Reflections on Nonjudgment in Death Work
During my training in the Death Doula program with Home Hospice Association, I’ve been struck by similarities between death work and anthropology, particularly the emphasis on nonjudgment. A key tenet of cultural anthropology is relativism, which entails setting aside personal values and judgments in order to understand the behaviors of others. This doesn’t mean that we can’t hold personal opinions or disagree with certain beliefs or choices. But it requires temporarily suspending those perspectives to delve into the internal logics that drive individuals' actions. In other words, the anthropologist’s task is to understand the mental models and belief systems that give meaning to people's behaviors, even if they may appear strange, illogical, or contrary to one's own understanding.
Likewise, my training as a death doula has reinforced the notion that it’s not about imposing one's idea of a "good death" on others. Instead, the role of a death doula is to create a safe and supportive space for clients to explore and articulate their own desires, accompany them on their dying journey, and advocate for the realization of their end-of-life plans based on their unique beliefs and values.
I recently spoke with Dr. Rachel Wortzman, a palliative care physician based in Toronto, who told me about a patient she worked with whose definition of a “good death” caused her to question her own assumptions. Dr. Wortzman explained to me that she had previously expected her patients to want a calm and peaceful death; but she came to realize that for this particular patient, a woman in her 40s with ovarian cancer, “a good death seemed to be one where she showed up with fierceness, with passion, and with strength.” For this patient, who believed death should be treated as a battle, fighting to the end was considered something of a badge of honor. The patient was not interested in measures to alleviate her symptoms; instead she wanted to be present and actively endure the physical distress. Dr. Wortzman described this experience as reminding her that what a “good death” looks like is highly personal; and what seems off putting to one person may hold deep sacred meaning for another.
Consider the variation that exists in body disposition practices, or what people choose to do with their bodies after death. One particular disposition practice that may stretch the limits of our relativism is called "compassionate cannibalism," which involves the burning and consumption of the flesh of deceased relatives as a mourning ritual. I first learned about this practice during my undergraduate anthropology studies, and initially had a strong visceral reaction, finding it extreme and shocking. By learning more about the cultural context surrounding it, I came to understand that for those who practiced it, compassionate cannibalism was regarded as one of the most caring acts one can undertake for a deceased loved one. In her ethnography Consuming Grief, Beth Conklin details this practice among the Wari’ Indians in the Amazon rainforest, who regularly consumed their dead as a mortuary practice up until the 1960s. Conklin explains that while this practice may seem barbaric to Westerners, customs that seem appropriate to us, such as burial, seem(ed) equally barbaric to the Wari’. For them, to bury a corpse is to abandon it in the wet, cold, polluting ground. By consuming the flesh, not only is the deceased spared the dishonor of decay, the bereaved are also spared having the tangible reminder of their grief around in the form of a corpse. To the Wari’, it is important to remove all concrete reminders of the deceased in order to alleviate grief. From this perspective, the practice of consuming the flesh is an act of kindness, care, and respect to both the deceased and the bereaved.
Conklin's work illustrates the importance of understanding the cultural context that shapes the meaning of mortuary practices. For instance, she addresses the misconception that the Wari' practice of endocannibalism (eating members of their own group) must have been an act of hostility or aggression due to their practice of exocannibalism (eating enemies they killed). From the Wari' perspective, eating kin and eating enemies are as unrelated as burying kin and burying garbage would be to Westerners. Even though both acts can be considered forms of "burial," it is unlikely that most Westerners would attribute similar meanings to burying the deceased and burying garbage. This example powerfully demonstrates that the meaning of a practice lies not solely within the act itself but in the constellation of beliefs that imbue it with significance.
One aspect of Conklin’s description that particularly resonates with me is the Wari’ people’s own ambivalence surrounding this practice. As her informants tell it, they did not approach mortuary cannibalism with enthusiasm, but rather had to be repeatedly encouraged to do it, even as the thought disgusted them. Often, they would become ill, temporarily leave to vomit, and then return to continue the ritual. But they continued because they felt it was necessary to honor the deceased, and this overrode their discomfort.
This speaks to the universal experience of ambivalence surrounding dead bodies. Corpses are simultaneously sacred and revolting, objects of honor and fear. In many societies, the customary acts of care performed by families and loved ones to honor the deceased may provoke discomfort, anxiety, or disgust. For instance, in the Islamic faith, family members are tasked with cleaning and preparing the body, an act that some individuals have described as a source of fear; similarly in the Jewish faith this task is considered very holy and allocated to a specific group of trained people in the community. During my field research in Indonesia, I learned about a group called the Toraja, for whom it is traditional practice to keep corpses in the home for a long time, or even forever. Family members may treat these corpses with fear and even be scared to be around them, while simultaneously experiencing this is a form of honor and love.
This ambivalence around death and corpses is common across cultures. During my death doula training I attended a talk from funeral director Glen Burkholder who shared his experiences serving a variety of communities in Toronto. Over the years, he has begun encouraging family members to be present and participate in the "transfer of care" process, which involves moving the deceased from the home to a stretcher. Previously, he would shield families from this experience, asking them to leave the room while he prepared the body for transfer. However, he discovered that while families may be initially hesitant or nervous to engage with the body, when they do so they often find that this act of care can lead to significant healing and meaning.
Given the vast diversity of cultural and religious practices surrounding death, there may be instances as a death worker where people’s preferences seem counterintuitive, disconcerting, or even upend some of our most basic assumptions. Seeking to deeply understand their beliefs and values enables us to provide meaningful and culturally sensitive support. Beyond that, it can remind us of the beauty of the universals that underpin these differences, like the desire to honor our deceased loved ones–whatever form that takes.
