Today in this first part of a three-part interview, SevenPonds speaks with Pashta MaryMoon, Death Midwife at Journeys Beyond, and co-founder of CINDEA (Canadian Integrated Network of Death Education and Alternatives). Pashta lives and works in Victoria, BC, Canada.
Juniper: What is a Death Midwife? What services does a Death Midwife offer?
Pashta: In North America, the term “Death Midwife” is often used rather loosely to refer to anyone involved in alternative dying work. I use it as a very specific term that identifies someone who can provide a continuum of services across most of the seven stages of the pan-death process. There are many parallels to Birth Midwifery — home-based, active/hands-on involvement of the family, the basic philosophy, and especially in terms of having a trust-based relationship that spans the time of the whole birth or death journey. A Death Midwife, for example, may or may not be involved in advance care planning, but they would definitely be available as soon as someone knows they are moving toward death, whether that be receiving a terminal diagnosis, or being told they have a life-limiting illness. Throughout that whole process, all the things that that person may want to do in their remaining time can be planned with a Death Midwife’s help, right through to the active dying stage. A Death Midwife can also facilitate a home funeral, if that’s the family’s choice, as well as a ceremony around internment or spreading of ashes, grief support, and ceremony to mark the one year anniversary following a death. So, I only use this term “Death Midwife” for someone whose practice encompasses this broad spectrum approach and offers their services throughout its entirety.
Juniper: You’re the co-founder of CINDEA: the Canadian Integrative Network of Death Education and Alternatives. What is the purpose of CINDEA?
Pashta: CINDEA is a non-profit organization born from my own research as I began investigating Death Midwifery. As I was collecting resources for my own practice in British Columbia, I often came across useful ones for other provinces as well; and kept track of them, being sure that eventually someone would need them. When CINDEA was later created, one of its major projects was to fill out those resources for each province/territory and make them available through the website. Over the years, CINDEA has cultivated a network that includes the Slow Medicine movement, the Right to Die movement and the National Home Funeral Alliance in the States. It also includes some resources in the UK and Australia, in recognition that we live in a global community and have family (blood-relations and chosen family, including close friends and spiritual community) all over the world.
CINDEA realizes that it will be at least a decade before Death Midwives or related support services are available, even in most urban centres across Canada. So, CINDEA supports people in several ways: for those who are interested in practicing Death Midwifery, it directs them to training resources that are accessible to Canadians; for those interested in caring for their own, it provides simple, practical advice and information necessary to do that – from filling out and filing paperwork to preparing a body for a home funeral. People accessing CINDEA for the latter purpose will likely be working with a palliative care team, and may need a grief counsellor or other professional aid afterward, but at least they will have the ability to do a home funeral on their own. CINDEA also has a strong commitment to ecologically responsible practices. There’s a lot of information about green burial, including up-to-date news on the availability of aquamation (alkaline hydrolysis), the use of shrouds and ‘green’ caskets. We are working towards a Canadian company to produce 100 percent recycled cardboard caskets.
Juniper: What is the Slow Medicine movement?
Pashta: It’s an approach that sees certain kinds and quantities of medical intervention at the end of life as unnecessary in the sense that they do not support quality of living or quality of dying. So, that would include decisions like having fewer surgeries to prolong life, foregoing palliative chemotherapy and reducing the number of medications taken. When an individual is taking more than four or five medications at a time, then more medication is needed to treat the side effects of those initial prescriptions, which puts undue stress on an already frail body.
Slow Medicine also focuses on making the hospice and palliative care environment more humane, which includes training doctors in end-of-life issues (right now they get only an hour of training in their curriculum). We are fortunate that within the last five years or so, we have seen a progressively rich body of articles and books produced by doctors and palliative care professionals about why they are pulling back from the med-tech default approach, which is to apply all treatment options possible. Currently, it’s felt that if someone dies, it’s a failure of the medical industry, not a natural conclusion of having lived.
The Facebook page for the Slow Medicine movement is run by a woman named Katy Butler, who wrote the bestselling book Knocking on Heaven’s Door, which recounts the story of her father’s final years suffering through dementia and physical pain as a result of having a pacemaker put in unnecessarily. Slow Medicine is about encouraging holistic approaches to wellness, but its main focus is on preventing unnecessary medical intervention like surgery and drugs, and making the whole end-of-life experience much more humane.
Juniper: Tell us about your personal journey to become a Death Midwife: your experiences, inspiration, teachers.
Pashta: When I was seven years old, I was watching TV when I wasn’t supposed to be. It was one of those stereotypical Cowboy-and-Indian movies from the ’50s. There was this pioneer family setting off into the West in a covered wagon – you know, a husband, wife and a couple of kids. They get attacked by a group of “Indians” and the husband gets killed. The wife has no other choice than to clean him up, dig a grave, put him in it, fill it in, get back in the wagon and carry on with the kids, because they were already in the middle of nowhere. I left that movie feeling like that’s the way it should happen.
Since then, in every decade of my life, something drew me back to death. In my thirties, I took a degree in World Religions and Jungian psychology, doing a lot of research into cultural attitudes toward death, particularly in the western world. During the same time, the AIDS crisis happened. I was involved in a lot of support groups for people who were dying of AIDS, caring for some of those people as they died, and then doing funerals and memorials for them. In the 1990s and 2000s, I spent several years working in prisons with “lifers” who go through a process very similar to the five stages of grief outlined by Elisabeth Kubler-Ross. Also in the 1990s, I was the very first non-Christian on the spiritual care team at my local hospital in Victoria. I spent a lot of time on the renal ward, where you know that about half the patients are going to die soon, because their kidneys are failing and dialysis has stopped working for them. In the 2000s, I started a Bedside Singing and training program with another woman in the hospice unit at that hospital. Afterwards, I began working privately using vocal music to support individuals with later stage dementia and/or who were actively dying.
One of my greatest teachers is Jerrigrace Lyons of Final Passages. When I connected with her in 2005, I realized that I already had experience in all of the pieces that are involved in being a Death Midwife, except for the actual practical part of a home funeral. Jerrigrace was very generous: I wasn’t able to travel to study with her, so she sent me lots of materials, as did other people, as I began sharing my process. Eventually it occurred to me that I had all seven stages of the pan-death continuum covered – I’d worked in counseling; I’d worked with grief; I’d worked with people before their death and I’d organized and led funerals and memorial services for a lot of people with very different cultural and religious backgrounds. In 2013, Jerrigrace was coming up to visit family in the Pacific Northwest, and she trained me in person while she was here. Ken Wilber’s work in the 1980s was also significant for me.
Juniper: Why is Death Midwifery important?
Pashta: The pan-death process is a difficult time for family. Even when a death is expected, it’s still a shock when it happens. There are two main ways that a Death Midwife can help. The first is to help navigate ideas around death, encompassing quality of living but also quality of dying. The medical community is still life-biased and talks about quality of life right up to the moment of death. They never talk about quality of dying, but to me it’s a balance of both. And then home funerals, they have a hands-on approach that is participatory and very helpful for family in their grief process.
I believe that there is a need for consistent support across the entire pan-death continuum, because the reality right now is that you get connected with hospice, and that’s great because they are very supportive, but those individuals don’t work 24/7 so there will be different nurses and home care people coming in who don’t know the personal history of the Death Journeyer and their family dynamics and personal preferences. Then, after death, the family needs to deal with funeral directors and other professionals who have no idea what they’ve just been through and who often do not have the same philosophy. There’s a big gap there. So there’s a real value in having a person like a Death Midwife accompany a family throughout the entire continuum. You might see them more after the death when they come in to organize a home funeral and do a memorial service, but they’ve been part of the story before the death, know what’s happened and what the death was like, what the dying was like, what the family baggage is. A Death Midwife is trained to recognize when the family is tapping into ideas that are really meaningful for them and how to cultivate that in such a way that is helpful to everyone. By guiding a home funeral, which has a very hands-on and participatory approach, the Death Midwife can support the further drawing-out of elements of personalized meaning, which itself tends to deepen the family’s grieving process.
Many of the pieces of the continuum are already offered by individual services, some of which are progressive and more humane, but they are often not linked in practice or in philosophy. Therefore, there is a benefit in having a single person to walk through the whole journey with you. A relationship with a Death Midwife is built on a foundation of trust, so that the family feels comfortable communicating what’s really going on and what is wanted. I think that that is really important. In the system that we have now, despite all our compassionate professionals, people still get abandoned because they haven’t had the chance to build a relationship with a care provider in which they can go to the depth they need to in order to have a meaningful death. This is what I mean by “quality of dying.” Some people in the North American alternative deathcare community claim that in about 20 years time people won’t need Death Midwives because there will be so much information accessible that they can just do everything themselves. However, death is a major life transition, and I believe that nobody should ever have to go through it by themselves unless they choose to.