In the article, Pandemic Underscores Need for End-of-Life Training, Dr. Tim Short, the CMO of Hospice of the Piedmont, in Charlottesville, VA says, “Our society has lost touch with the last experience of every living thing.  In the United States, we have almost come to think of dying as elective” (1).  In the same vein, there is what Jack Riemer calls “medical mythology,” the “conspiracy of silence” that “sets in around the terminally ill patient” (2).  Medical mythology occurs within the denial of death.  Following Riemer, Rebecca Golbert says, “By hiding or disguising death, medical mythology removes death from the home, the family, and the community and from its rightful place in the life cycle” (3).  Keeping with this attitude proposes a significant risk, not only for the dying and their loved ones but also for the workers in our healthcare system.  A "no dying" mentality harms society as a whole. “Faced with death, expected or unexpected, the living must respond” (4).

There is an increasing need for change in end-of-life care in America.  At this time, the American population is facing an eldercare crisis because of the large number of aging individuals of the Baby Boomer Generation.  The changing trend of individuals making plans to die at home is thrusting families into a caregiving role they are likely unprepared for. As this larger generation ages, trained death doulas are trending as an essential role in the future of death care.  

Hospice is an invaluable resource for terminally ill patients and their loved ones.  The specialized hospice care team consists of medical providers, social workers, home health aides, and chaplains providing patients with the best end-of-life experience possible, including pain management in the final months leading up to death.  The Medicare Hospice Benefit limits the amount of time hospice workers can spend in the home.  End of Life Doulas are not medical professionals, but they are a necessary supplement for holistic death care alongside hospice because caregiving for the dying can overwhelm families creating a “gap” in care for dying patients (5).

Death Positive: A New Wellness Initiative

Death Positive is a secular and philosophical movement aimed at redefining the way we think and feel about death:  Living well today can include an acceptance of death. Currently, death is the second leading fear for Americans (6). Death has become a topic we avoid. Wellness is not complete if talking about death is forbidden. Death Positive proposes an opportunity to explore death from practical, ritualistic, and spiritual points of view:

1.  Practical: What might I do to prepare for a better end of life for myself and my loved ones? Quoting from an article in the Journal of the American Medical Association, “patients who reported having end-of-life discussions received less aggressive medical care and were more likely to receive hospice services for more than a week. Less aggressive care and earlier hospice referrals were associated with better patient quality of life near death. Of note, patients who received less than a week of hospice care had the same quality of life scores as patients who did not receive hospice at all, suggesting that patients benefit more from early hospice referrals. Better patient quality of life near death, in turn, was associated with better quality of life among surviving caregivers who experienced less regret and showed improvements in self-reported health, physical functioning, mental health, and overall quality of life during the bereavement period” (7).

2.  Ritualistic: Can we recover the ways in which deathcare has been handled in the past? Only in the past century have we lost our connection to death. Medical modernization keeps us living longer, and we no longer have to see death when it does occur. Add to this the funeral industry, which has taken a prominent role in death management and societal pressures around aging, which give us a false sense of control over mortality. 

3.  Spiritual:  What do we believe about life and death? The decline of religion in a postmodern era plays a role in how we view or think about death. An interesting fact is that hardly do we even say someone died.  We say, they passed.

On Death and a Theology of the Cross 

The Very Rev. Dr. John Behr makes a critical point regarding what we risk when death is taken from our sights:

"In the latter part of the last century, there has been much discussion of our ‘denial of death.’ But it would seem to me that the problem is deeper and more difficult. If it is true that Christ shows us what it is to be God in the way that he dies as a human being, then, quite simply, if we no longer ‘see’ death, we no longer see the face of God" (8).

In the Garden of Gethsemane, Jesus prays in such agony over His death that His sweat turns to blood (Luke 22:44).  Death is real, even for God.  God can do what He pleases, and God chose to plunge into the misery of death and demonstrate dying in front of the world, nailed to a cross.

The idea that Jesus came to us to teach us to be like him is a theological concept that is not limited to Christian denominations.  Many “spiritual” non-Christians won't deny Jesus’ goodness as theoretically pleasing.  Yet it is a concept that quickly loses its appeal once we understand the reality of Christ's earthly mission, which is to lay down His life for His friends (John 15:13).  The last thing we anticipate to learn from Christ is to be like him in his death.

When a death occurs, is not always the physical loss of a human being.  When we are baptized as Christians, we die with Christ (Romans 6:3-4). This means that our time on earth is a continual experience of the death of our former selves, which makes room for renewal in a faithful Christian Life. Theologically speaking, this is understood as sanctification.

In the second century and the early days of the Church, a theologian named Irenaeus of Lyons formulated from Scripture a systematic response in order to protect Church doctrine from the heretical beliefs of Gnosticism, a mystic and divine knowledge of God made apparent through the senses.  Irenaeus' recapitulation theology, emphasizes Christ as the new head of mankind, which is emphasized throughout both the Old and New Testaments.  In fact, the incarnation, death, and resurrection of Jesus Christ is the restoration of humanity back to God’s image and likeness that was lost through Adam and Eve’s apostasy or disobedience recorded in Genesis 3.

Ireneaus envisioned salvation as a single economy or a continuous arc from the creation of all things to the return of Christ, or the parousia. Our individual lives are lived within this economy, and our experience on earth cannot be separated from the actual transformation and completion in Christ.  Adam (the standard of the human being) was created only as a "pattern of the one to come" (Romans 5:14), and therefore, the original formation of Adam is brought to completion in Christ, which is the life he is to grow into “by learning through experience” (9).

Ireneaus' theology will be joined with the work of several more recent theologians (16th century - Present) creating a refreshing theological foundation desperately needed in a culture that has dismissed death from a holistic understanding of what it means to be a human being. Without a comprehensive understanding of recapitulation -- the renewal of life in Jesus Christ -- a post-modern re-acceptance of death will lack the most fundamental aspect of well-being, which is to be made complete in Christ. 

Such a theological program must emphasize faith: "For by grace you have been saved through faith; and this is not of yourselves, it is the gift of God" (Ephesians 2:8). The Death and Resurrection Doula curriculum is a comprehensive training program for anyone who feels called to serve their neighbors. The program includes training in theology, pastoral care, end-of-life planning (including funeral planning), patient advocacy, and caregiving to the dying individual, their families, and their communities. For those in need of a professional Christian Death Doula, the Death and Resurrection Doula is building a complete network of trained doulas to meet the needs of anyone who is facing death.

In his book, The Crisis of US Hospice Care:  Family and Freedom at the End of Life, Harold Braswell writes extensively about the crises facing America in regard to gaps in death care and the limits of the Medicare Hospice Benefit. This book is an invaluable resource for understanding how we have arrived at a shortage of caregiving. I am a theologian, and Braswell is coming from a secular perspective, but I share his overall sentiment: “By rethinking America from the perspective of the end of life, we can also adopt a fresh perspective on a broader crisis currently unfolding about the meaning of American national identity" (10). There is eschatological significance in human beings participating in their neighbors’ needs relating to death.

In his article, “A Question of Death: Paul’s Community-Building Language in 1 Thessalonians 4:13-18,” (11) Richard Ascough writes about the ancient voluntary associations in the Greco-Roman world of the first century.  Burial or funerary associations were organized to ensure a proper burial for its deceased members, and also for the social importance of belonging to a group. Ascough incorporates these burial associations with Paul’s eschatological hope defined in his first letter to the Thessalonians.  Paul urges the Thessalonians not to “grieve as others do who have no hope” (v. 4:13).  Ascough notes the Thessalonians were concerned with the community status of those who have already died.  The Thessalonians’ conversion to Christianity involved a new way of understanding death.  The Thessalonians questioned the participation and relationship between the living and dead Christians in the event of Christ’s return. Paul answers the Thessalonians by assuring them the dead will have priority over the living at the parousia:  “For the Lord himself will come down from heaven, with a loud command, with the voice of the archangel and with the trumpet call of God, and the dead in Christ will rise first” (v. 16). 

When we look to Scripture, we read that Christ will return among the living people of that generation. This means that at some point in the future, there will be people who do not die before Christ’s return. We have no idea when that time will be, but until that time, the living will be tending to the dying. St. Paul’s eschatology puts a priority on the dead, and this expectation should govern our work in caring for the dying now. Therefore, preparing our communities to take on the caretaking of the dying is the way to reorient America toward the eschatological service of the arriving Kingdom of God.