human experience, care for the dying has changed remarkably throughout history. Some of the oldest hospices can be traced back to 1000 A.D. in Europe. One of the first hospices, l’Hotel-Dieu, or ‘God’s Hotel’ was built on the core belief that care for the body necessarily involved caring for the soul. Many traditions guided the culture of hospice care, such as the Ars Moriendi, or ‘the art of dying’, the Tibetan Books of the Dying and Celtic Books of the Dead, and most recently, Ars Bene Moriendi, ‘the art of dying well’. These guides all have a common focus on the interconnection between physical and emotional pain, providing holistic approaches to relieving suffering at the end of life. Many traditions provide maps of the intersections between the physical and emotional, psychological or energetic bodies such as the chakras, the Sephirot of Adam, chi and acupressure points, indicating that an imbalance in any part will affect the entire organism.

Since modernization began, cultural beliefs and practices surrounding death and dying have made huge changes. Modern Western end of life care focuses exclusively on the physical aspects, losing its ancient instinct about caring for all dimensions. Care in the West is now based on a crisis-management model, where death is seen as an enemy to be fought and conquered, and the human is seen as fragmented parts rather than a unified whole. Family and friends are often no longer a part of end of life care. These views are beginning to change and give rise to more holistic care with the advent of hospice in America. Hospice care is built on the philosophy of comfort rather than cure, and is a holistic approach to managing symptoms and providing emotional, social and spiritual support at the end of life. Hospice use in America is growing rapidly. Acknowledgement of unmet needs at end of life is expanding with projects such as the Zen Hospice, and increased national funding for research and implementation of integrative therapies.

References

Groves, R., & Klauser, H. A. (2005). The American Book of Living and Dying: Lessons in Healing Spiritual Pain. New York: Celestial Arts.

Institute of Medicine. (2014). Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Retrieved from http://www.nationalacademies.org/hmd/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx

Zen Hospice Project. (2017). Who We Are.   Retrieved from https://www.zenhospice.org/