The Good Death: Making the Final Transition a Positive Experience for All


Liza McClure and Jennifer Hamilton of Thresholding in Fairfield.

Death. Okay, how many of you are still reading? “Our culture has an aversion to death,” says Jennifer Hamilton, RN. “Death in our culture is almost always portrayed as a terrible loss.” For the past 13 years, Hamilton has attended to the needs of the dying and their families. She calls herself a death midwife.

Back up for a second—a death midwife? Yes. Just as there are those who can guide us through the process of coming into the world, there are those who can guide us through the process of leaving it.

More Than Hospice

In the Fairfield area, people know to ask Jennifer Hamilton and Liza McClure (LPN) to midwife their deaths, a service they call Thresholding. They do what hospice services often can’t—hold vigil with the dying person for hours, even days. In that time, they can help prepare the dying person and their loved ones for what is to come.

“The dying often want to reach out to those they love and want the ones they love to be there,” says Hamilton. But that same love, she says, can make people dread the coming separation, paralyzing them with a crippling fear of death.

Often whole families will avoid the topic until a death is happening. Many, according to Hamilton, will deny death even as it is occurring. This can make for intense situations as people try to avoid separation and grief.

“Grief is natural,” says Hamilton. “Grief is good.” Even when the living have had vivid, beautiful experiences with the passing of a loved one, she says, those people will grieve. “Each in their own way, but they will grieve. Grief shows that someone was loved. Then life goes on, changed forever, but it goes on, just as the departed loved one would wish that it would.”

In fact, because of the intense emotions that come up during the dying process, one of a death midwife’s most important duties is to be the strong, unaffected anchor when everyone else in the room is overcome with emotion.

“There was one situation where a young girl was so upset while her grandmother was dying that the family planned to tell her that the grandmother had not died but  moved to Florida,” remembers Hamilton. But as Hamilton spent time with the family, learning more about them and becoming part of their situation, she was able to find a natural opening to talk about dying, and the family was able to tell the daughter the truth.

The Wisdom of Being Prepared

While death certainly is about loss, there is much more to it than that—much that is often missed, especially if you haven’t planned in advance.

“If you are not prepared,” Hamilton says, “then dying becomes confusion for the living.” Arguments can break out over things that should have been decided beforehand. Hamilton reports hearing heated discussions on the order of “She would want to be cremated”—“Oh no, she wouldn’t.” “She would want Christian rites”—“No, she told me that she didn’t.”  She speaks from the experience of attending more than 150 “transitions,” as she calls them. In such contentious situations, “the last moments of someone’s life can be filled with fighting. It can be awful.”

Worst of all, in the confusion, “the transformational and revelatory” aspects of the dying experience can be obscured or totally missed, she says.

But those who make plans in advance open themselves to an entirely different experience. According to Hamilton, those who “clean the room, make it beautiful, make the dying person comfortable, and make sure that everyone takes the chance to say what they need to say” consistently experience “the joy that the person is feeling” once they have left their body behind.

The Five Wishes

One way to prepare for your own death is to answer these questions, called the Five Wishes. They were developed by Jim Towey while working in a Washington, DC, hospice run by Mother Teresa. This process is not only an elegant way to address the issues of dying, but it also pretty much covers legal requirements in Iowa and 42 other states.

1. Who is the person I want to make care decisions for me when I can’t?
2. What kind of medical treatment do I want (and not want)?
3. How comfortable do I want to be?
4. How do I want people to treat me?
5. What do I want my loved ones to know?

The Death Café

Of course, these wishes only scratch the surface on the topic of death. Those who want to talk clearly and openly about all aspects of death can attend a discussion group called the Death Café, either online or in person. It’s not a grief support or counseling session but a non-profit group whose objective is “to increase awareness of death with a view to helping people make the most of their (finite) lives.”

Considering that every one of us faces this big moment in life, and considering all the different ways that people think about death, there’s a lot to discuss. Thresholding plans to hold a Death Cafe on Saturday, February 22, 2:00-4:00 p.m. at Revelations Bookstore and Café in Fairfield. Everyone is invited to attend, but advance registration is required.

Changing Ideas About Death

Currently, ideas about death run the gamut, but according to Hamilton and McClure, they often rise out of our culture’s attempts to separate us from death, which leads to our lack of experience with it. Even a brief history of death shows that humans have thought very differently about death at different times.

The Egyptians left instructions on how to navigate the world of the dead written on the walls of their tombs and perfected the art of embalming, so that the dead would have a body to use after death.

Hamilton credits Queen Victoria of England, mourning the death of her beloved Prince Albert, with creating a tradition of long and elaborate grieving. “In Victoria’s time,” Hamilton says, “no one would talk about sex, and everyone would talk about death. In our time, everyone will talk about sex and no one will talk about death.”

The Civil War became a turning point in America’s cultural response to dying, disrupting the previous culture of “the good death”—which was death at home surrounded by loved ones, the natural result of a good life. After half of the 750,000 war casualties died anonymously on the battlefield, people began to dread disappearing off the face of the earth unknown, and soon to dread death itself.

Our ideas about death may be changing again as aging baby boomers have brought the issue to the fore. With boomers’ parents even farther down the road, a very big part of the American public is encountering death.

“It’s already happening,” says California hospice social worker Deb MacQueen. “And it’s what is going to be happening for the next 15 to 20 years.” With so many people dying and dealing with death, it will be harder and harder to keep death a cultural secret.

Hamilton and McClure say they have encountered people who think of “death as a spiritual failure,” especially, they say, among those who are dying of cancer.  There are people who “fear judgment” after death, leading them to cling onto life.  There are those who think that “planning for death will cause it,” which makes it all but certain that there will be confusion at the end.

And, according to Hamilton and McClure, one of the most common ideas about death they’ve run into is “taking it personally.” Hamilton describes this as thinking that death is some rare event that is being done to them, that could be somehow avoided.

Death happens to everyone. You and I are not being singled out. This is something that we all share.