We need to rethink how we manage deathcare

Death is a phenomenon like no other. It touches all dimensions of human experience, as a biological process and as an event of profound cultural, spiritual, economic, legal, and social significance.

Despite this, we lack a comprehensive system for dealing with death that respects people’s wishes and dignity, that is sustainable from both environmental and financial perspectives, and that responds to diverse and changing needs and values in our society.

And this is a serious problem because as baby boomers age, Australia will enter a period of “peak death” and the need for creative, effective and lasting solutions is now urgent.

Death pressure

Since 1950, Australia’s population has tripled, but so far deaths haven’t kept pace as advances in medicine, nutrition and care have kept people alive for longer. This has led to a fifteen-fold increase in the proportion of society made up of the “oldest old” – people aged 85 years or more.

By 2042 ABS forecasts that the number of Australians aged 85 or over will have doubled from 2017 to over a million people. The pressures involved in caring for members of our ageing population before and after death are only set to intensify.

Additionally, in the last two years, we have seen our deathcare services and industries seriously challenged by the COVID-19 pandemic, and without radical intervention, they will be increasingly unable to provide a “good death” for Australians.

Deathcare services include a wide range of actors, from palliative care and nursing home staff to funeral and cemetery workers, chaplains, grief counsellors, and lawyers to handle wills and probate. The ways we currently handle dying, death and grief all too often result in dissatisfaction and distress, from strained last goodbyes and unsatisfying funeral services to crippling financial burdens from funeral debts.

There are also troubling inequalities in who can access high-quality care and support at the end of life and in bereavement.

The urban squeeze (for the dead)

A comprehensive survey from 2020 in Sydney shows that there are virtually no available burial plots in cemeteries close to the communities that most people live in, identify with, and want to remain in after death.

Where plots are still available, they are prohibitively expensive for most people. A crypt for two in the Melbourne General Cemetery can cost as much as $A94,000 and a single gravesite costs more than $A50,000.

We often talk about investing in the built environment for “life”, but we rarely consider the development of urban spaces for the dead, who are always still among us – albeit in different sites and forms. The sidelining of the dead and their remains have the potential to compound grief and loss, and to fracture social practices of memorialisation, visitation and commemoration.

For example, while new cemeteries are being planned and constructed, they are increasingly placed on the outer fringes of major cities. This means families and communities can be disconnected from their dead because it becomes too hard to commute to these distant places of burial.

Compounding these problems are issues with the governance of cemeteries, like in New South Wales where religious and secular cemetery authorities are in dispute. Cemetery governance across Australia is characterised by confusion and inconsistent regulation over grave tenure and crematory and cemetery ownership.

Deadly disadvantage

For those marginalised in life, death often adds insult to injury. “Destitute funerals” typically result in cremation, but otherwise can involve interring two, three, or more dead bodies together in common graves, their names unmarked.

Cultural and religious practices also aren’t always properly catered for. While dying on Country is important for many Indigenous communities, community members who die elsewhere aren’t routinely repatriated.

Religious minorities don’t always have ready access to the rites their cultures demand, particularly in rural and regional locations. Such rituals include witnessed cremation for Hindus and Buddhists, and rapid burial for Muslims and Jews.

Home for the dead?

Modern western burial and cremation practices have serious environmental impacts. Their outputs contribute to global warming; the depletion of the ozone layer; human, aquatic and terrestrial toxicity; the acidification of soil; and land competition. There is growing public concern about the unsustainable nature of body disposal methods, and funeral industry innovators are responding with new methods to reduce environmental impacts.

However, few of Australia’s established cemeteries and crematoria are playing their part in considering and adopting eco-friendly alternatives to burial and cremation, at a time when the public needs alternatives and wants to care for the environment.

It is time to care for, and effectively regulate, death

So, what should we do? First, we need to recognise that death is both a systemic social issue and a continuous responsibility, not a momentary issue to neglect until brought to the fore by a pandemic or other crisis.

Policy and governance for the deathcare sector need to be directly and cohesively refigured. This refiguring would include establishing a Commissioner for Death in this country, and an agency to oversee the quality of death care that goes beyond end of life care.

Transforming death care in Australia requires multifaceted policy development and implementation, with significant and ongoing investment in deathcare integration that builds and innovates.

We also need a new social infrastructure that encourages society to talk and think more openly about death rather than sidelining or hiding it.

Finally, calls for change must be underpinned by a robust evidence base.

We need to start now, before the next crisis, to build a new system for death care that is sustainable, respectful and responsive to diverse community needs, with benefit to all.

The researchers include members of the DeathTech Research Team based at the University of Melbourne, funded by Australian Research Council grants DP18010314 and LP180100757.

The DeathTech Research Team is hosting the Redesigning Deathcare Conference, online and in person at the University of Melbourne, 27-29th October 2022 (EOIs open now). The Conference aims to bridge the divide between research and practice at the end of life and death, through dynamic conversations about how to meet the challenges facing our future deathcare system.

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