DIY Death: A Priest Opens Champagne, And Other Personal Funeral Moments

(Alex Kingsbury/WBUR)

(Alex Kingsbury/WBUR)

In case you missed Radio Boston yesterday, take a listen to this thoughtful conversation on do-it-yourself funeral arrangements, based on our wildly popular post on the topic (with over 3000 comments on NPR’s Facebook page; and over 70,000 CommonHealth Facebook shares so far).

Even though caring for our own dead loved ones used to be the norm (right up until the the last quarter of the 19th century) many people responded to our story on modern home funerals with a resounding: “Who knew?”

Transatlantic99 wrote, “I had no idea that this was allowed and will seriously consider staying out of funeral homes when the time comes.”

And a surprising number of commenters described their own experience with personal funerals, for instance, Boomer: “We have done two funerals from home to grave and will do it from now on…I am no longer afraid of dead bodies. The moment of death as each happened was a little traumatic. But the death care was peaceful, poignant, even humorous as we all worked together. Caring for our dead felt natural and right; fulfilling our responsibility. My family is agreed we dislike funeral businesses and having strangers with a vested financial interest involved with such a personal occasion. We dislike the exorbitant and unconscionable markups in costs at funeral businesses. The reaction I get from friends is, ‘I didn’t know that was legal!’ then, ‘How do I do it!?'”

The Radio Boston program touched on a number of topics we didn’t get into in the post, for example, what to do if a loved one dies in the hospital and you want to take the body home. (Short answer: it’s pretty much always legal, but some hospitals make it easier than others.)

Josh Slocum, executive director of the Funeral Consumers Alliance, a Burlington, Vermont nonprofit, was on the show answering questions and offering important context. “Human beings have been caring for their dead since we walked upright,” Slocum said, adding that when people actually confront death they tend to be much more emotionally resilient than they imagine. He said in the 10 years he’s been working with families in this arena he’s found that when a survivor cares for a dead loved one — that is, actually does something — it truly helps the grieving process and makes people feel a little less powerless. “Actually having something to do that was hands on,” he said, whether washing the dead body or making food for people coming to the house to pay respects, “was better therapy then they could pay for at a counselor’s office.”

My favorite comment came from a Belmont, Mass. priest, Patrick, who called in to the program.

Patrick said that several years ago, some parishioners asked for his help to try to figure out home funeral arrangements without using a funeral home. This family ended up “waking” their mother at home for two days, Patrick said, and the intimacy of the experience shifted his own thinking on death when his father died. “It changed my own take on what we would do as a family,” Patrick said. His father died at home in Stoneham after receiving hospice care. “Because I’d had this experience with parishioners, I didn’t feel that sense of rush that one normally feels at the time of death,” Patrick said. “My father died at 2 am, and we didn’t call the funeral home until that morning. We sat around his bed, we opened a bottle of champagne, we toasted him, we remembered him, we celebrated him.” This private family time, Patrick agreed, was invaluable.

So, readers, when you’re sitting around the Thanksgiving table later this week, why not raise some of these important issues with your family? How do you want to die? And how would you envision caring for loved ones after death?

Public Health Alert: One In 10 High Schoolers Hurt By Dates With Slaps, Strikes

A new study by Boston public health researchers paints a bleak portrait of the dating scene among young people: One in 10 high schoolers say they’ve been hit or otherwise physically hurt by someone they dated in the past year.

The study, published in the Journal of School Violence, found that “9.3 percent of U.S. high school students have been ‘hit, slapped, or physically hurt on purpose’ by a boyfriend or girlfriend in the past year – an annual prevalence rate that has not changed significantly in the past 12 years.”

“Dating violence is a big deal. It’s one of the more serious public health problems that high school students are facing,” says Emily Rothman, the study’s lead author and an associate professor at Boston University School of Public Health. “But where it ranks in funding is not commensurate with how prevalent it is and how potentially harmful.”

Rothman says that several violence prevention programs have been shown to be effective, including one that trains middle and high school sports coaches to spend 15 minutes once a week at the end of practice talking to boys about healthy relationships with women and girls. Unfortunately, Rothman says, “too few schools have the support they need to implement these…programs.”

Here’s more from the BU news release:

HeatherKaiser/flickr

HeatherKaiser/flickr

Rothman and Ziming Xuan, faculty at Boston University, analyzed data from 100,901 students who participated in the national Youth Risk Behavior Surveillance System survey (YRBSS) for the years 1999-2011. They found that 9.3 percent of U.S. high school students have been “hit, slapped, or physically hurt on purpose” by a boyfriend or girlfriend in the past year – an annual prevalence rate that has not changed significantly in the past 12 years.

The experience of being hit, slapped or otherwise physically hurt was reported at nearly equivalent rates by males and females who participated in the survey. There was a statistically significant increased rate of dating-violence victimization among black (12.9 percent) and multiracial (12.2 percent) youth, as compared to whites and Asians (8 percent) or Hispanic youth (10.5 percent). The rate of dating violence victimization remained stable over the 1999-2011 period for both males and females, and for each racial subgroup, despite a number of efforts to curb dating violence in the last decade. Continue reading

Why To Exercise Today: Preserve Your Ears (You Heard That Right)

(Wikimedia Commons)

(Wikimedia Commons)

They just don’t stop coming — the far-flung body parts and systems that you can help by exercising. The latest: Your ears.

Brigham and Women’s Hospital researchers report in the American Journal of Medicine that in women, exercise is linked to a lower risk of hearing loss. (And on the flip side, obesity is linked to a higher rate.) From the Brigham press release:

Using data from 68,421 women in the Nurses’ Health Study II who were followed from 1989 to 2009, researchers analyzed information on BMI, waist circumference, physical activity, and self-reported hearing loss…Compared with women who were the least physically active, women who were the most physically active had a 17 percent lower risk of hearing loss. Walking, which was the most common form of physical activity reported among these women, was associated with lower risk; walking 2 hours per week or more was associated with a 15 percent lower risk of hearing loss, compared with walking less than one hour per week.

But wait just a minute, you may say; for me to exercise, I have to pipe loud music into my ears. Surely that negates any positive effect? I asked the study’s lead author, Dr. Sharon Curhan. She emailed:

Regarding your question about listening to music and using earbuds/headphones while working out–absolutely! What is important is that people learn how to listen to music safely. In order to avoid noise-induced hearing damage, both the “level” (volume) and “duration” of the noise exposure need to be considered. This means that the louder the music, the shorter the time of safe exposure. For example, if you want to listen to your music with earbuds for a long time (say 90 minutes/day or more), then set the volume at 60% volume or less. The longer you want to listen, the lower the volume should be. The headphone types may make a difference, too. Noise-canceling headphones or insert earphones may help reduce background noise so that the volume will not need to be turned as high. However, there are some situations when it is essential to be aware of background noise for safety reasons, such as running or biking on a busy road.

And in case you’re wondering how exercise might preserve hearing, I’d sum up the theories as “exercise makes your body healthier, including your ears.” The paper offers some possible mechanisms: Continue reading

DIY Death: Natural, At-Home Funerals And Their Boomer Appeal

WELLFLEET, Mass. — When 20-month-old Adelaida Kay Van Meter died of a rare genetic disease last winter, her father, Murro, gently carried her body out of the house to his wood shop in the pines near Gull Pond. He placed her in a small cedar box and surrounded her with ice packs. For three days, the little girl’s grieving parents were able to visit her and kiss her and hug her. Then, on the third day, after the medical examiner came to sign the last bit of paperwork, Van Meter and his wife, Sophia Fox, said good-bye to their baby, screwed the lid on the box and drove to a Plymouth, Mass. crematorium, where they watched the little coffin enter the furnace.

“We took care of Adelaida when she was an infant, we took care of her when she was healthy, we advocated for her in the hospital, we took care of her when she was sick,” her father said. “Why wouldn’t we take care of her when she was dead?” Sophia Fox added: “There was no way I was going to hand her over to some stranger at a funeral parlor where she’d be put in a refrigerator with a bunch of other dead bodies. This way was so much more natural. We saw the life leave her body and we were better able to let go.”

Death remains a topic that many of us would rather avoid. And when it comes to the actual nuts and bolts of caring for the dead, most of us tend to think it’s best — and furthermore, required by law — to let professional funeral arrangers handle the arrangements.

Well, it turns out that in most states it’s perfectly legal to care for your own dead. And, with new momentum to shatter longstanding taboos and stop tip-toeing around death — from “death with dignity” measures sweeping the country to projects promoting kitchen table “conversations” about our deepest end-of-life wishes — a re-energized DIY death movement is emerging.

This “personal funeral” or “home death care” movement involves reclaiming various aspects of death: for instance, keeping the dead body at home for some time rather than having it whisked it away; rejecting embalming and other environmentally questionable measures to prettify the dead; personally transporting a loved one’s corpse to a cemetery; and even, in some cases, home burials. Families are learning to navigate these delicate tasks with help from a growing cadre of “death midwives” “doulas” or “home death guides.”

When Adelaida Van Meter died last winter, her parents decided to keep her body at home for several days to say good-bye.

(Courtesy Murro Van Meter)

The DIY death movement is loosely knit, and motivations vary, ranging from environmental concerns to religious or financial considerations. (Traditional funerals can cost around $10,000 or more; when you do-it-yourself, the cost can be reduced into the hundreds, experts says.) Each case is fiercely personal — there’s no playbook — but they all share a very intimate sense that death should unfold as a family matter, not as a moment to relinquish loved ones to a paid stranger or parlor.

This Is Legal?

The highly personal nature of home funerals appealed to Janet Baczuk, 58, of Sandwich, Mass. So, when her 93-year-old father, Stephen, died in September, 2011, she said, “I thought, I’d like to do that for my dad.” “It’s more humane, more natural…and more environmentally sound.”

Baczuk and her sister washed their father’s dead body using essential oils, and got a permit to drive the corpse to the cemetery in their (covered) pickup truck. A World War II veteran, Stephen Baczuk was buried at Massachusetts National Cemetery in Bourne, where officials allowed his simple pine and cherry casket to be placed directly on the ground, covered by an inverted concrete vault with no lid, “like a butter dish,” Baczuk said. When her mother died back in 2006, Baczuk said, she had no inkling that home funerals were an option — but wishes she did. “I didn’t know it could be done,” she said. “I think a lot of lay people don’t know this is legal or possible.”

She’s right.

“When it comes to death, it doesn’t matter where you are on the scale of education or socioeconomics, many people are shocked to find that it’s legal to care for your own dead at home,” says Josh Slocum, Executive Director of the Funeral Consumers Alliance, a Burlington, Vermont, nonprofit that works on all aspects of funeral education, from helping consumers reduce costs to advocating on DIY methods. “And I think this speaks to how distant death has become for us in just over a century. In the late 1800s, even turn of the century, caring for the dead was as prosaic and ordinary as taking care of the children or milking the farm animals.”

Slocum offers this analogy: If a woman wants to run a restaurant, she needs approval from the health department and officials, of course, would be permitted to inspect her kitchen. But the health department would have no jurisdiction over the same woman’s own kitchen at home. “They cannot come in and tell her that her refrigerator is subpar, and they have no authority to tell her she is not allowed to cook dinner for her kids. They can’t compel her to order dinner from a commercial, licensed restaurant,” Slocum says. “The same holds with state funeral regulatory boards. Their job is to ensure public welfare and protect paying consumers. Bizarrely, however, many think their jurisdiction extends to telling families they must pay an unwanted third party funeral home to do something the family could do for themselves.”

Kyle Gamboa, 1995-2013 (Courtesy Kymberlyrenee Gamboa)

Kyle Gamboa, 1995-2013 (Courtesy Kymberlyrenee Gamboa)

What characterizes the DIY death experience is that it’s so very personal.  Consider these vastly different snapshots:

• In northern California, Kimberlyrenee Gamboa’s son Kyle committed suicide by jumping off the Golden Gate Bridge in September, three weeks into his senior year in high school. A seemingly happy 18-year-old with lots of friends and into competitive lasertag, Kyle’s death was such a shock, his mother said, she doesn’t know how she’d have managed it through a typical funeral. Instead, with help from her church and and home death guide, Heidi Boucher, Kyle’s body was returned to the family home one day after his death. Boucher washed Kyle and helped arrange the body on dry ice changed every 24 hours; she gathered information to fill out Kyle’s death certificate and managed all coordination with the mortuary. For three full days, Kyle’s body lay in the family living room in an open casket, not embalmed. During that time, day and night, surrounded by pictures and candles and flowers, all of his friends and family could say good-bye and remember his short life. For Kyle’s mother, that time was critical to her healing. Continue reading

Berwick Platform: ‘Seriously’ Explore Single Payer, Review Cost Control

Dr. Donald Berwick (Jesse Costa/WBUR)

Dr. Donald Berwick (Jesse Costa/WBUR)

Granted, a candidate releasing his platform on health care for a race that’s a full year away might not strike you as big breaking news. But what if that candidate is one of the country’s leading health policy thinkers? And what if he’s stepping right into territory that proved highly contentious on the federal level?

That candidate is Dr. Donald Berwick, former chief of Medicare in the Obama administration, and that territory is the idea of a “single-payer” system — a sort of “Medicare for all” that’s common in other developed countries but that faces some strong opposition in the United States. (On the national political scene, Berwick took some major flak from opponents for expressing enthusiasm for Great Britain’s National Health Service.)

Berwick released his official health care platform for Massachusetts this morning, and it includes these two points — Chapter 224 refers to the state’s latest health reform, aimed at controlling costs:

As Governor:

On day one, I will convene a summit of all stakeholders to conduct a top to bottom review of Chapter 224 and develop an action plan to ensure it meets Triple Aim goals of better care, better health, and lower cost. If Chapter 224 results lag behind, within my first 100 days I will work with the Legislature to craft a new wave of stronger legislation to incentivize increased transparency, payment changes, and care reorganization.

It is time to explore seriously the possibility of a single payer system in Massachusetts. The complexity of our health care payment system adds costs, uncertainties, and hassles for everyone – patients, families, clinicians, and employers. I will work with the Legislature assemble a multi-stakeholder Single Payer Advisory Panel to investigate and report back within one year on whether and how Massachusetts should consider a single payer option.

Readers, reactions? Let’s note that neighboring Vermont is already pursuing a statewide single-payer system, so the idea is not all that revolutionary around here. But Massachusetts is a very different state, where health care dominates the economy to a far greater extent than in Vermont. Will the idea fly here? Does it make you more or less likely to vote for him in that distant election? Does it mean that at the very least, the pros and cons of a single-payer system will figure in campaign debates?

Berwick’s full health care platform is here. A couple of other points worth highlighting: Continue reading

The Great Healthcare.gov Mistake: Having An ‘Older Accountant’ Create It

President Barack Obama speaks about his signature health care law, Thursday, Nov. 14, (AP)

President Barack Obama speaks about his signature health care law, Thursday, Nov. 14. (AP)

By Michael Doonan
Guest contributor

The Center for Medicare and Medicaid Services is the behemoth federal agency that, despite limited resources, does a pretty good job of carrying out its core mission: running programs that provide health insurance for older and poorer Americans.

Expecting that this agency can also run the federal health insurance exchanges for Obamacare, however, sets it up for trouble right from the start.

The failure to locate accountability in the appropriate hands helps explain the Website debacle and anemic early enrollment, if not the president’s early miscue that everyone would be able to keep their current health insurance.

CMS simply does not know how to regulate health insurance for individuals and small business at the state level. Case in point: The agency’s previous troubles implementing insurance reforms that were part of the Health Insurance Portability and Accountability Act of 1997 (HIPAA), which, among other things, stipulated that the federal government would step in if a state was non-compliant.

Michael Doonan (Photo: Mike Lovett)

Michael Doonan (Photo: Mike Lovett)

This was like telling your kids to clean their rooms or else you will do it for them — and in the end, national regulations turned out to be weak and ineffectual.

Turned out CMS didn’t know much about the range of health plans and insurance products in certain states. Federal officials were more scared of taking over state regulation than the states. As a result, they begged the states to comply and bent over backwards in the regulations to find any state “effort” acceptable.

With the roll out of the federally mandated health exchanges, it is déjà vu all over again. Continue reading

Study: Insomnia Linked To Heart Disease Deaths In Men

New research says anti-anxiety and insomnia drugs can increase the risk of death

As if it weren’t bad enough that insomnia in and of itself can be torture. New research just out in the journal Circulation suggests that insomnia may increase a man’s chances of dying from heart disease — though just modestly.

The study adds yet another incentive for the estimated one-third of Americans who suffer from insomnia to work on sleeping better. It comes on the heels of other findings that curing your insomnia could double your chances of recovery from depression.

From the Brigham and Women’s Hospital press release on the Circulation study:

“Insomnia is a common health issue, particularly in older adults, but the link between this common sleep disorder and its impact on the risk of death has been unclear,” said Yanping Li, PhD, a research fellow in the Channing Division of Network Medicine at BWH and lead author of the paper. “Our research shows that among men who experience specific symptoms of insomnia, there is a modest increase risk in death from cardiovascular-related issues.”

Specifically, researchers report that difficulty falling sleep and non-restorative sleep were both associated with a higher risk of mortality, particularly mortality related to cardiovascular disease.

Researchers followed more than 23,000 men in the Health Professionals Follow-Up Study who self-reported insomnia symptoms for a period of six years. Beginning in 2004 through 2010, researchers documented 2025 deaths using information from government and family sources. After adjusting for lifestyle factors, age and other chronic conditions, researchers found that men who reported difficulty initiating sleep and non-restorative sleep had a 55 percent and 32 percent increased risk of CVD-related mortality over the six year follow up, respectively, when compared to men who did not report these insomnia-related symptoms.

Doing The Statin Math: What The Loud Debate Could Mean For You

Dr. Vikas Saini

Dr. Vikas Saini

It’s disconcerting when medical authorities get into a pissing match over potentially life-and-death issues — as they have, very publicly, in the last few days over new guidelines for prescribing cholesterol-lowering statin drugs.

The new guidelines could result in millions more people taking statins. Some see statins as such wonder drugs that they recommend just putting them into the public water supply, or doling them out to just about everyone over 50,  but statins can also have very real side effects. The ping-ponging medical opinions in the new recommendations and resulting backlash are likely to leave many confused — me included. So I turned to an authoritative source: Dr. Vikas Saini, president of the Lown Institute, a cardiovascular specialist and a reasoned opponent of over-treatment. Our conversation, lightly edited:

So what are we, the public, to make of this great big loud debate over statins and the new risk calculator?

Firstly, for those with coronary disease or other vascular disease, statins are an essential medication in a program of prevention. Nothing has changed here.

Also, the controversial new risk calculator applies to people who don’t have heart disease and are not at immediate high risk — millions of people — so there is no rush to change our practice today until we are clear on this issue of the right calculator.

To start, I’d like to quote Dr. David Newman of the Mt. Sinai School of Medicine, who has done some calculations: “We need to tell patients the actual numbers. For patients without diabetes or a prior heart attack or stroke who are treated with statins for five years, 98% will see no benefit; 1.6% will be spared a heart attack and 0.4% a stroke — and, importantly, there will be no difference in overall mortality. At the same time, 2% of individuals treated with statins will develop diabetes and 10% will have muscle damage.”

Those numbers, he says, are aggregate numbers from large studies, and, most importantly, assume that “duration of therapy is 5 years, age is about 60, and comorbidities and baseline risks are relatively high.” For lower-risk patients the numbers will be even more unfavorable for statin use.

Aside from risk calculations, what is new in the new guidelines is the general idea that we should treat overall risk, and not target a hard number of the LDL (bad) cholesterol. This is generally a good idea.

Even here, however, there are some problems with the guidelines, in my opinion — particularly for women.

The guidelines basically have four risk groups. There’s very little debate around two of them: people with cardiovascular disease and people with diabetes. Another group is if your LDL (bad) cholesterol is greater than 190 — and if you look at the way it’s laid out, if your LDL is higher than 190, you should be on a statin.

The issue here is that if that’s the only number that’s wrong with you, and you’re a woman and your HDL (good) cholesterol is 80 or 90 — very high and probably protective — these guidelines seem to say you should go on a statin, and yet the evidence that your group would benefit from a statin is practically non-existent. Continue reading

Why To Exercise Today: ‘Fit Is The New Rich’

(Wikimedia Commons)

(Wikimedia Commons)


Let’s not get into the dark motivations of those who hate and harass runners that Kevin Helliker writes about in the Wall Street Journal. That’s depressing. Let’s focus instead on the fact that if you’re fit, you may become the object of envy, as rich people do (only, I’d like to note, it will be envy you’ve earned rather than inherited.) Helliker writes:

The enormous popularity of Stafko’s essay confirms a long-standing sense I’ve had that many Americans are annoyed by public displays of fitness. I’ve never owned an expensive car or million-dollar home. But fitness-induced annoyance strikes me as similar to the resentment that symbols of wealth can provoke. In a nation grown fat, fit is the new rich. Among fitness have-nots, there’s a simmering distaste for runner smugness, perhaps even a desire to see runners trip and fall.

Such pettiness isn’t beneath me. When a woman ahead of me in an airline queue recently contorted herself into a yoga pretzel, I found myself hoping she’d lose her balance, especially since I’m barely flexible enough to touch my toes.

(Hat-tip: Tom Anthony)

Dr. Tim Johnson’s ‘Truth About Obamacare:’ Is The Law Doomed?

Dr. Timothy Johnson, retired Medical Editor for ABC News, in the WBUR studios. (Jesse Costa/WBUR)

Dr. Timothy Johnson, retired Medical Editor for ABC News, in the WBUR studios. (Jesse Costa/WBUR)

“Tumultuous,” is how Dr. Timothy Johnson describes the recent roll-out of Obamacare in his latest podcast. (Click on the “play” arrow above right to listen.) And that’s not nearly strong enough, he adds. “Many people are saying Obamacare is doomed,” in the wake of all the current Website and insurance problems, he says.

Is it? Dr. Johnson, retired medical editor for ABC News and author of ”The Truth About Getting Sick in America,” discusses the outlook with his regular podcast guests: John McDonough, a professor at the Harvard School of Public Health; Dr. Gail Wilensky, a health official under the first President Bush and Larry Levitt, a senior vice president at the Kaiser Family Foundation.

The first answer to the “Is it doomed?” question comes from McDonough, who offers a clear “no.”

“I’m just dumbfounded by the media’s unbelievable hyperventilation about every small detail and the implications it has for the law as a whole and Obama’s presidency and the fate of the republic,” he says. “This is on track to open up affordable coverage for tens of millions of Americans starting Jan. 1. Once we get past Jan 1, i don’t believe there’s any retreat…and I think we will get through this difficult patch.”

Wilensky agrees that the law is not doomed, but adds:

“There is a problem, and it’s not just that people are having great difficulty accessing the Website, some of whom are at risk of losing their individually purchased insurance by the end of the December….The most serious issue is that there has been a real loss in trust in the president, and that is way more of an issue than the hiccups that have gone on with regard to the Website. When people don’t feel like they can trust what their president says, it has ramifications far greater than the Affordable Care Act. And wait until people discover the second part of the president’s pledge — ‘And if you like your doctor you can keep your doctor’ — isn’t true either, not for a lot of people. That’s the next shoe that’s going to fall.”

Listen to the full podcast above, and check out Dr. Johnson’s previous Obamacare podcasts here, here and here.