Deathcare

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Deathcare processes. Clockwise from upper left: Body laying in a mortuary, morgue slabs with preparation tools, headstones, and funeral procession.

Deathcare (also death care, death-care or after-deathcare) is the planning, provision, and improvement of post-death services, products, policy, and governance. Here, deathcare functions to describe the industry of deathcare workers, the policy and politics surrounding deathcare provision, and as an interdisciplinary field of academic study. [1]

Contents

Deathcare, from the point of clinical death, has a diverse timeline. The first point of care often involves immediate healthcare professionals and responders closest to the person who has died, including doctors, nurses, palliative and end-of-life care workers. [2] From here, the care of deceased individuals has a culturally, religious, and personal course. This can involve a range of people from religious figures, morticians, to grave keepers – all of these roles formulating to what can be known as deathcare workers. [3]

Etymology

The word deathcare is a compound term from the words death and care. It can also take the form of death care, [4] however this is mostly used in the United States and Canada in the Anglosphere, where deathcare is a preferred variation elsewhere in the English speaking world reflecting on the preferred version of healthcare in places like the UK, Australia, India, etc. [5]

History

The provision of deathcare has historically [6] and often continues to be a highly decentralized and diverse practice combining multiple actors and stages. [7] [8] Nonetheless, trends in providers and purveyors of deathcare do exist throughout different eras: in the time prior to the American Civil War, for instance, the majority of care for the deceased was performed by one's own family members. Specifically, women in the family were expected, as a part of their domestic duties, to oversee and execute the sanitization, dressing, and ultimately burial of their families' corpses. [9] However, following the number of deaths during the Civil War, the practice of embalming became commonplace, as fallen soldiers had to be preserved before their bodies could be transported vast distances from the battlefield back to their hometowns. Following the war, it became the norm to have loved-ones bodies prepared and cared for by morticians, and spaces for services to be provided by funeral home directors. [10] Coinciding with the professionalization of the funeral industry, the advances of the medical field changed expectations around an infectious disease course. That is, rather than comfort care, medical providers began to offer life-saving, and thus life-changing measures, e.g. antibiotics. [11] This resulted in a change in the concentration of the placement of ill-people: rather than remaining at home, people began to rely increasingly on hospitals as a place of healing, especially in urban areas where hospitals were more accessible. [12] In areas that allowed for access to hospital systems, this inevitably resulted in a greater proportion of deaths occurring in hospitals rather than at home, thus bolstering the change from home-based care to professional, funeral home-based care of the deceased in the urban West. [9]

In other countries, the social practices around deathcare vary compared to the U.S. For instance, in Hindu culture, women have been barred from attending cremation rituals, and even from touching the deceased. [13] Before World War Two in Britain, women were "commonly responsible for laying-out the body", but following the war were barred from such a role given the expedient professionalization of the deathcare industry. [14]

21st century

Examples of government policy involvement include the impact of new burial methods like human composting [15] to pressures like COVID-19 placing on those involved with deathcare as well as their families. [16] [17] [18] In addition to government policy, the effects of COVID-19 have directly impacted those involved in deathcare: funeral directors were shown to have increased rates of burnout following the first wave of the pandemic. [19]

Delivery

Government

National and regional governments are often responsible for providing the legal framework for deathcare to operate within, including laws and guidance on what deathcare techniques, practices, and what individuals/ organisations are involved. However, this has a varying level of non-government organisations, third-sector, religious, and private organisations (such as funeral homes) [20] take part in both providing and shaping deathcare policy and practice. [21] [22] However, most research on state interactions within deathcare is limited to the US, with further research needed elsewhere. [23]

Governments can also become a major focal point for deathcare services in specific situations, such as with deaths in the military, prisons, or in extraordinary events. COVID-19 is an example of global governmental intervention to provide mass fatality management to cope with high human fatality around the world. [23] This also brought up issues of inequality and inequity within deathcare as some deaths throughout the pandemic were treated as "more tragic" compared to others, highlighted as a public values failure as economic productivity and social worth overruled public health and humanity. [24]

Industry

Analysts have stated that the deathcare industry can be divided into three portions: the ceremony and tribute (funeral or memorial service); the disposition of remains through cremation or burial (interment); and memorialization in the form of monuments, marker inscriptions or memorial art. [25]

Deathcare industry is a multifactorial sector including, but not limited to: companies and organizations that provide services related to death memorials, funerals, and burials. Theses types of ceremonies includes service use of coffins, headstones, crematoriums, and funeral homes. Most of the death service industry has consisted of small businesses that have been consolidated as time has gone on. [26]

There is a global marketplace for deathcare in the produces, services, and insurance that surrounds someone's death. This is a market that has shown expanding fiscal growth in years 2020 to 2021 supported by a compound annual growth rate of 5.6%. The market is expected to continue to grow to a compound annual growth rate of 8% by year 2025 expecting to reach a value of 147.38 billion dollars up from 103.93 billion dollars in 2020. [27]

The deathcare process comes with multiple costs to allow for certain rituals to take place. Including to removal/transfer of remains to funeral homes (est $340), embalming (est $740), Hearse use ($340), metal burial casket (est $2500). The estimated median cost of funeral with burial and funeral was estimated by an NFDA news release to be $7640. [28]

Deathcare industrial complex (DIC) has been outlined as a concept, mirroring the military-industrial complex concept, in at least the US and potentially Western countries as an industry: "profit-driven, medicalised, de-ritualized and patriarchal [in] form, modern death care fundamentally distorts humans' relationship to mortality, and through it, nature". [29] The death care industry in the United States is deemed controversial due to high costs and negative environmental impacts. [4]

Localized efforts to reform and offer innovative deathcare practices can be seen in the natural deathcare movements such as human composting to natural burials. [9] [30]

Environmental impact

Common funeral practices in Western society are associated with notable environmental impacts. [31] Metal caskets can deteriorate and release harmful toxins when buried, leading to contamination of land and water. [31] Cremation also uses a significant amount of fuel consumption, releasing chemicals and carbon emissions. [31]

With the threat of climate change, conversations about green death practices are becoming more prevalent. [31] Natural burial methods are being developed to promote eco-sustainability in deathcare. [31]

Related Research Articles

<span class="mw-page-title-main">Burial</span> The ritual act of placing a dead person or animal into the ground

Burial, also known as interment or inhumation, is a method of final disposition whereby a dead body is placed into the ground, sometimes with objects. This is usually accomplished by excavating a pit or trench, placing the deceased and objects in it, and covering it over. A funeral is a ceremony that accompanies the final disposition. Evidence suggests that some archaic and early modern humans buried their dead. Burial is often seen as indicating respect for the dead. It has been used to prevent the odor of decay, to give family members closure and prevent them from witnessing the decomposition of their loved ones, and in many cultures it has been seen as a necessary step for the deceased to enter the afterlife or to give back to the cycle of life.

<span class="mw-page-title-main">Embalming</span> Method of preserving human remains

Embalming is the art and science of preserving human remains by treating them to forestall decomposition. This is usually done to make the deceased suitable for viewing as part of the funeral ceremony or keep them preserved for medical purposes in an anatomical laboratory. The three goals of embalming are sanitization, presentation, and preservation, with restoration being an important additional factor in some instances. Performed successfully, embalming can help preserve the body for many years. Embalming has a long, cross-cultural history, with many cultures giving the embalming processes religious meaning.

Palliative care is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Within the published literature, many definitions of palliative care exist. The World Health Organization (WHO) describes palliative care as "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain, illnesses including other problems whether physical, psychosocial, and spiritual". In the past, palliative care was a disease specific approach, but today the WHO takes a broader patient-centered approach that suggests that the principles of palliative care should be applied as early as possible to any chronic and ultimately fatal illness. This shift was important because if a disease-oriented approach is followed, the needs and preferences of the patient are not fully met and aspects of care, such as pain, quality of life, and social support, as well as spiritual and emotional needs, fail to be addressed. Rather, a patient-centered model prioritizes relief of suffering and tailors care to increase the quality of life for terminally ill patients.

In medicine, specifically in end-of-life care, palliative sedation is the palliative practice of relieving distress in a terminally ill person in the last hours or days of a dying person's life, usually by means of a continuous intravenous or subcutaneous infusion of a sedative drug, or by means of a specialized catheter designed to provide comfortable and discreet administration of ongoing medications via the rectal route.

Terminal illness or end-stage disease is a disease that cannot be cured or adequately treated and is expected to result in the death of the patient. This term is more commonly used for progressive diseases such as cancer, dementia, advanced heart disease, and for HIV/AIDS, or long COVID in bad cases, rather than for injury. In popular use, it indicates a disease that will progress until death with near absolute certainty, regardless of treatment. A patient who has such an illness may be referred to as a terminal patient, terminally ill or simply as being terminal. There is no standardized life expectancy for a patient to be considered terminal, although it is generally months or less. Life expectancy for terminal patients is a rough estimate given by the physician based on previous data and does not always reflect true longevity. An illness which is lifelong but not fatal is a chronic condition.

<span class="mw-page-title-main">Telehealth</span> Health care by telecommunication

Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions. Telemedicine is sometimes used as a synonym, or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. When rural settings, lack of transport, a lack of mobility, conditions due to outbreaks, epidemics or pandemics, decreased funding, or a lack of staff restrict access to care, telehealth may bridge the gap as well as provide distance-learning; meetings, supervision, and presentations between practitioners; online information and health data management and healthcare system integration. Telehealth could include two clinicians discussing a case over video conference; a robotic surgery occurring through remote access; physical therapy done via digital monitoring instruments, live feed and application combinations; tests being forwarded between facilities for interpretation by a higher specialist; home monitoring through continuous sending of patient health data; client to practitioner online conference; or even videophone interpretation during a consult.

Disposal of human corpses, also called final disposition, is the practice and process of dealing with the remains of a deceased human being. Disposal methods may need to account for the fact that soft tissue will decompose relatively rapidly, while the skeleton will remain intact for thousands of years under certain conditions.

<span class="mw-page-title-main">Viewing (funeral)</span> Funeral custom

In death customs, a viewing is the time that family and friends come to see the deceased before the funeral, once the body has been prepared by a funeral home. It is generally recommended that a body first be embalmed to create the best possible presentation of the deceased. A viewing may take place at the funeral home's chapel, in a family home or at a place of worship, such as a church. Some cultures, such as the Māori of New Zealand, often take the body to the marae or tribal community hall.

<span class="mw-page-title-main">Natural burial</span> Method of burial

Natural burial is the interment of the body of a dead person in the soil in a manner that does not inhibit decomposition but allows the body to be naturally recycled. It is an alternative to typical contemporary Western burial methods and modern funerary customs.

End-of-life care (EOLC) is health care provided in the time leading up to a person's death. End-of-life care can be provided in the hours, days, or months before a person dies and encompasses care and support for a person's mental and emotional needs, physical comfort, spiritual needs, and practical tasks.

The death care industry in the United States includes companies and organizations that provide services related to death: funerals, cremation or burial, and memorials. This includes for example funeral homes, coffins, crematoria, cemeteries, and headstones. The death care industry within the U.S. consists mainly of small businesses, although there has been considerable consolidation over time.

Neglect is defined as giving little attention to or to leave undone or unattended to, especially through carelessness. Mortuary neglect can comprise many things, such as bodies being stolen from the morgue, or bodies being mixed up and the wrong one was buried. When a mortuary fails to preserve a body correctly, it could also be considered neglect because of the consequences.

<span class="mw-page-title-main">Health care access among Dalits in India</span>

Achieving Universal Health Care has been a key goal of the Indian Government since the Constitution was drafted. The Government has since launched several programs and policies to realize ‘Health for All’ in the nation. These measures are in line with the sustainable development goals set by the United Nations. Health disparities generated through the Hindu caste system have been a major roadblock in realizing these goals. The Dalit (untouchables) community occupies the lowest stratum of the Hindu caste system. Historically, they have performed menial jobs like - manual scavenging, skinning animal hide, and sanitation. The Indian constitution officially recognizes the Dalit community as ‘Scheduled Castes’ and bans caste-based discrimination of any form. However, caste and its far-reaching effects are still prominent in several domains including healthcare. Dalits and Adivasis have the lowest healthcare utilization and outcome percentage. Their living conditions and occupations put them at high risk for disease exposure. This, clubbed with discrimination from healthcare workers and lack of awareness makes them the most disadvantaged groups in society.

<span class="mw-page-title-main">Medical–industrial complex</span>

The medical–industrial complex (MIC) refers to a network of interactions between pharmaceutical corporations, health care personnel, and medical conglomerates to supply health care-related products and services for a profit. The term is derived from the idea of the military–industrial complex.

Terminal lucidity is an unexpected return of consciousness, mental clarity or memory shortly before death in individuals with severe psychiatric or neurological disorders. It has been reported by physicians since the 19th century. Terminal lucidity is a narrower term than the phenomenon paradoxical lucidity where return of mental clarity can occur anytime. However, as of 2024, terminal lucidity is not considered a medical term and there is no official consensus on the identifying characteristics.

A death midwife, or death doula, is a person who assists in the dying process, much like a midwife or doula does with the birthing process. It is often a community based role, aiming to help families cope with death, recognizing it as a natural and important part of life. The role can supplement and go beyond hospice. These Specialist perform a large variety of services, including but not limited to creating death plans, and providing spiritual, psychological, and social support before and just after death. Their role can also include more logistical activities, helping with services, planning funerals and memorial services, and guiding mourners in their rights and responsibilities.

Women have had varying roles in the death care industry in the United States since its mid-nineteenth century inception.

Healthcare chaplaincy is the provision of pastoral care, spiritual care, or chaplaincy services in healthcare settings, such as hospitals, hospices, or home cares.

Homecare, also known as domiciliary care, personal care or social care, is health care or supportive care provided in the individual home where the patient or client is living, generally focusing on paramedical aid by professional caregivers, assistance in daily living for ill, disabled or elderly people, or a combination thereof. Depending on legislation, a wide range of other services can also be included in homecare.

Azeem Majeed is a Professor and Head of the Department of Primary Care & Public Health at Imperial College, London, as well as a general practitioner in South London and a consultant in public health. In the most recent UK University Research Excellence Framework results, Imperial College London was the highest ranked university in the UK for the quality of research in the “Public Health, Health Services and Primary Care” unit of assessment.

References

  1. ↑ Marsh, Tanya (2018). "The Death Care Revolution" (PDF). Wake Forest Journal of Law & Policy. 8 (1): 1–4.
  2. ↑ Hill, Christine (1997-11-12). "Evaluating the quality of after death care". Nursing Standard. 12 (8): 36–39. doi:10.7748/ns1997.11.12.8.36.c2487. ISSN   0029-6570. PMID   9418467.
  3. ↑ Johns Hopkins Berman Institute of Bioethics; University of Colorado Boulder MENV (2021-10-24). "Essential Death care workers briefing book" (PDF). Archived (PDF) from the original on 2021-10-24. Retrieved 2021-10-24.
  4. 1 2 Kopp, Steven W.; Kemp, Elyria (2007). "The Death Care Industry: A Review of Regulatory and Consumer Issues". The Journal of Consumer Affairs. 41 (1): 150–173. doi:10.1111/j.1745-6606.2006.00072.x. ISSN   0022-0078. JSTOR   23860018.
  5. ↑ "Healthcare vs. health care – Correct Spelling – Grammarist". grammarist.com. 10 May 2011. Retrieved 2021-10-24.
  6. ↑ Spellman, W. M. (2015). A brief history of death. London. ISBN   978-1780235042. OCLC   905380333.{{cite book}}: CS1 maint: location missing publisher (link)
  7. ↑ Gordon, Michael (2015-01-29). "Rituals in Death and Dying: Modern Medical Technologies Enter the Fray". Rambam Maimonides Medical Journal. 6 (1): e0007. doi:10.5041/RMMJ.10182. PMC   4327323 . PMID   25717389.
  8. ↑ Brennan, Michael (2014). The A–Z of death and dying : social, medical, and cultural aspects. Santa Barbara, California. ISBN   978-1440803437. OCLC   857234356.{{cite book}}: CS1 maint: location missing publisher (link)
  9. 1 2 3 Olson, Philip R. (2018-06-01). "Domesticating Deathcare: The Women of the U.S. Natural Deathcare Movement". Journal of Medical Humanities. 39 (2): 195–215. doi:10.1007/s10912-016-9424-2. ISSN   1573-3645. PMID   27928653. S2CID   43800390.
  10. ↑ Finney, Redmond; Shulman, Lisa M.; Kheirbek, Raya E. (April 2022). "The Corpse: Time for Another Look A Review of the Culture of Embalming, Viewing and the Social Construction". The American Journal of Hospice & Palliative Care. 39 (4): 477–480. doi:10.1177/10499091211025757. ISSN   1938-2715. PMID   34219498. S2CID   235734505.
  11. ↑ Lowey, Susan E. (2015-12-14). "A Historical Overview of End-of-Life Care".
  12. ↑ Rainsford, Suzanne; MacLeod, Roderick D; Glasgow, Nicholas J (September 2016). "Place of death in rural palliative care: A systematic review". Palliative Medicine. 30 (8): 745–763. doi:10.1177/0269216316628779. ISSN   0269-2163. PMID   26944531. S2CID   4682978.
  13. ↑ Baker, Hugh D. R. (December 1989). "Death Ritual in Late Imperial and Modern China. Edited by James L. Watson and Evelyn S. Rawski. [Berkeley, Los Angeles, London: University of California Press, 1988. 334 pp. $4000.]". The China Quarterly. 120: 875–876. doi:10.1017/s0305741000018658. ISSN   0305-7410. S2CID   155077233.
  14. ↑ Howarth, Glennys (2016). Last Rites. doi:10.4324/9781315224251. ISBN   978-1315224251.
  15. ↑ "Human composting could be the future of deathcare". The Guardian. 2020-02-16. Retrieved 2021-10-24.
  16. ↑ APPG PPG for Funerals and Bereavement (2021-01-01). APPG 2020 2021 Annual Report.
  17. ↑ "Digitization In Deathcare". Forbes. Columbia Business School – Eugene Lang Entrepreneurship Center. Retrieved 2021-10-24.
  18. ↑ Denborough, David; Sanders, Cody J. "Death-care practices in the shadow of the pandemic: Can history help us?". International Journal of Narrative Therapy and Community Work (2): 20–33.
  19. ↑ Van Overmeire, Roel; Van Keer, Rose-Lima; Cocquyt, Marie; Bilsen, Johan (2021-12-10). "Compassion fatigue of funeral directors during and after the first wave of COVID-19". Journal of Public Health (Oxford, England). 43 (4): 703–709. doi:10.1093/pubmed/fdab030. ISSN   1741-3850. PMC   7989438 . PMID   33635314.
  20. ↑ West Park Healthcare Centre, Ontario, Canada; Anderson, Barbara (2017-05-17). "Facilitating person-centred after-death care: unearthing assumptions, tradition and values through practice development". International Practice Development Journal. 7 (1): 1–8. doi: 10.19043/ipdj.71.006 .{{cite journal}}: CS1 maint: multiple names: authors list (link)
  21. ↑ United States Government Accountability Office (2011). "Death Services: State Regulation of the Death Care Industry Varies and Officials Have Mixed Views on Need for Further Federal Involvement" (PDF). Archived (PDF) from the original on 2021-05-18. Retrieved 2021-10-27.
  22. ↑ UK Competition & Markets Authority (2020). "Funerals market investigation: Quality regulation remedies" (PDF). Archived (PDF) from the original on 2021-06-16. Retrieved 2021-10-27.
  23. 1 2 Entress, Rebecca M.; Tyler, Jenna; Zavattaro, Staci M.; Sadiq, Abdul-Akeem (2020-01-01). "The need for innovation in deathcare leadership". International Journal of Public Leadership. 17 (1): 54–64. doi: 10.1108/IJPL-07-2020-0068 . ISSN   2056-4929. S2CID   228855678.
  24. ↑ Zavattaro, Staci M.; Entress, Rebecca; Tyler, Jenna; Sadiq, Abdul-Akeem (2021). "When Deaths Are Dehumanized: Deathcare During COVID-19 as a Public Value Failure". Administration & Society. 53 (9): 1443–1462. doi: 10.1177/00953997211023185 . ISSN   0095-3997. S2CID   236312716.
  25. ↑ Lawton, William (September 12, 2022). "Industry Focus: Death Care" (PDF). 2016.export.gov. Archived from the original on September 27, 2022. Retrieved September 12, 2022.{{cite web}}: CS1 maint: bot: original URL status unknown (link)
  26. ↑ Cummins, Eleanor. "How 'Big Funeral' Made the Afterlife So Expensive". Wired. ISSN   1059-1028 . Retrieved 2022-09-12.
  27. ↑ PR Newswire (2021). "Global Death Care Services Market Report (2021 to 2030) – COVID-19 Impact and Recovery" . Retrieved 2021-10-24.
  28. ↑ "2019 NFDA General Price List Study Shows Funeral Costs Not Rising As Fast As Rate of Inflation". nfda.org. Retrieved 2022-09-12.
  29. ↑ Westendorp, Mariske; Gould, Hannah (2021). "Re-Feminizing Death: Gender, Spirituality and Death Care in the Anthropocene". Religions. 12 (8): 667. doi: 10.3390/rel12080667 . hdl: 11343/289692 .
  30. ↑ Harker, Alexandra (2012). "Landscapes of the Dead: an Argument for Conservation Burial". Berkeley Planning Journal. 25 (1). doi: 10.5070/BP325111923 .
  31. 1 2 3 4 5 Shelvock, Mark; Kinsella, Elizabeth Anne; Harris, Darcy (2021). "Beyond the Corporatization of Death Systems: Towards Green Death Practices". Illness, Crisis & Loss. 30 (4): 640–658. doi: 10.1177/10541373211006882 . ISSN   1054-1373. PMC   9403370 . PMID   36032317.
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