Textbook Chapter Notes: Let’s Talk About Death And Dying PDF

Chapter 1 Notes: (“Let’s Talk About Death and Dying”) Despite our daily exposure to death through the media, we rarely voluntarily engage with death-related topics on a more personal level. We typically do not think or talk about death, ours or our loved ones, and when such death-rel...

Chapter 1 Notes: (“Let’s Talk About Death and Dying”) Despite our daily exposure to death through the media, we rarely voluntarily engage with death-related topics on a more personal level. We typically do not think or talk about death, ours or our loved ones, and when such death-related topics come up, we feel discomfort and often shy away from them and/or discourage the discussion through our words and actions There are social norms and cultural beliefs that discourage us from talking about death, including beliefs that talking about death can bring bad luck, illness and or actual death Birth and death are the two biggest rites of passage we all will experience in our lives. Both often are associated with pain and discomfort and the cycle of life – the start of it and the end of it. However, while we talk about, plan for, and celebrate birth, dying and death are not similarly honoured Death Avoidance: Often when people learn that someone they know is dying or has a terminal illness, they avoid talking about it with them. They neglect to initiate, be receptive to, or engage in a dialogue about important EOL issues People who provide care for the dying indicate that engaging in discussions of death and dying with loved ones is the biggest act of love you can give each other, helping both the person being cared for and the care giver Having these conversations provides us the opportunity to really connect with the people in our lives and to realize some of the richness of life that is only made possible by acknowledging the inevitability of death Ideally, these important conversations should happen long before we get old or sick or start the dying process, but we often wait until we have no choice. When these discussions must occur in the midst of a crisis, they are much more difficult and heart wrenching. It also often means that we end up having to guess a loved ones wishes The concept of death positivity: being death positive by being open to honest conversations about death and dying. It is the foundation of a social movement that challenges us to reimagine all things tied to death and dying, including the development of Compassionate Communities (CCs) A good way to start a course on death and dying is by listening to the voices of people who are nearing the end of life, to hear their experiences, their struggles, and the wisdom they share According to the World Health Organization (2021), the world’s population is aging faster than it has in the past. This means that people are living for longer; living for longer periods with chronic illnesses and with increasingly complex needs; and dying at older ages As a result, a civil society effort referred to as the Compassionate Communities (CC) initiative/model has emerged to deal with such changes. The CC model “aims to de-professionalize, de-medicalize end- of-life care, return it to the community, and build up social capital that can then be mobilized when citizens come to the end of their life”. In a CC, members of the community play an active role in caring for each other. CCs can therefore be viewed as circles of care or social support networks available in the community to aid people as they age, develop illnesses, approach the end of life, and experience bereavement CCs are part of a broader 21st century death positive movement. The movement began in 2011 with Caitlin Doughty’s founding of a funeral reform collective known as The Order of the Good Death. The aim of the movement is to “promote open, honest engagement with” and discussions about death and dying End of life rituals tied to funerals/memorials and ways to deal with dead bodies are evolving rapidly Focusing on the positive, rather than the negative, can help us rethink death. Various parts of the death positivity movement aim to enhance life, a sense of community, caring and connection and ultimately to make sure that at the end of it all, we die well Death positivity is a social movement that challenges us to reimagine all things tied to death and dying, including the development of compassionate communities. Some examples of initiatives designed to get us talking about death are Death Cafes, Death over Dinner, and the Conversation Project Videos to watch/Websites to visit: Body or Soul: Why We Don’t Talk About Death and Dying To Die Well, We Must Talk About Death Before the End of Life ‘How Will I Move on Without You?’: What I Learned When I Talked to My Parents About Death https://youtu.be/wPh32g0j9HY https://youtu.be/DYbosNFtAmk Compassionate Communities https://youtu.be/dRqjkIPMBhw https://youtu.be/NM1V_CPRCSo https://youtu.be/akS6w7Bi66s https://youtu.be/J1r0Xbh0UVo Video/Website Notes: Body or Soul: Why We Don’t Talk About Death and Dying Western societies avoid discussing death, largely due to a loss of belief in an afterlife, making death seem like the absolute end of existence. Although churches don’t advocate for extreme measures to prolong life, societal resistance to accepting death as natural has grown since the Enlightenment, when science began to dominate over religion. Scientific and technological advances in medicine developed separately from considerations of the soul, emotions, and personal values, causing a focus on preserving life at all costs. The belief in the sanctity of life persisted even as societies became less religious, with medical practice emphasizing saving and extending life. The medical profession struggles to acknowledge the potential harms of relentless treatment, as being responsible for death is seen as a greater harm. This focus on curing and preserving life makes discussions about death or recognizing when treatment is causing more harm than good, difficult. Physicians, particularly specialists, often hesitate to refer patients to palliative care because it is seen as giving up and abandoning hope, delaying essential conversations about end-of-life care. To Die Well, We Must Talk About Death Before the End of Life Everyone will eventually die, and advance care planning (discussing future healthcare preferences) has proven benefits. Research shows that many seriously ill older patients receive invasive treatments they don’t want because their future care preferences haven’t been discussed, even in long-term care homes where life expectancy is short. Moving from thinking about end-of-life care to discussing it is challenging. Families fear it will destroy hope, while residents avoid the topic to protect their loved ones. Many long-term care staff don’t feel trained to handle these conversations, and only 21% distribute pamphlets that could help initiate them. Those who did have conversations after receiving information felt relieved, with families appreciating the clarity it provided. The issue extends beyond care homes: while 93% of Canadians believe discussing future care is important, only 36% have actually done so. There is a need for better training and clearer roles for long-term care staff to support these important conversations, especially given their close relationships with residents. ‘How Will I Move on Without You?’: What I Learned When I Talked to My Parents About Death The conversation about death is not just about how people would like to die, what treatments they want, and what should happen to them after death. It is also about how they want us to cope, what they want us to do to keep their memory alive https://youtu.be/wPh32g0j9HY: Learning how to think about death changed how I live Notes on ipad, move here https://youtu.be/DYbosNFtAmk: Imagine Aging Project: Exploring Death Friendliness Notes on ipad, move here Compassionate Communities Social isolation and loneliness are significant public health issues linked to increased disease burden, morbidity, and premature mortality. Positive social relationships improve quality of life, reduce healthcare use, and lower the risk of early death. Community social capital, such as support networks, can complement formal healthcare systems by addressing social determinants of health and fulfilling practical and emotional needs. A Compassionate Community involves members actively supporting those with serious illness, caregiving, dying, grieving, or experiencing social isolation. They assist people in their homes, raise awareness about end-of-life issues, and create supportive networks. Each community tailors its approach to building compassion based on its specific needs, recognizing that health crises and grief affect everyone and are a shared responsibility, not just that of healthcare providers. Compassionate Communities support healthcare by focusing on prevention, early detection, harm reduction, and altering social environments to improve outcomes, aiming to de-professionalize and return end-of-life care to the community. The Compassionate Communities program in Ontario strengthens physical, mental, social, and spiritual care, targeting at-risk populations to improve quality of life and reduce emergency department admissions. The model uses tools to predict risks, modifies social environments, and provides goal planning for high-risk individuals, complementing primary care and home care services. Like many developed countries, Canada faces challenges in providing end-of-life care due to evolving palliative care practices, demographic changes, and healthcare system constraints. This has made palliative care a growing public health priority. https://youtu.be/dRqjkIPMBhw: A new vision for death and dying | The Lancet Commission on the Value of Death Chapter 2 Notes: (“Historical Beliefs and Death-Related Practices") There are an abundance of death-related beliefs and practices (e.g., customs and rituals) that we as humans have used to deal with our dead. Through end-of-life (EOL) rites, the living honour the dead and/or address fears of the dead (e.g., the threat the dead pose to the living) For example, the practice of closing or covering the eyes or the face of the dead and moving bodies feet first, were meant to protect the living. The former practice is believed to have started as a way to close a “window from the living world to the spirt world”. The latter practice was tied to the belief that if a body was moved headfirst, it could look back and beckon the living to follow them The fear of calling a loved one to follow is also part of the reason why widowed Victorian women wore black. The belief was that dressed in black, they would appear as a shadow and were therefore at less risk of being beckoned by the spirits of their dead husbands to join them Archeological research details the numerous ways bodies have been dealt with. Dead bodies were left in caves, in trees or on mountaintops, burned on pyres or other forms of ritual cremation, placed in catacombs, buried in the ground or under mounds of earth For example, early Italian farmers about 7000 years ago placed their dead in caves, after they defleshed and then broke apart the skeletal remains  Anglo-Saxons (from the 5th-10th century) buried their dead in organized graveyards, using small burial mounds as markers for each. However, much larger barrows/burial mounds were also built by the Anglo-Saxons to honour their high-status dead, possibly kings According to ancient Hindu custom, the Hindu funeral/cremation ceremony involves placing the dead on a pyre of logs and then setting it alight. This tradition is still the dominant practice today In other parts of the world (e.g., Rome, Paris, Lima), at different periods of time, the bodies or bones of the dead were placed in catacombs. The Roman catacombs, dating back to the first century, “were constructed as underground tombs, first by Jewish communities and then by Christian communities Among the Igorot people of the Philippines, there is an ancient practice dating back 2000 years (and still practiced today), involving the suspending of coffins on the side of a cliff, in order to allow the dead closer proximity to ancestral spirits who predeceased them In Western cultures such as early U.S. and Canada (not including Indigenous peoples), customs and rituals surrounding death directly evolved from those in Europe and England, resulting in a set of death- related beliefs and practices meant to show proper respect for the dead. Death was viewed as inevitable and an integrated part of the community. People died at home and family members, typically the women, cared for their loved one’s body (i.e., bathed and dressed). Neighbours or the local carpenters, would build a very simple wooden casket/box. The body would then be laid out and displayed at home, on the dining table. Burials took place close to home, either at a family or church cemetery Not only did these rituals and practices result in more exposure to death, but the process of attending to the dead allowed communities to come together to support one another in grief, strengthening interpersonal and social bonds. Ultimately, these rites of passage and celebrations that dealt intimately with death, allowed people to avoid a fear-based understanding of the end of life There were important societal level changes beginning in the late 1800s through the early 1900s that moved death away from the daily lives of non-Indigenous North Americans, influencing how we view death and deal with the dead. The four key changes were: an increase in life expectancy; enhancements in medical knowledge, skills and technology (e.g., better understandings of viruses such as polio, vaccine developments and improvements, and the development of antibiotics), including the development of the hospital; the emergence and professionalization of the funeral industry; and the move from urban church yard cemeteries to rural park-like settings In the early 1800s, life expectancy in North America was around 35 years of age. As public health improvements evolved, and medicine and medical advancements became focused on preventing death, life expectancy increased to 50 years by 1900 and has steadily increased since then By the end of the 19th century, cemeteries began to be moved outside of urban areas to allow for more space for the dead. The funeral industry also began the process of professionalization – moving from the undertaker who built caskets, dug graves, and transported bodies to graves, to the mortician who offered full funeral package services outside of the home, including the increasingly popular practice of preserving bodies through embalmment. With the assistance of medicine and the funeral industry, death was literally cleansed from people’s lives These key societal changes have led to physical and social distancing from death. Such distancing helps account for a rising fear of death and the death avoidance practices common today A variety of factors make it challenging to provide a brief overview of traditional death-related beliefs and practices among Indigenous peoples in Canada. These factors include: the diversity among Indigenous peoples; the use of oral traditions to share histories and pass on knowledge; and the impact of colonization on traditional cultural and spiritual beliefs and ways of knowing. There is much cultural and spiritual diversity across Indigenous peoples with traditional “beliefs, values and practices, [vary[ing] widely…over thousands of years”. This includes death-related beliefs and practices Traditional Indigenous knowledges, and cultural and spiritual practices are passed down orally from one generation to the next within each community via storytelling, dances, performances, songs, and art. Oral traditions are the foundation of Indigenous societies, “connecting speaker with listener in communal experience and uniting past and present in memory”. Despite the diversity among Indigenous  peoples, there is a common traditional spirituality “rooted in their connection to nature, the earth, and one another” and in the recognition of death as part of the circle of life The cycle of life reflects the belief that “birth and death are inextricably linked as a transition of the spirit through this world”. For example, the Anishinaabe (Ojibway) perspective on life and death is that “in order to understand death, one must first embrace the cycle of life… with birth, life, death, and the afterlife…[being] four stages of the human spirit.” Representations of the cycle of life, such as the medicine wheel, provides a way of interpreting life and death beyond the physical and into the spirit realm, where spirits are believed to live on. The focus of many traditional Indigenous end-of-life rituals is on healing the spirit and preparing it for its journey to the spirit world For some Indigenous peoples, forced Christianity has overwritten and almost completely replaced traditional cultural practices. For others, it has resulted in a combining of spiritual practices, “a fusion” of traditional Indigenous beliefs and Christianity. In other communities, there is a growing revitalization and embrace of traditional Indigenous beliefs and practices Videos to watch/Websites to visit: Why I Wore Black After He Died: Lessons from Victorian Mourning Culture Death, Burial & the Afterlife in the Ancient Celtic Religion What Ancient Cultures Teach Us About Grief Mourning and Continuity of Life https://youtu.be/8HegwRtbDSU (watch to 4:57 mark) https://youtu.be/-aBhT3ItQeI When You Die, You’ll Probably Be Embalmed. Thank Abraham Lincoln For That https://youtu.be/uYdNx3hiwJw https://youtu.be/S7nb4rJ_N14 (watch to 3:30 mark) https://vimeo.com/151016925 https://vimeo.com/150905087 https://vimeo.com/151016929 https://vimeo.com/151016926 Chapter 3 Notes (“Cultural & Religious Beliefs & Death-Related Practices”): Death-related beliefs and practices are part of every culture, but how we deal with death is diverse. Although post-death events typically involve honouring the dead and supporting the bereaved (i.e., an individual, a family, or a community), these events can take a variety of forms (e.g., funerals, wakes, celebrations of life, etc.). Culture is comprised of the beliefs, values, customs, language, symbols, and artifacts that are shared by a collective of people, which includes religious beliefs and practices. These shared aspects of culture shape how we, as cultural beings, behave and think – even if we are unaware or unconscious of such influences. Shared elements of culture enable us to have both a common understanding of the world around us, as well as a sense of purpose and collective identity. The various aspects of culture are passed down from generation to generation, and subject to cultural shifts over time Despite wide cultural variation, in terms of behavioural norms or standards, there are some commonalities between cultures often tied to life course or transition events, such as birth, marriage and death. For example, most cultures throughout human history have had ceremonies and rituals surrounding the death of a member of the community with funerals being “one of the most ancient known tangible signs of human social ritual”. The meaning attributed to death, and the practice and purpose of established death rituals or ceremonies that are used to mark this rite of passage, however, vary from culture to culture According to Anderson and De Souza, “a ritual is the undertaking of specific activities or behaviours that express symbolic… meaning, whereby specific thoughts and feelings are experienced individually, or as a group.” Rituals reflect cultural norms and values. Whether performed alone or with others, they are an important part of a culture because they reaffirm individual and group identity and help us recognize and make sense of life transition events  There are a myriad of cultural rituals, ceremonies, and practices, including those tied to death. For example, the el Día de los Muertos (the Day of the Dead) is a traditional Mexican holiday, dating back to the Aztecs and Toltecs. It is celebrated each year between October 31 and November 2, a time when it is believed the dead can leave the spirit world to reunite and celebrate with their loved ones. The Day of the Dead is “a joyous, ritualistically elaborate celebration of life”, with traditional rituals and celebratory activities like parades, donning of skeletal face painting, erecting of decorative alters for loved ones, feasting, etc., serving to remind participants that life is cyclical, and that death is not “the end of one’s existence, but simply another chapter of life” “Death ceremonies are rites of passage for both the deceased and for the living”. Ritualistic practices around death involve activities and behaviour that are performed or engaged in to mark the significance of the loss to the bereaved and the community. Death rituals commence the moment a person is declared dead, although definitions of death vary historically and cross-culturally. Depending upon cultural practices, many of which are tied to religious beliefs, such rituals can involve: preparing of the body (e.g., it may be washed by family or community members or professional funeral staff; it may be dressed, kept naked, or wrapped in a burial shroud; it may be embalmed; etc.); watching over the body (e.g., pre-burial vigils); a funeral and body disposal (e.g., burial, cremation, etc.); prayer; a mourning period; ritual providing of food (i.e., feasting); and celebratory events. Death rituals provide bereaved individuals and the community with time to process their loss and acclimate to the dramatic changes associated with that loss, Grief and mourning rituals typically begin shortly after death. depending on culture and religion, grief rituals can take a variety of forms before, during, and after a funeral ritual and body disposal. serve several important purposes. They provide the bereaved an opportunity to acknowledge and share their experiences of loss, as well as their memories of the relationships they had with the deceased. They facilitate the offering of support and comfort to the bereaved, and they serve as a means through which to express loss Throughout history and cross-culturally there are numerous examples of ritualized public outpourings of emotion, many of which take oral and physical forms, as part of the process of meaning-making and coping with death. For example, loud vocal expressions of grief such as “death wailing”, “keening”, “lamenting”, and “chanting” can begin shortly after death and last until after the burial. Or they can occur at rituals that take place prior to funerals and body disposal and during the gatherings that often occur after these events. Such public rituals of sorrow are a “powerful way to give voice to the impact of the…loss on the wider community” and can have a cathartic, grief releasing effect for participants and observers An example of a traditional ritual emotional outpouring that is still practiced today, is the Haka chant dance of the Māori of New Zealand. The Haka is used for a variety of purposes, but it is “an integral part of the Māori mourning process…. Show[ing] love and compassion…and uplift[ing] the spirts of bereaved families Wailing, keening, lamenting performances, as traditional parts of expressing grief, are evident in various cultures historically and, to a lesser extent, today. A few examples include the keen, or lament for the dead that is at the core of traditional Irish wakes, and the ancient wailing practice of Yemenite-Jewish women. These rituals are/were typically carried out by women, who are/were paid for their mourning services. Although there is much historical and cultural variation in the roles and styles of professional mourners, these individuals played an integral role in both pre-funeral events and funeral services Professional mourners are still used in various parts of the world. Professional mourners are hired to provide the oral expression of emotion at a pre-funeral event and/or at a funeral and/or increase the number of people in attendance at a funeral. In cultures where public expression of emotions by the bereaved are viewed as inappropriate, professional mourners may be hired to express emotions for the family. Paid mourning services are, however, not always sombre and emotional, they can also provide entertainment through music, dance, etc., for funeral attendees as they celebrate the life of the deceased Cultures and religions around the world use a wide variety of different rituals, ceremonies and practices relating to dying and death. Despite diversity in form and style, there are some cross-cultural similarities  in rituals and ceremonies, with many involving the sharing of food, expectations regarding appropriate attire, spending time with loved ones, and the use of song, prayer, and celebrations. Videos to watch/Websites to visit: Day of the Dead (Dia de los Muertos) Teenager Breaks Down in Tears During Memorial Māori Haka https://youtu.be/kJUQxelrZX4 https://youtu.be/gR8zPWCGHEs Buddhist Funeral Service Rituals Christian Funeral Service Rituals Hindu Funeral Customs and Rituals Islamic Funeral Customs and Service Rituals Jewish Funeral Service Rituals Sikh Funeral Service Rituals Wiccan Funeral Service Rituals https://doi.org/10.12968/bjon.2021.30.1.34 https://australian.museum/about/history/exhibitions/death-the-last-taboo/ https://theconversation.com/why-we-need-end-of-life-rituals-107249 https://theconversation.com/for-believers-fear-of-atheists-is-fueled-by-fear-of-death-41724 https://www.arkansasonline.com/news/2021/may/29/you-are-doing-to-die-nun-finds-comfort-in-knowing/ Chapter 4 Notes (“Dealing with Bodies after Death”): When death occurs, the first thing that has to be decided upon is the means of body disposal. In Canada, when we consider typical ways to deal with dead bodies, we usually are thinking about burial and cremation. The reason for this is that these methods have been around for a long period of human history. The actual practices have changed substantially over time, however, with burial and cremation practices today differing from ancient or older rituals. Currently, there is a revival of more traditional versions of some of these methods of body disposal, reflected in what is referred to as the green burial or funeral industry. There are also some newer technological advances that provide alternative means of body disposal, some of which address concerns for environment and reducing our environmental footprint at the end of our lives. Embalming is a method/tool of body perseveration dating back to ancient Egypt, where the practice of mummification was used to ensure the preservation of the body, a requirement for the afterlife. Mummification is a multi-step process involving organ removal, the drying out of the body; the wrapping of the body; the application of resin and oils; and eventually sealing the mummy in a sarcophagus. There is evidence that mummification was used in many civilizations for thousands of years (e.g., Incan, Aztec, Africa, ancient Europe, Indigenous people of Australia, etc.). In some cultures, evidence points to mummification as a process reserved for royalty or the privileged class, but in others it was more widely available. For example, in Sicily in the 18th and 19th centuries mummifying was also available to the middle class The modern concept of embalming began in the mid-1800s during the U.S. Civil War as a means to preserve bodies for the transport home for burial. The popularization of embalming and the beautification of the corpse, led to increasing demand for the service and the emergence of the modern funeral industry. Current embalming practices involve replacing the body’s blood with chemicals that help prevent body decomposition. The body is then further protected from decay that occurs after burial by the layers of metal and wood that surround casket and entombment in a vault. Today, traditional embalming services cost around $800, however, the U.S. company Summun, is offering modern mummification services. The process takes around 90 days and costs approximately $67,000 USD Burial is an ancient form of body disposal, however, what we view as traditional burial practices today actually began with the reintroduction of embalming type processes and the professionalization of the funeral industry in the mid-1800s in North America. Burial as a method of body disposal typically  requires the purchase of a burial, a wood or metal casket, and an outer burial container. Burial containers come in two forms, burial vaults and grave liners. Both function to prevent soil sinkage, which would normally occur as the casket and body decompose, helping to maintain cemetery landscapes. The former also tightly seals the casket to prevent exposure and decay. The number of services and associated fees required for a burial today are costly, with a typical burial in Canada costing on average around $10,000 The burning of the dead is another example of an ancient means of body disposal and was the preferred custom in some cultures like ancient Greek and Roman societies. Although the practice waned after the 1st century CE, due to the rise of Christianity and its prohibition on cremation, today cremation is one of the most common forms of body disposal. In Canada, the first crematorium opened in 1901 at Mount Royal Cemetery in Outremont Québec. Since then, the practice has continued to grow in popularity among residents of Canada and has become the preferred method of body disposal. According to a 2021 statistics report, 73% of the body disposals in Canada in 2020 were via cremation. That number was more than double the cremation rate two decades earlier Flame-based cremation involves the use of high heat to reduce human remains to bone and ash and the pulverization of the bone into tiny pieces, which are then placed into a container commonly referred to as an urn. Prior to incineration, the body is placed into a casket or container made of wood or other flammable material (e.g., cardboard). The cultural shift to this form of body disposal has been attributed in part to the lower costs of this procedure — between $2000 and $5000, considerably less than burial. Cremation also provides families with more time and greater flexibility to determine both the type of memorial service they want and what to do with their loved one’s remains. Options for cremated remains are quite diverse. Urn contents can be scattered as part of a memorial process, or urns can be kept in one’s home, buried or placed in a mausoleum or a columbarium. Other newer options for ashes include turning them into a diamond, jewellery or glass art or even fireworks or part of a reef. It is often said that death is a cycle whereupon the body, carbon and a person’s essence are returned to the earth. What this maxim forgets to include is 6 billion tons of concrete, 800,000 gallons of Formaldehyde, and enough wood in one year to build 4.6 million single family homes. In fact, you could drive almost 4,800 miles on the energy used to cremate one person. There is a lot of steel, wood, cement and fuel needed to accommodate the over 3.5 million deaths in North America each and every year. As our society has become more environmentally conscious, we have begun to make fundamental changes in our lives. Today, the option of green burials, biodegradable caskets, and donations to offset one’s carbon emissions are slowly gaining traction Another big problem associated with conventional body disposal methods is that we are running out of room to bury our dead in existing cemeteries (e.g., in graves for caskets or urns, in mausoleums, columbarium’s, etc.) and geographically, as not all land is usable for cemeteries/burials. This situation is particularly problematic for members of religions whose beliefs dictate that bodies must be buried in their entirety (e.g., Muslim and Orthodox Jewish). Finding a way to deal with this situation becomes even more dire when we consider the space requirements that may be needed for the large aging population Issues with cemetery capacity are not a new phenomenon. For example, in Paris in late 1700s cemeteries were literally overflowing with corpses. The chosen solution was to dig up the remains of the dead and move the bones to the tunnels under the city, that had existed since the 13th century. This process continued, on and off into the mid-1800s, with the tunnels used as a direct burial location at some points in time. In total, it is estimated that the bones of around six million Parisian’s are housed in the Catacombs of Paris Today, cemetery capacity issues in various parts of the world are making the news. For example, in 2019 Happy Valley Christian cemetery, one of Hong Kong’s oldest cemeteries, dating back to 1845, made the headlines because it had reached its space capacity, with hundreds of thousands of human remains waiting for a spot. In 2015, BBC News did a story entitled “The word is running out of burial space.” It reported on how cemeteries in the UK are largely full and some have ceased providing burial services. As a result of the 6 million COVID-19 related deaths worldwide, the issue has become even more dire in  various parts of the world. In Sao Paulo Brazil, for instance, efforts to empty old graves have had to be sped up to make room for soaring death tolls One solution being explored to address limited space for the dead and inground burials is to build up. Multistory columbaria are already in use in some cities. Other ideas include vertical cemeteries that can house caskets in high rise structures. There are proposals to build such structures in Oslo Norway, Paris France, Mubai India, and Santos Brazil. These structures would house not only the dead, but could also provide a variety of services including onsite faculties for funerals, prayer, and visiting with deceased loved ones Grave recycling is another means by which to help with the problem of limited burial space in cemeteries. The term applies to several different practices. It refers to the deepening of graves, where bodies are exhumed, graves are made deeper, then bodies are placed back inside, with other bodies placed on top. Grave recycling also refers to the process of exhuming bodies from graves and burying new ones in that cemetery plot. The exhumed remains are then: placed in a mass grave or a common ossuary; boxed and placed in a different part of the cemetery; or cremated and returned to family In 19th Century Europe, for instance, families only leased their plot spaces and were allowed to renew those leases after eight to fifteen years if they wished to keep their loved one in that resting space. In the late 1800s in Portugal, most dead were buried in churchyards until the plot was needed for a new body, at which time the old body would be dug up and placed in a common ossuary. A version of the practice was re-introduced in Portugal in 1962 As we grapple with issues of burial space, grave recycling is making a comeback in Europe. Although some places still permit perpetual burial plot purchases, there is a trend toward term limited grave/cemetery space rental in most European countries. Temporary leases are available for varying periods of time in countries like Germany, Greece, Italy, Portugal, Sweden, Switzerland, and the Netherlands. Depending on the country, leases can last anywhere from 3 to 50 years. In Greece, burial plot rentals are usually 3 years in length and prices for extensions are extremely expensive. In the UK, some cemeteries are initiating grave recycling practices. For example, the City of London Cemetery has begun reusing burial plots that are at least 75 years of age Another form of grave recycling occurs in some family tombs, such as those found in New Orleans, Louisiana. These above ground burial sites typically have 2 shelves, one above the other, that are large enough to hold a casket. Despite their size they can actually house the remains of many family members. The newest casket is always placed on the top shelf and left for a minimum of a year and a day. After that time, when the space is needed for another family member, the casket is removed, the remains placed on the lower shelf, and the casket destroyed. In some tombs, there is space to gather up decomposed remains under the tomb. As space is needed, skeletal remains, ashes, etc. are pushed to the back of the tomb where they fall through a gap into to the space beneath Natural, woodland, ecological, or green burials are environmentally friendly alternatives to the traditional methods of body disposal (i.e., burial and cremation). This method is closely associated with traditional burials, but involves eco-friendly materials and adoption of more ancient practices (e.g., the use of burial shrouds). Bodies are not embalmed. They are buried in biodegradable containers/caskets (e.g., bamboo, cardboard, paper, wool, willow, etc.) and/or burial shrouds, typically with no permanent markers such as had headstone. One interesting variation is the use of a shroud or burial suit embedded with mushroom spores. The mushrooms help decompose the body, cleansing it of toxins that would otherwise end up in the earth Green burials are done in such a way as to minimize any negative impact on the land or burial site. The idea is to return the “body directly to the earth…[as] humans have been doing since time immemorial” and allow the body to decompose naturally and nourish the earth. Such burial practices benefit the living by preserving green spaces (i.e., forests and open fields) and protecting them from future development. They are also a more cost-effective alternative to traditional burial. There are a variety of other green burial type options including placing the body or ashes into a pod that will be used to grow a tree, with pod burial sites eventually becoming forests  While green burial practices are re-imagining traditional body disposal practices, aquamation is a funerary innovation. Aquamation, also referred to as water, bio-, green, or flameless cremation, or resomation, uses the process of alkaline hydrolysis to mimic natural decomposition. The body is placed in a sealed chamber that is filled with water and alkaline chemicals. Then heat, gentle water flow, pressure and/or agitation is applied. At the end, bone fragments are pulverized as with regular cremation. The process results in about one-third more cremated remains, that can be returned to the family. Alkaline hydrolysis is a much greener process than traditional fire-based cremation. There is no release of chemical compounds or carbon emissions during the process, it requires far less energy, and allows for the safe disposal of mercury from dental fillings The COVID-19 pandemic transformed the way we deal with dead bodies and the end of life. These changes were tied to the sheer volume of deaths and resulting number of bodies that had to be processed, as well as safety concerns tied to bodies of people who died of COVID-19. Large numbers of dead meant that normal religious requirements for burying the dead, such as the Jewish practice of burial within 24 hours, were difficult to follow. Delays in access and COVID-19 safety protocols made the organizing and performing of religious rituals on or for the dead by family and religious officials (e.g., washing and shrouding the body, sitting vigil with the body until burial), more challenging, difficult, and sometime impossible. Safety guidelines for the funeral industry, such as those detailed by the World Health Organization, further altered normal practices. For example, WHOs guidelines included recommendations to avoid embalming bodies and prohibiting family and loved ones from touching or kissing the body. Local, regional and national public health restrictions, capacity limits, and social distancing requirements further impacted traditional death-related practices. At various points during virus surges and shutdowns, funeral homes were either unable to allow people inside or only a few at a time. Traditional rituals and ceremonies were virtually eliminated (e.g., Christian practice of visitations prior to a funeral and Jewish Shiva customs of visitations after the funeral). This served as an impetus for the evolution of virtual forms of visitation and funeral attendance, as well as the popularization of alternative means to sharing condolences, memories and other information via social media. These changes may well become a normal part of funerals after COVID to accommodate loved ones who are not able to travel to attend end-of-life events, who prefer online services and/or to reduce funeral related costs. Funeral homes are now offering live-streaming as part of funeral packages or as an alternative to the traditional funeral for the budget conscious Videos to watch/Websites to visit: https://youtu.be/-MQ5dL9cQX0 https://youtu.be/KepeRLQ_G1A Losing the Plot: Death is Permanent, But Your Grave Isn’t How Long are Graves Kept https://youtu.be/DhggumD8yKY (begin video at 1:04 mark) https://youtu.be/_7rS_d1fiUc https://youtu.be/afc91CbdBzY https://youtu.be/G8WLYCFgMnI https://youtu.be/iTD0GltXB50 The Green Death: How Environmentally Friendly Options Are Changing The Way We Bury Our Dead Return to Nature Small Funerals, Online Memorials and Grieving from Afar: The Coronavirus Is Changing How We Care for the Dead Coronavirus Is Changing Funerals And How We Deal With The Dead Chapter 5 Notes (“Plagues, Pandemics & Mass Death Events”):  A pandemic is an epidemic occurring worldwide, crossing international boundaries and usually affecting a large number of people. The World Health Organization (WHO) declares a pandemic when the growth rate of an infectious disease skyrockets, and each day cases grow more than the day prior. Plagues are a type of infectious disease pandemic, but the term is often used in describing older pandemics like the Black Death. “The word ‘plague’ is a polyseme, used interchangeably to describe a particular, virulent contagious febrile disease caused by Yersinia pestis, as a general term for any epidemic disease causing a high rate of mortality, or more widely, as a metaphor for any sudden outbreak of a disastrous evil or affliction” As human civilizations grew, constructing cities and creating trade routes to connect those cities, the more likely pandemics became. This is also true today, as increasing global connections and interactions (i.e., globalization) represent a driving force behind pandemics Healthcare advancements and improvements in understanding the factors that lead to pandemics have been progressively more effective in reducing the loss of life Most of the infectious diseases that lead to pandemics are caused by zoonotic pathogens that have been transmitted to humans due to increased contact with animals through: breeding, eating, hunting, global trade activities, deforestation and its impact on biodiversity. As long as these practices persist, pandemics will continue to occur, and their likelihood will increase. In fact, it is estimated that “the probability of novel disease outbreaks will likely grow three-fold in the next few decades” Pandemics and plagues of the past have been powerful change makers throughout history, shaping: politics; revolutions; war; entrenched racial- and economic-based discrimination; the redistribution of income and reduction of inequality; and societal world views The most fatal pandemic in recorded human history was the Black Plague, which began in 14th century Europe, lasting from 1346-1353. The plague bacteria, Yersinia pestis – a type of zoonotic bacterium – is transmitted to humans through bites of infected fleas. The Black Death is believed to have been a Bubonic plague (although some scientists disagree). It originated in central Asia from fleas that lived on black rats and was transmitted to humans via infected rodent flea bites. The theory is that the plague later spread through the human population via human fleas and head lice. The inclusion of the term “Black” in the name of the pandemic is tied to one of its telltale visible physical symptoms, large swollen lumps in the groin and armpits referred to as buboes that turned the skin black prior to bursting. The plague resulted in the deaths of an estimated 75-200 million people, approximately 30-50% of Europe’s population. The aftermath of the plague created a series of religious, social, and economic upheavals, which had profound effects on the course of European history. Plague is divided into three main types – bubonic, septicemic, and pneumonic – depending on which part of the body is affected. The Spanish Flu, which lasted from 1918 through 1919, was caused by the H1N1 virus, a strain of avian flu. In an 18-month period, over one-third of the world’s population was infected and 3% of the world’s population (an estimated 50 million worldwide) died. In many countries, including Canada, more people died of the Spanish Flu than during WWI. Since the pandemic began during the last year of WWI, wartime media censorship led to inaccurate reporting of flu-related rates of infection and death. In early 1918, the only country reporting on widespread flu rates was Spain. As a result, the flu that caused the 1918 pandemic became known as the Spanish Flu. The origins and initial geographical starting point of the Spanish Flu remain a mystery. One of the more recent and devastating pandemics/epidemics is HIV/AIDS. HIV infection has led to the death of over 36 million people since the late 20th century with over 37 million people living with HIV at the end of 2020. The origin of HIV/AIDs infection in humans is linked to a chimpanzee version of the virus (Simian Immunodeficiency Virus – SIV). It is believed that the virus was transmitted via blood contact to humans as far back as the late 1800s, likely through hunting chimpanzees. Since that time, it spread across Africa and to other parts of the world. The first human illnesses associated with HIV that made the headlines began to appear in 1981 in the gay male population of New York and San Francisco. The societal prejudice against the gay community at the time, led to stigmatization, discrimination, and a  backlash against the gay community and the gay rights movement. There was a general apathy on the part of governments towards people infected with the virus, which impacted research funding. As a result, most efforts to help people living and dying with the virus were community-based. In the late 1990s medication was developed that now allows people with the disease to experience a normal life span with regular treatment. Although the medication doesn’t cure HIV/AIDS, and has many side effects, it does prevent the virus from multiplying and destroying a person’s immune system. However, access to this life-saving medication remains a problem for people living in certain areas of the world, such as sub-Sahara Africa COVID-19 was declared a pandemic by the World Health Organization on March 11, 2020. Since that time there has been a degree of conflation between coronaviruses and the COVID-19 virus. While Coronaviruses (CoVs) refer to the family of viruses that cause respiratory and intestinal illnesses in humans and animals. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the virus responsible for the outbreak of COVID-19. The COVID-19 virus leads to acute respiratory distress syndrome (ARDS), which results in dangerously low levels of oxygen in the blood. As of March 2022, over 6 million people have died from COVID-19 worldwide. As new strains emerge (e.g., Delta, Omicron), the world continues to be impacted by the virus, as well as the restrictions that follow it. Throughout history and within contemporary society, disease and pandemics have typically been accompanied by extreme accusations, denial, misinformation, and mistrust, which only exacerbate the death toll. Examples of pandemic denial were evident during the Spanish flu. During the flu’s first wave in the spring and early summer of 1918, some European and U.S. newspapers claimed that the flu wasn’t a serious threat. In the late summer, during the deadly second wave, the Interior Minister of Italy denied reports of the flu spreading. Anti-masking claims were also evident during the Spanish flu pandemic. Although there was wide-spread support for wearing masks, support waned quickly and masking compliance levels fell, due to issues of comfort, doubts regarding efficacy, and impact on businesses/commerce. This rings true during the COVID-19 pandemic as well. Less than half of the people in the U.S. follow health recommendations to wear a mask when out in public The stigmatizing and scapegoating of convenient targets is common during pandemics. Pandemic misinformation, conspiracy theories and the impact of low-science literacy levels, are integral in creating and reinforcing “us versus them” mindsets that lead to stigmatizing, scapegoating, and targeting of certain populations during pandemics. During the Black Death, Jewish people were blamed for spreading the plague by poisoning wells and streams. This led to the mass murder of the Jewish population by Christian mobs, across hundreds of communities. In 19th century U.S, immigrants were blamed for a variety of infections, including polio and cholera. Despite the Spanish Flu being accelerated by the movement of soldiers during WWI, German submarines and “enemy agents” were blamed for the spread of the flu by allied nations (e.g., the UK, U.S.). With AIDS, the 2SLGBTQi community was targeted, followed by people who inject drugs (PWID), Haitians, and people with Hemophilia. With COVID-19, hate, violence and blame has been levelled against people of Asian descent, resulting from its label as “the China virus” Another common feature of both past and present pandemics is disinformation, including: the denial of the safety and importance of vaccinations. The deep-rooted beliefs that underlie vaccine opposition have remained somewhat consistent since the introduction of smallpox vaccine in 1796, the very first vaccine created, although the exact concerns vary according to the cultural anxieties of the time. Anti- Vaccination leagues, founded in the mid- to late-1800s in the U.K. and U.S, spurred anti-vaccination sentiments and distrust of medicine. This resulted in the questioning of the safety and efficacy of, and the motives behind, the smallpox vaccine and every vaccine developed since then (e.g., Diphtheria, Tetanus, Polo [DTP]; Measles, Mumps and Rubella [MMR]). Vaccine hesitancy has had negative public health impacts. In terms of smallpox, anti-vaccination sentiments led to a significant decline in immunization rates, and the re-emergence of smallpox just a couple of decades later. Over the past few decades, hesitancy has led to “outbreaks of communicable infections such as measles”. With COVID-19, we find rates of hospitalization and death increase in regions where vaccine hesitancy and resistance to other health preventive measures, like masking and social distancing, are prevalent. We also see attacks  against people associated with the virus, vaccines, and public health measures. This ranges from violence against people of Asian descent, to the picketing of hospitals, as well as harassment and assault of medical and hospital personnel Videos to watch/Websites to visit: Epidemic, Endemic, Pandemic: What are the Differences? Visualizing the History of Pandemics Pandemics That Changed History How Medieval Writers Struggled to Make Sense of the Black Death https://youtu.be/4c-ZGeeCErs Stories of the 1918 Flu Pandemic (Read contents under Introduction tab and the tab on Indigenous Communities and the 1918 Flu Pandemic). https://youtu.be/3x1aLAw_xkY Why the HIV Epidemic is Not Over https://youtu.be/dvv35bUz0JY COVID-19 in Canada: A One-year Update on Social and Economic Impacts (Read Pages 10-14 & 16- 27). How to Heal the ‘Mass Trauma’ Of COVID-19 https://youtu.be/sa2Sud16Log Masking Resistance During A Pandemic Isn’t New – In 1918 Many Americans Were “Slackers” https://www.youtube.com/watch?v=1PLBmUVYYeg https://theconversation.com/aids-homophobic-and-moralistic-images-of-1980s-still-haunt-our-view-of- hiv-that-must-change-106580 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7123574/pdf/978-3-030-15346-5_Chapter_2.pdf https://www.livescience.com/worst-epidemics-and-pandemics-in-history.html https://www.nationalgeographic.com/science/article/vaccines-are-highly-unlikely-to-cause-side-effects- long-after-getting-the-shot- https://www.history.com/news/pandemics-advances https://jamanetwork.com/journals/jama/fullarticle/2772693 https://www.paho.org/en/topics/immunization/debunking-immunization-myths https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7874133/pdf/fmicb-11-631736.pdf https://theconversation.com/coronavirus-and-the-black-death-spread-of-misinformation-and- xenophobia-shows-we-havent-learned-from-our-past-132802 https://news.stanford.edu/2020/04/30/pandemics-catalyze-social-economic-change/ https://www.theguardian.com/society/ng-interactive/2020/apr/29/how-humans-have-reacted-to- pandemics-through-history-a-visual-guide https://www.frontiersin.org/articles/10.3389/fpubh.2021.630449/full https://theconversation.com/from-black-death-to-covid-19-pandemics-have-always-pushed-people-to- honor-death-and-celebrate-life-170517 Chapter 6 Notes (“Genocide”): The term “genocide” was first developed by Polish lawyer Raphäel Lemkin in 1944 in response to the actions of the Nazi’s during WWII and the mass murders of other groups throughout history. For years Lemkin lobbied the United Nations to recognize genocide as a crime under international law. This occurred in 1948 with the adoption of the U.N. Convention on the Prevention and Punishment of the Crime of Genocide (1948). Although the convention was ratified by only 149 States, all nations are “bound as a matter of law by the principle that genocide is a crime prohibited under international law” Definition of Genocide in the U.N. Convention: the current definition of Genocide is set out in Article II of the Genocide Convention: Genocide means any of the following acts committed with intent to  destroy, in whole or in part, a national, ethnical, racial or religious group, as such: (a) Killing members of the group; (b) Causing serious bodily or mental harm to members of the group; (c) Deliberately inflicting on the group conditions of life calculated to bring about its physical destruction in whole or in part; (d) Imposing measures intended to prevent births within the group; (e) Forcibly transferring children of the group to another group. Genocides have been occurring since the beginning of human civilization, with one of the earliest known examples being the destruction of Carthage at the end of the Third Punic War in 149– 146 BCE. Some genocides are more widely known than others, usually due to death tolls, when/where they occurred, and the amount of existing documentation and evidence detailing what occurred. One of the central characteristics of genocides is the targeting, vilification, blaming, and scapegoating of people due to perceptions of difference, typically tied to religious affiliation, sexual orientation, gender identity, and certain constructions of race and ethnicity. Once a specific group has been successfully targeted and labeled, the next step in the process is dehumanization. Successful dehumanization efforts facilitate the process of systematically removing the identified population through sterilization, deportation, and/or mass execution. Periodically over the centuries, the Armenian population in Ottoman Turkey were the targets of persecution. The first Armenian massacre in Turkey occurred under Abdul Hamid II between 1894 and 1896, taking the form of a state-sanctioned pogrom, resulting in the death/murder of hundreds of thousands of Armenians and the destruction of their homes and villages. Although the Armenians hoped their status in Turkey would change under the new “Young Turks” government that came into power in 1908, they continued to be seen, depicted, and treated as a threat to the State. During WWI, the Armenians were blamed for Turkey’s military and economic losses and portrayed as traitors by Turkish military leaders, who feared they would conspire for independence with European States. The result was increased hostilities directed towards the Armenian population of Turkey. In April of 1915, Turkish leaders began executing a plan to expel and massacre all Armenians from the country. This marked the start of what is referred to as the Armenian genocide. Through death marches across the Mesopotamian desert and targeted acts of violence by “killing squads/butcher battalions,” 600,000-1.5 million Armenians were murdered. The adults who survived were forcibly removed from Turkey, while children were kidnapped and assimilated into Islam and Turkish families. The Ottomans eventually surrendered in 1918. Although most historians classify what occurred in Turkey as a genocide, as of 2021 the Turkish government has yet to recognize the Armenian Genocide and there are doubts that it ever will Jewish people have been the subject of prejudice and discrimination for centuries. The Holocaust, which occurred during WWII, is not only the most horrific example of anti-Semitism, it is the largest known genocide in human history. During the Nazi movement’s rise to power, Hitler targeted the Jewish population of Germany using a four-step process of dehumanization: Prejudice (e.g., propagating the belief in the “inferiority” of Jewish people and the “superiority” of “native born Germans”, especially “Aryan” people, etc.). Scapegoating (e.g., Jewish people were blamed for: Germany’s defeat in WWI; most social and economic problems leading up to and during WWII, etc.). Discrimination (e.g., boycotting of Jewish owned businesses; excluding Jewish children from public education; passing discriminatory laws; expulsion from professions and opportunities to earn a living; forced wearing of a yellow Star of David; isolation and segregation, etc.) Persecution (e.g., the forced removal from homes; belongings and assets confiscated; forced to live in crowded “ghettos” with inadequate living conditions that took the lives of hundreds of thousands of people, etc.). The dehumanization and isolation of Jewish people in ghettos, was part of the Nazi’s “final solution” to the “Jewish question”. The next part involved deporting large numbers of people to concentration camps and ultimately mass executions. When Allied soldiers began liberating the camps in 1945, they witnessed the horror of the Nazi crimes including: hundreds of thousands of starving and sick prisoners living alongside thousands of dead bodies; gas chambers and high-volume crematoriums; thousands of mass graves; documentation of horrific medical experimentations; as well as other war crimes and crimes against humanity. By the end of WWII, the Nazis had killed over 6 million Jewish people, along with 5 million people from other  minority populations including: Romani people, communists, members of the LGBTQ+ community, and people with disabilities A complex interplay of a number of deep-seated social, economic and political forces throughout the history of Rwanda created the cultural dynamics that precipitated the Rwandan genocide. Rwanda society is comprised of three groups: the Tutsi, the Hutu and the Twa. The Hutu make up the majority (85%) of the Rwandan population. Although these identities existed prior to colonialization, they became much more rigidly entrenched and racialized under Belgian colonial rule. Tensions between the Hutu and Tutsi have a long history, rooted in colonialism, revolution (in 1959), and civil war (starting in 1990), with conflicts and violence between the two groups occurring long before the 1994 genocide. The factor that appears to have sparked the genocide was the murder of the Rwandan president. On April 6, 1994, a plane carrying President Ntaryamira was shot down. Although those responsible for the assassination were never identified, some believe it was carried out by Hutu extremists in an attempt to gain public support for a planned massacre of the Tutsi population. Shortly after the crash, members of the Rwandan armed forces (FAR) and Hutu militia groups (Interahamwe), carried out an organized and planned attack against the Tutsi people with the help of the Hutu population. They went door-to-door and set up roadblocks in order to find, identify, rape and slaughter Tutsi people. Support for the genocide and encouragement to rape and murder was rallied by propaganda that portrayed Tutsi as outsiders, inferior, traitors, dangerous, “vermin” or “cockroaches” that needed to be exterminated. The violence was brutal and vicious, carried out with machetes, clubs and guns. The genocide lasted 100 days, ending in July 1994, when the Tutsi led Rwandan Patriotic Front (RPF) took control of Kigali, the capital of Rwanda. An estimated 800,000 to one million Tutsi were slaughtered. Moderate Hutus were also murdered, including those who refused to participate in the genocide. The mass rape of approximately 250,000 Tutsi women and girls resulted in two-thirds of them contracted the AIDS virus From the actions of European settlers during colonization to Canadian Government policies, such as the Residential School (IRS) system and the Sixties Scoop, Indigenous peoples, as well as their cultures and ways of life, have been the target of systematic eradication. The experiences of Indigenous communities in Canada, especially experiences tied to the IRS and the Sixties Scoop, were referred to by the Truth and Reconciliation Commission (TRC) as cultural genocide. The findings of the National Inquiry into Missing and Murdered Indigenous Women and Girls (MMIWG) drew a different conclusion – that the Government of Canada perpetrated genocide against Indigenous peoples. As noted by Fannie Lafontaine, “Canada has demonstrated a continuing policy, with varying motivations but with an underlying intent that’s remained the same – to destroy Indigenous peoples physically, biologically and as social units”. The criteria set forth in the UN Convention on Genocide (1948) can be applied to the IRS system to illustrate the appropriateness of the term genocide to describe Canadian government policies, actions and inactions. The IRS resulted in Indigenous children being forcefully removed from their communities to be assimilated into a Euro-Canadian style of life, at institutions run by the State and religious organizations. Children were often deliberately malnourished, housed in cramped and dirty quarters, and not provided medical treatment when they became ill. Although the members of the Catholic Church are largely responsible for the mental, physical, sexual, and spiritual abuse that occurred within these schools, “the Canadian government was happy to leave these children to die because they were Indigenous”. As of June 2021, there were “4117 [documented] deaths of First Nations, Inuit and Métis children at residential schools across Canada”. This number grows with each site study. The refrain “Every Child Matters” has been used to show support for the continued exploration of all IRS locations. The genocide against Indigenous peoples in Canada, however, is much larger than the IRS or the Sixties Scoop. It continues in many ways today, for example, through inadequate government policies and action to address the crisis of murdered and missing Indigenous women and girls (MMIWG); and through insufficient government funding to address structural racism, evident in current living conditions in Indigenous communities throughout the country (i.e., water and air pollution, housing insecurity, inadequate educational and medical facilities, etc.), that continue to negatively impact the health and well–being and life-expectancy of Indigenous peoples Videos to watch/Websites to visit: https://youtu.be/Xj_IKM7QdCU https://youtu.be/MFxeCe8zVQo https://youtu.be/WbpP8BYBsis Genocide: An Introduction https://youtu.be/gh598vX7tqs https://youtu.be/Ty4iRT0z5Ms https://youtu.be/KwCg3f00TEc https://www.youtube.com/watch?v=RphYwV91MN4 No Longer ‘The Disappeared’: Mourning the 215 Children Found in Graves at Kamloops….Residential School How Canada Committed Genocide Against Indigenous Peoples, Explained by the Lawyer Central to the Determination https://youtu.be/kqokpUqkLqo https://www.utm.utoronto.ca/alumni/sites/files/alumni/public/shared/UofT_M_magazine_Spring_2019.p df (Read pages 20-21) Chapter 7 Notes (“End-of-Life Care: Hospice, Palliative Care & Medical Assistance in Dying”): Personal or emotional dignity is tied to a person’s sense of feeling worthy, esteemed, and respected. It is subjective in nature, varying from person to person, and influenced by a variety of factors including interpersonal relations and culture (e.g., beliefs, mores, values, social-customs, religious beliefs and practices). When using terms like dignified death, death with dignity, dying with dignity, or dignity in dying, we are talking about personal dignity as we approach the end of life, the experience of dying in a manner that the person who is dying feels is dignified, which is considered an important attribute of dying well. Definitions of dying with dignity vary and can be associated with a variety of factors including: the impact of the illness (on cognitive and physical abilities); a sense of autonomy and self- determination; being treated with respect and understanding; the ability to participate in activities the dying person finds meaningful (e.g., those that bring them joy, happiness, fulfillment, contentment). It can also be tied to having one’s wishes respected about one’s final days, so that death can be met on one’s own terms. Caregivers (family, medical personnel) typically play a pivotal role in a dying person achieving a dignified death. Even though caregivers may have their own understanding of “dying with dignity” and place a priority on different factors (i.e., their own personal definition of quality of life), dignity in dying requires that others ask, listen, respect and honour the dying persons wishes (including end-of-life choices). Since dying with dignity can be tied to maintaining a sense of personal integrity, which can be nurtured, or not, by caregivers, it is also important that caregivers honour aspects of the dying individual as they once were. All of this means that the experience of death with dignity can easily and (un)knowingly be denied a person through silence, a failure to listen, lack of communication and/or not honouring and respecting the wishes of the dying individual or not treating them with respect and understanding In terms of end-of-life care, dying with dignity consists of honouring a person’s choices and wishes about how, where, and with whom they wish to die. The assurance that everything will be done as per their specifications both before and after death is also an essential part of a dignified death. This can include: upholding advanced directives; wishes laid out in documented end-of-life and estate plans/wills; preserving dignity and privacy of the body after death; observing any specified cultural and religious practices; and giving loved ones the opportunity to grieve. Dying with dignity ultimately works to create not only a “good death” for the dying individual, but it can also lessen the grief and suffering among loved ones left behind. The aim of palliative care is to enhance quality of life and promote patient dignity. Its defining principles include controlling physical symptoms and supporting psychological and spiritual needs. These services are delivered by multidisciplinary teams of experts and can take place in a hospital, hospice, and at  home. Although often thought to be a service only for the dying, palliative care is not only about end-of- life care Palliative Care Efforts Focus On: Improving quality of living and dying; Placing patient values and wishes at the forefront of treatment considerations; Managing stress; Comforting patients; Treating and controlling symptoms; Reducing pain and suffering; Mitigating the consequences of a disease; and providing psychological, social, emotional, spiritual, and practical support for patients and their families The modern-day concept of hospice as a place for end-of-life care began with the work of Dr. Cicely Saunders of the UK. Focused on providing the terminally ill with end-of-life care, she founded St. Christopher’s Hospice on London UK in 1967. In Canada, hospice care started in the mid-1970s as hospice-palliative care units in hospitals. The first community-based hospice in Ontario opened in 1979 in the Windsor-Essex region. Hospice of Windsor and Essex County has been serving the local community since that time and now has two residential campuses, one in Windsor and one in Erie Shores. Hospice Care is one type of end-of-life care program that incorporates a palliative philosophy of care and is used by people with serious illnesses who are nearing the end of life. It is both a type of care and a philosophy of care that focuses on the needs of the terminally ill, including pain and symptom management and psychosocial needs (psychological, emotional, spiritual, interpersonal) Similarities between Hospice and Palliative Care: Provides specialized care and support for individuals living with serious illnesses; Main goal is to improve the quality of life of patients via interventions that focus on improving comfort and reducing the complications associated with illness; Programs are family oriented; Uses a team approach, typically a physician, nurse, and social worker; and can occur at home, in an assisted living facility, nursing home, hospital, or hospice residential facility Differences between Hospice and Palliative Care: Hospice requires patients to forgo all medical treatments that are life-sustaining or curative. Focus shifts completely to comfort-oriented care. In contrast, with palliative care patients can receive life-sustaining or curative treatments alongside palliative care; and hospice is usually reserved for people who have a prognosis of 6 months or less to live. In contrast, there are no time limits with palliative care. In 2017, the Act providing for the development of a framework on palliative care in Canada, was passed by Parliament. After consulting with Provincial and Territorial governments and various other groups, Health Canada eventually provided the foundation for the “Framework on Palliative Care in Canada”. One of the features of the framework was the formation of guiding principles that are fundamental to the provision of high-quality palliative care in Canada. The Guiding Principles of Palliative Care in Canada: Palliative care is person- and family-centred care; Death, dying, grief and bereavement are a part of life; Caregivers are both providers and recipients of care; Palliative care is integrated and holistic; Access to palliative care is equitable; Palliative care recognizes and values the diversity of Canada and its peoples; Palliative care services are valued, understood, and adequately resourced; Palliative care is high quality and evidence based; Palliative care improves quality of life; and palliative care is a shared responsibility. Although there have been changes and improvements to palliative care in Canada since it was first introduced in the mid-1970s, various reports have demonstrated gaps in access and quality of palliative care across Canada. A report by the Canadian Institute for Health Information (CIHI) (2018), for instance, found that: While 75% of Canadians would prefer to die at home, only about 15% have access to palliative home care services; Recipients of home palliative care services are 2.5 times more likely to die at home and are less likely to receive care in an emergency department or intensive care unit; and cancer patients are up to 3 times more likely to receive palliative care, even though approximately 89% of people with life-limiting illness, such as a progressive neurological illness, organ failure, or frailty, were not able to benefit from palliative care. Several recommendations have been made by palliative care organizations to overcome these gaps in access and quality of care. They include “establishing consistent definitions and measures of palliative care, improving palliative education for health professionals, ensuring adequate training for caregivers and increasing awareness among patients and their families”  According to the Canadian law, MAiD is the process whereby a person seeks and obtains medical assistance in ending their life. There are two legal forms of MAiD, both of which involve a medical practitioner (i.e., a physician or nurse practitioner): Clinician-Administered MAiD: A medical practitioner administers the substance that results in death (e.g., injection of substance). Self- Administered MAiD: A medical practitioner prescribes or provides a substance that the person then takes in order to end their life. On June 17, 2016, Bill C-14 received royal assent, making medical assistance in dying (MAiD) legal in Canada. This legislative change was the result of the Supreme Court of Canada ruling in Carter v. Canada (2015. In their ruling the Supreme Court stated that Canadian “law must permit some form of physician-assisted dying”. The Court gave the government 12 months to rewrite the law. In January 2016, that deadline was extended by four months. At that time, the Supreme Court also granted an exemption that allowed people to access MAiD by applying to the Superior Court in their jurisdiction, until the new law came into force. Various amendments have been made to the MAiD legislation since enacted. The most recent changes occurred on March 17, 2021, when the Parliament of Canada (2021) passed the revised MAiD legislation. The key changes in the new legislation relate to: eligibility criteria; the assessment process; procedural safeguards; advance requests; and reporting/monitoring/analysis Notions of dying with dignity or death with dignity are tied to the quality of the dying process. These terms, however, have also become synonymous with the right to assisted death movement. Dying with Dignity is a Canadian based organization, while Death with Dignity is a U.S. organization. Both are leaders in their respective countries in terms of end-of-life advocacy, education, and support. Their emphasis is on choice and the right to choose one’s own good death, whether that be a natural death from age, disease/illness, accident, or medically assisted dying. Dying with Dignity Canada is also fighting for the rights of people who want MAiD to be able to die where they want. Currently, there are many institutional and community settings (e.g., care homes, hospices, religious oriented hospitals) that will not permit MAiD on their premises. This means that people in very fragile states, near the end of life, must be relocated if they wish medical assistance in dying. In response, there is an initiative to create MAiD suites, where people can receive assistance in dying in a supportive, home-like setting (e.g., MAiDHouse, and funeral home MAiD suites). In addition to Canada, a number of countries around the world have legalized some form of assisted dying, including Switzerland, the Netherlands, Spain, Belgium, Luxembourg, Colombia, Australia, France, New Zealand, and parts of the USA. Each country has its own restrictions, rules, and regulations regarding when, how, and where assisted dying is permitted, as well as who is eligible to receive it. There is also a range of terms used to refer to the various processes tied to assisted dying. Assisted Dying Terminology: Correct and accurate terms include: Physician-Assisted Death; Physician-Assisted Dying; Aid in Dying; Physician Aid in Dying; Medical Aid in Dying (MAiD) (Most commonly used in Canada); and voluntary Assisted Dying (VAD) (Most commonly used in Australia). Inaccurate and outdated terms: Assisted Suicide; Doctor-Assisted Suicide; Physician-Assisted Suicide; and (Active) Euthanasia In Switzerland, there is no specific law permitting or outlawing assisted dying. Under Swiss Criminal Law, assisted dying has been tolerated since 1937, provided that the person who is providing the required assistance has no selfish motive. Switzerland is one of a few countries that permits non- residents to access assisted dying, earning the country the reputation of a “suicide tourism” destination Assistance in dying is available in a number of U.S. states including: California, Colorado, Hawaii, Maine, New Jersey, New Mexico, Oregon, Vermont and Washington D.C.. The first U.S. state to officially legalize assisted dying was Oregon. In November 1994, the Oregon Death with Dignity Act (DWDA), a citizen’s initiative, was passed by Oregon voters. After some delay, the law was enacted on October 27, 1997. The DWDA allows terminally ill residents of Oregon to end their lives through the voluntary self-administration of lethal medications prescribed by a physician if they meet the required criteria. The criteria stipulates that a patient must: be 18 years of age or older; a resident of Oregon; capable of making and communicating health care decisions to health care practitioners; and diagnosed with a terminal illness that will lead to death within six months. “Since the law was passed in 1997, a  total of 2,895 people have received prescriptions under the DWDA and 1,905 people (66%) have died from ingesting the medications”. Videos to watch/Websites to visit: https://youtu.be/apbSsILLh28 10 Myths About Palliative Care Final Days https://vimeo.com/140868833 https://youtu.be/HBenNG7xoVY Language Matters: Why We Use the Term ‘Medical Assistance in Dying Canada’s New Medical Assistance in Dying Law Get the Facts: Canada’s Medical Assistance in Dying Law Medical Assistance in Dying How can Canada Safeguard those Marginalized by Society as MAiD Expands? Medically Assisted Death Non-Profit Says Fear is Hampering Its Search for Permanent Space Assisted Dying Around the World Suicide Tourism” & Understanding the Swiss Model of the Right to Die https://youtu.be/1lHXH0Zb2QI https://www.youtube.com/watch?v=kTCZOiabEYw https://youtu.be/ZWLoQkJD0WA https://youtu.be/Mc5ImaOciR4 https://podcast-a.akamaihd.net/mp3/podcasts/whitecoat-h0SkFJP9kp6abaN.mp3 https://theconversation.com/end-of-life-care-people-should-have-the-option-of-general-anaesthesia-as- they-die-159653 https://windsorstar.com/news/local-news/windsors-first-death-doula-helps-people-plan-their- exits#:~:text=Whether%20it’s%20planning%20a%20living,help%20people%20do%20dying%20right. https://bjgp.org/content/bjgp/71/708/318.full.pdf https://www.health.gov.on.ca/en/pro/programs/maid/ https://www.cmaj.ca/content/cmaj/193/4/E139.full.pdf https://www.cbc.ca/news/canada/london/funeral-homes-pivot-to-offer-rooms-for-medically-assisted- deaths-1.6224353 https://theconversation.com/dying-virtually-pandemic-drives-medically-assisted-deaths-online-139093 https://theconversation.com/last-wishes-and-clear-choices-learning-how-to-talk-about-end-of-life-care- 35665 https://theconversation.com/what-is-palliative-care-a-patients-journey-through-the-system-82246 https://theconversation.com/five-common-myths-about-palliative-care-and-what-the-science-really- says-82248 https://www.canada.ca/en/health-canada/topics/end-life-care.html https://khn.org/news/living-their-values-palliative-care-power-couple-faces-cancer-at-home/ Chapter 8 Notes (“Grief, Loss & Bereavement”): Grief is the psychological, emotional, physical and social, reaction to loss. Although the experience of grief is unique to each individual person, there are some commonalities. Some common reactions associated with grief include: “shock, disbelief and confusion; anger; trouble concentrating and focusing on tasks; altered patterns of eating and sleeping; physical changes such as dizziness, headaches or upset stomach; sadness and yearning; memories and thoughts about who or what has been lost; and withdrawing from usual activities” The outward expression of grief is referred to as mourning. There are individual, cultural, and religious variations in terms of the physical manifestations of grief. Common forms of mourning include: “crying, and expressing grief through art or writing, rituals, and/or religious practices such as prayer”  Bereavement is the period of sadness and sense of loss felt after experiencing a loss in one’s life. The loss does not necessarily have to involve death. Instead, bereavement can follow other life transitions or change events, such as the ending of significant relationships (e.g., with spouse or friend) or a relocation of oneself or others to a new area or type of living situation. It can also be tied to loss of parts of oneself, due to changes in life circumstances or physical/psychological health. Both mourning and grief are “part of the bereavement process”. While bereavement is the broader term used to refer to the internal process that an individual experiences following a loss of any kind, grief is a part of the pain and suffering that constitutes bereavement following a loss There is no definitive set of criteria for the characteristics of grief. Important things to keep in mind when experiencing or helping someone through the bereavement process is that grief: Does not follow a linear process; Can include different types of change or loss that don’t involve death (e.g., loss of a limb, health/abilities, home, job, routine, etc.); Is an ongoing process. It does not have a timeline or expiration date; and never looks the same, even for the same person. Each person’s experience of grief is unique to them. One of the most widely known people associated with understanding dying and grief is Elizabeth Kubler-Ross, who was a pioneer in palliative care. Her work brought attention to the subject of illness and dying, challenged social norms regarding talking about death, and caused “a public outcry for compassionate care of the dying”. It also altered the way medical staff attend to those that are dying. Although her original model of dying and grief has been the subject of criticism, her work in the field helped inspire others’, resulting in several theories of grief and bereavement including: Bowlby’s Attachment Theory (1969-80); Parke’s Psycho-Social Elaborations (1972); Worden’s Four Tasks of Mourning (1991); Silverman and Klass (1996); and Stoebe and Schutt (1999) There’s no perfect combination of words that will take away a grieving person’s pain, but there are ways we can support them and show we care. Calling, texting, or showing up face-to-face, for instance, are some of the best things we can do for someone who is grieving. We can also send cards and/or gifts, anticipate their needs, check up on them, and listen with compassion. There are, however, things that should be avoided, including: trying to “fix” their grief, not saying the deceased person’s name, making it about us, and/or encouraging them to “move on” In the 21st century, social media has not only become a key component in the everyday lives of many people, it also has therapeutic benefits for people who are grieving. It provides a forum for the grieving person to post photos, comments, and memorials to express their respect and love for the deceased. Social media also serves as a useful tool in disseminating information regarding funeral arrangements. Despite the benefits social media may provide, there are things that should be avoided. These include: posting comments such as “they’re in a better place,” especially if those posting are not familiar with the bereaved person/family’s beliefs; asking the bereaved invasive, personal questions; and sharing information about the deceased in an online platform. It is the deceased person’s closest family members who should be deciding when, what, and how they want to post about their loved one Much of the media coverage on the COVID-19 pandemic has focused on the number of people who are gravely ill and who have died from the virus. As of April 2022, the worldwide death toll is over six million. Although we see and hear these numbers daily, we rarely hear about those who are experiencing mourning and grief. According to Cadell, “it is estimated that for every one person who dies, there are five left grieving those loses.” However, as noted in the previous sections of this chapter, grief is not just a reaction to death but can also be tied to other forms of loss. During the COVID-19 pandemic, many people have experienced loss on multiple levels. There is the loss tied to physical, economic, and housing security. There is the psychological toll tied to a lack of emotional and physical connection, relationships, and mental health support that help us through difficult times. We are also losing a sense of predictability in or control over our lives, including our ability to protect our loved ones, especially the most vulnerable (children, elderly). And there are the losses associated with the pandemic’s impact on healthcare, education, and world economic stability and peace. Not only does postponing, curtailing, or eliminating end-of-life rituals impact both how we mourn the dead and grieve, it impacts how we grieve all of these losses  The COVID-19 pandemic has shed light on the importance and necessity of the government implementation of a national grief strategy. This strategy could include public awareness campaigns, educational initiatives, and increased funding for grief-related research. Such a strategy would help us to better understand and deal with grief, recognize grief in ourselves, and better support one another through grief. Since the Canadian Grief Alliance (CGA) was formed by the Canadian Virtual Hospice in 2020, it has called for government funding of a national strategy. As of March 2022, the CGA is still waiting for government funding and action. In the interim, every November since 2017, the CHPCA has sponsored a National Grief and Bereavement Day to encourage “Canadians to engage government and all sectors of Canadian society in a national dialogue to identify and support access to necessary resources for those living with grief and bereavement”. The importance of the initiative has grown exponentially due to COVID-19. Videos to watch/Websites to visit: Grief Never Ends, and That’s Okay Untangling Trauma and Grief After Loss https://youtu.be/6GfthkyzW5s What to Say When Someone Dies Grief – How to Support the Bereaved https://youtu.be/khkJkR-ipfw 11 Etiquette Rules You Need for Dealing with Death on Social Media Mourning with Social Media: Rewiring Grief Grief & COVID-19: Mourning Our Bygone Lives Loss, Grief & Healing https://youtu.be/eEcaUhxAH2g https://www.ted.com/talks/dr_edith_eva_eger_the_journey_of_grieving_feeling_and_healing (Watch to 11 minute mark). https://theconversation.com/coping-with-loss-we-need-a-national-strategy-to-address-grief-beyond-the- coronavirus-pandemic-153824 https://www.forbes.com/health/mind/what-is-anticipatory-grief/ https://theconversation.com/singing-death-why-music-and-grief-go-hand-in-hand-81679 https://theconversation.com/what-chinese-philosophers-can-teach-us-about-dealing-with-our-own-grief- 85959 Chapter 9 Notes (“Memorials, Commemoration & Remembrance”): Memorials are things created to honour and remember the dead. They “are the products of collective memory of social groups or [of] collective importance of an event, person, or circumstance, linking the past to the present and future”. Memorials can take many forms (Bruggeman, 2020). Although some are permanent (e.g., official memorials, grave markers, dedicated park benches, or trees) living creations (e.g., a memorial garden), others can take the form of remembrance gatherings, including the smaller/personal events hosted by families to honour the death of a loved one. Living memorials vary in form. They can be “a location or monument where people gather”. They are memorials that can grow, change, or evolve over time. Examples include: adding panels to the NAMES Project AIDS Memorial Quilt; adding names to plaques, such as the ones that are part of the Ian Anderson Hospice Memorial Garden; as well as leaving flowers, notes, teddy bears, etc. at static memorial sites, such as the Vietnam memorial in Washington DC. Living memorials can also be spontaneous in nature, such as those that take shape and grow in the aftermath of acts of violence, accident or mass death events. Examples include the temporary memorials to honour the victims of the Pulse Nightclub shooting in Orlando FL, and those in Minneapolis MN to honour the life and protest the killing of George Floyd by police  Commemoration is the act of remembering, honouring or showing “respect to a person or event.” Acts of commemoration can include both special actions, like ceremonies or celebrations and “the creation of an object, work of art, writing, music, or a memorial” Remembrance is more than the act of remembering. It is about “keeping a memory alive [of a person or event], or at least not allowing ourselves to overlook…[or forget what has] happened in the past” The term monument typically refers to a structure, edifice or a figurative object (e.g., statue, structure, building) that is constructed to commemorate a notable individual or event. The definition of who or what is considered notable of being remembered is determined by the individuals who commission the work, and thus the subject of contestation and debate Humans have honoured their dead in a variety of ways over time. We mark death often through memorials, with urban landscapes containing a variety of commemorative objects. Some memorials are for individual loved ones. Others are more public in nature, commemorating people and events who are defined as important (e.g., statues, naming of buildings) and/or larger groups of people who died either together or from a common cause (e.g., war, genocide, violence, terrorism, disease, natural disasters, mass causality events, etc.). At their most basic level, memorials to loved ones serve to remind us of the person(s) we have lost, the frailty of life, and/or the inevitability of death. Larger public memorials play a broader range of roles including: honouring, commemorating, and remembering the dead; aiding the understanding significant human events; the construction of official and counter narratives; creating symbolic representations; and stimulating dialogue The birth of modern-day forms of memorial and commemoration began after 1918. Most of the WWI memorials constructed in the years between the two world wars relied on more traditional modes of representation and symbolism. They borrowed heavily from ancient Greece and Rome, and spoke to the conservative orientation of the time. Many of the monuments created are statuesque in nature, often depicting a male person or persons atop a pedestal. These strongly gendered, conservative expressions of public remembrance are attempts “to set our understanding of what has happened in stone, beyond interpretation, investigation and critique”. The nature and form of these historical monuments, including who is depicting and who is not, is intended to “to secure narratives of nation-building” patriotism, and white, male/patriarchal power Public monuments and memorials can be powerfully symbolic. Having a white, rich, man memorialized in metal or stone, set on a pedestal in a central public space “makes a deliberate, eminently visible claim about to whom the space belongs, and thus who belongs here and who does not”. Efforts to write the past in stone, however, are destined to provoke controversy, hostility or fade into irrelevancy. Since history is a social construct, who, what, and in what format someone or something is memorialized is subject to re-evaluation, re-examination, reinterpretation, and debate. The meaning attributed to more static older monuments and memorials, and the historical people and events they represent, is therefore open to contestation, something we have increasingly bore witness to since the mid-1960s. In recent years, there have been numerous headlines about the defacing and destruction of regional and national monuments and the call for the removal of statues that were erected to honour people and/or events whose celebrity was built on colonization and/or the crushing of racialized and Indigenous peoples and their cultures. The hotly contested nature of the politics of memory is not new. The basis of the contestation is “not just what monuments are, but more importantly, what monuments are intended to do for and within the body politic” Memorials rarely reflect consensus and are never silent. In most contemporary memorials we witness a shift away from traditional motifs toward memorials and monuments that are more abstract in their design. As noted by Kerby, “abstraction is better placed to challenge hegemonic views of the past…and…with the complexity of historical events.” This purposeful alteration in memorial style is meant to change the relationship between the memorial and the audience. Rather than instructing audiences as to what to think, feel, and remember, contemporary memorials and monuments are typically designed to embrace ambiguity and resist closure, thereby encouraging viewers to actively engage in reflection and interpretation. Many contemporary memorials not only engage with the viewer, they also symbolically and metaphorically challenge or counter existing relations of power and official  narratives regarding what and who should be memorialized, demanding inclusivity in collective memory. In doing so, such efforts by special interest and grassroots groups serve to initiate dialogue, and in the process engage the viewer as an active participant in the reconstruction of public memory Official memorials serve as reminders to the public of significant historical events and people. According to the Government of Canada, official memorials consist of public monuments, ceremonies, or testaments that pay tribute to important persons or events. Remembrance Day, observed each year in Canada on November 11, serves to remember both past and ongoing war-related sacrifices. It is celebrated through national ceremonies, the wearing of poppies, and the reading of “In Flander’s Fields?