This is my play s last scene:

Transcription

1 This is my play s last scene: Death Rituals in America GEC Faculty Scholars June 10, 2016 Michael D. Barnett, MD, MS, FAAP Assistant Professor of Medicine & Pediatrics UAB Center for Palliative & Supportive Care

2 Objectives 1. To describe the importance of ritual in death and dying. 2. To list common cultural customs surrounding death in America. 3. To recognize our role in the death rituals of our patients. 4. To reflect on ritual as part of our personal grieving process as clinicians.

3 Universality Death of elderly chimpanzee at a zoo in UK, Pre-death caregiving All-night vigil at time of death Testing for signs of life Male aggression towards corpse Cleaning of the body Mourning period Anderson, JR, et al. (2010) Current Bio. 20(8):R

4 Rituals Arnold van Gennep, French folklorist, published his model on rites of passage in Separation Transition Reintegration Hunter, J. (2008) OMEGA. 56(2):

5 Death Rituals Rites of passage that serve specific purposes surrounding death: 1. Provide social support to mourners. 2. Set limits to formal mourning. 3. Outline cultural obligations during mourning. 4. Restore the bereaved to society. Hunter, J. (2008) OMEGA. 56(2):

6 Death Rituals Medicine Sociology Religion/ Spirituality Psychology

7 Dying in America In 2013, there were ~2.6 million adult deaths in US ~2/3rds of adults prefer to die at home % of adults die in the hospital. We are players in our patient s last scene. Xu, J., et al. (2016) National Vital Statistics Report, 64(2). Pollock, L. (2015) BMJ. 351:h4855. Bell, CL, et al. (2010) J Pain Symptom Manage. 39(3):

8 Anatomy of a Scene Preparing for death Preparing the body Preparing for burial Preparing for life apart Hindu Islamic Jewish Western (Christian)

9 Hindu Because death is certain for the one who is born, and birth is certain for the one who dies. Therefore, you should not lament over the inevitable. - Bhagavad-Gita 2:27

10 Background Karma birth & death part of cycle of actions which lead to reincarnation or absorption into Brahman Multiple deities, each with devoted following: Brahma (the Creator) Vishnu (the Preserver) Shiva (the Destroyer) Clements, PT, et al. (2003) J Psychosocial Nurs, 41(7):18-26.

11 Preparing for death Fasting Singing of hymns (bhajans) Body laid on ground just before death with head facing south Firth, S. (2005) Lancet, 366:682-6.

12 Preparing for death Good death: Old age Right astrological time Right place Shining forehead Peaceful expression Eyes & mouth open Bad death: Premature Violent Wrong time Wrong place Unpleasant expression Vomit, urine or feces Firth, S. (2005) Lancet, 366:682-6.

13 Preparing the body Body bathed, massaged with oils, dressed in new clothes Ganges water on lips Basil (tulasi) leaf in mouth Eyes & mouth left open Sacred ash (bhasma) or sandalwood paste applied to forehead Firth, S. (2005) Lancet, 366:682-6.

14 Preparing for burial Antyesti funeral rites Oldest son (or priest) places flowers around body & lights funeral pyre Ideally before next sunrise Lobar, SL, et al. (2006) Pediatr Nurs, 32(1):44-50.

15 Preparing for life apart Formal mourning 10 days of prayer & abstinence Oil lamp kept lit at home On 10 th day, lamp taken to water & released Shradh month-long ceremony at 1 st anniversary Prayers made for the deceased Food given to poor Restrictions on new clothes & parties Clements, PT, et al. (2003) J Psychosoc Nurs, 41(7):18-26.

16 Islamic Wherever you are, death will overtake you, though you are in lofty towers. - Qur an 4:78

17 background Shari-ah (Muslim law) derived from Hadith (practice & sayings of Muhammad) Maut signs of death: 1. Legs become limp 2. Breathing becomes heavy & erratic 3. Nose bends slightly 4. Temples sag Gatrad, AR (1994) BMJ, 309: Sarhill, N, et al. (2001) Am J Hospice Palliat Care, 18:251-5.

18 Preparing for death Death seen as a chance to recite or redeclare faith Use of talismans or lockets Consumption of verses Lundquist, A, et al. (2003) J Perinatal Neonatal Nurs, 17(1): Sarhill, N, et al. (2001) Am J Hospice Palliat Care, 18:251-5.

19 Preparing the body Face turned to Mecca (or southeast or right) Mouth & eyes are closed Ritually bathed Wrapped in shroud (kafn) Body kept intact No organ donation No mementos of deceased Gatrad, AR (1994) BMJ, 309(6953): Lundquist, A, et al. (2003) J Perinatal Neonatal Nurs, 17(1): Sarhill, N, et al. (2001) Am J Hospice Palliat Care, 18:251-5.

20 Preparing for burial Burial within 24 hours preferably No embalming or cremation No open caskets No coffins or simple coffins only No flowers No loud wailing or tearing of clothes Women may not be allowed at funerals or cemeteries Clements, PT, et al. (2003) J Psychosoc Nurs, 41(7): Gatrad, AR (1994) BMJ, 309(6953): Sarhill, N, et al. (2001) Am J Hospice Palliat Care, 18:251-5.

21 Preparing for life apart Formal mourning may last for 3 to 40 days Iddah (period of waiting) 4 months + 10 days for widows Shoes removed when entering house of deceased Head covered when talking about deceased Gatrad, AR (1994) BMJ, 309(6953): Sarhill, N, et al. (2001) Am J Hospice Palliat Care, 18:251-5.

22 Jewish He uncovereth deep things out of darkness, and bringeth out to light the shadow of death. - Job 12:22

23 Background Three main branches vary based on adherence to Halakha (Jewish Law) Orthodox Conservative Reformed Sacred privilege to be present at the time of death Clements, PT, et al. (2003) J Psychosoc Nurs, 41(7): Loike, J, et al. (2010) J Palliat Med. 13(10):

24 Preparing the Body Chevra Kadisha Jewish Burial Society Ceremonial washing (taharah) Dressing in linen shroud (tachrichim) Eyes & mouth are closed Body laid on floor Shomer religious guardian watches over the body Clements, PT, et al. (2003) J Psychosoc Nurs, 41(7): Dimond, B. (2004) British J Nursing, 13(9): Loike, J, et al. (2010) J Palliat Med. 13(10):

25 Preparing for Burial Keri ah black ribbon pinned to lapel or cut lapels of suit Mirrors covered, pictures turned over Burial ASAP, preferably before sundown No embalming or cremation No open caskets No elaborate caskets Clements, PT, et al. (2003) J Psychosoc Nurs, 41(7): Dimond, B. (2004) British J Nursing, 13(9):547-9.

26 Preparing for Burial Wailing usually done by women Tells history of deceased, from birth to death During the days of tears Professional mourners Gamliel, T. (2007) Social Sci Med, 65:

27 Preparing for Life Apart Se udat havra ah meal of condolence Shivah for seven days after funeral Mourners sit shivah on low stools or floor No bathing or shaving No jewelry or leather shoes No work No sex Clements, PT, et al. (2003) J Psychosoc Nurs, 41(7):18-26.

28 Preparing for Life Apart Shloshim extended mourning for 30 days No shaving or haircuts No music No visitation of grave No weddings or other religious celebrations Gravestone placed at 1-year anniversary to mark official end of mourning Clements, PT, et al. (2003) J Psychosoc Nurs, 41(7):18-26.

29 Western No one has power over the wind to restrain the wind, or power over the day of death. - Ecclesiastes 8:8

30 background Based in Christian tradition Orthodox Roman Catholic Protestant Modern deritualization Familiarity with technology vs. unfamiliarity with death Romanoff, BD & Terenzio, M. (1998) Death Studies. 22: