How Ann Arbor's death-positive community is rethinking the way we die

This Friday, 20 participants will gather for an all-day doula training workshop at Ann Arbor's Center for the Childbearing Year. What makes this event different from the center's previous trainings — and from nearly all doula trainings anywhere, for that matter — is rather than learning to assist families during pregnancy and childbirth, participants will learn to be end-of-life doulas.
That's right. Instead of helping new lives enter the world, end-of-life doulas help people transition out of it in a more natural way. Or they will, at least, after they're trained. Currently, end-of-life doulas are a new and rare breed. Organizers Merilynne Rush, a natural death care educator, and Patty Brennan, a birth and postpartum doula trainer and founder of two community-based doula programs, hope Michigan's first end-of-life doula training will start to change that.
"There's always going to be the loss. There's nothing we can do about that," Brennan says. "But we can ease people through that and do it in a way that they're able to process some of it as they're experiencing it."
The Death-Positive Movement
Friday's sold-out training event is part of an international "death-positive" movement that seeks to change society's relationship with death and encourage more natural, in-home deaths with families and loved ones at the helm, rather than funeral directors and morticians.
Some have credited the Order of the Good Death, an L.A.-based organization founded in 2011 with a hipster bent, with beginning the death-positive movement. The group seeks to bring death and dying into the mainstream. But the International End of Life Doula Association was started in 2003, establishing perhaps the earliest iteration of the concept.
Brennan and Rush are associated with neither organization, but Rush has been involved with the death-positive movement in general for some time. The former home-birth midwife is the founder of After Death Home Care, a resource for individuals and families to prepare for death, in-home care after death, and green burials. She's also the facilitator of Ann Arbor's monthly Death Cafe, hosted at Crazy Wisdom Bookstore and Tea Room, where participants meet to discuss their mortality, preparing for their own death, and how to speak to their loved ones about their death plans. While Death Cafes are held from Australia to Chile to Spain, Rush says Ann Arbor's is the longest running in the world, having started in 2012.
"It's very uplifting. It's very real," Rush says of the monthly conversation. "When I face my own mortality, it helps me to live more fully."
Rush began developing a critical perspective on the traditional way of dealing with death in her 30s, when her grandfather died. She was with him until a few hours before his death, but she didn't see him again until he was embalmed.
"There was this weird disconnect," she says. "What I wanted to see when I saw my grandfather in the casket was how he'd looked when I'd last seen him. Old, wrinkly, kind of pale … to remind myself that he died. What I saw was this wax figure."
When Rush's aunt died a few years later, Rush was able to see her aunt's body in death.

"She looked like someone who had just transitioned, but it wasn't scary. It wasn't strange. It was just the next thing," Rush says. "It helped me viscerally to take in, through all my senses, that she was no longer with us, rather than this disconnect and disbelief."
Now Rush is dedicated to helping families have that natural grieving experience by caring for the bodies of their loved ones in their homes after death, including washing, cooling, and dressing the bodies, as well as keeping vigil and receiving visitors.
"When I first started reading about the home death movement, I thought, 'That's just what I want for myself and for my family,'" she says. "It had never entered my mind that you could care for your loved one at home."
A Doula Is a Doula
Rush and Brennan aim for their doula training to help give more people a chance to have more natural, in-home deaths. And though the idea of a doula, traditionally associated only with birth assistance, might seem like an odd choice to help deliver that care, Brennan says a large number of doulas eventually move to hospice or other end-of-life care when they're ready to retire from the demands of on-call birth work.
"It's kind of a natural transition," she says. "It involves this patient waiting and observing and trying to find in any way you can to ease that person through what is sometimes a struggle. It's amazingly similar."
Brennan counts herself and Rush among the older generation of those in the doula movement who have become interested in end-of-life care. The two longtime friends got to talking about the idea of training end-of-life doulas on their regular walks.
"We just cooked up the idea together," Brennan says.
The two created a custom end-of-life doula curriculum that Brennan feels fits more closely with the long-existing doula model of care than other end-of-life doula training programs do. They included a defined scope of practice, as well as ethical standards, like not giving medical advice, engaging in clinical care, or participating in assisted suicide.
As the goal of in-home care after death is for the family to care for the body, doulas would take on other work, offering the family respite, organizing support systems for the family, providing education and support, and otherwise addressing each family's unique needs.
"It's not usurping the role of the hospice workers or family members, but adding an extra layer of support and education and resources," Rush says.
While Friday's end-of-life doula training is sold out (with a wait list), there are more opportunities for those in the Ann Arbor area to learn more about the death-positive movement. Rush and Brennan will also be hosting a home funeral workshop on Sunday, and the Death Cafe meets monthly on Saturday mornings. Rush says the tenor of the conversation — and of the death-positive movement in general — is rarely what people expect.
"When you're no longer in denial that you're going to die one day, every day is a gift," she says. "It's not morbid. It's not depressing. You experience everything more deeply."

Natalie Burg is a senior writer at Concentrate.

All photos by Doug Coombe.
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