As we look at the complex issues related to death and dying, we see that who dies is complicated by cultural differences and inequality.

Like any other social problem, we see the presence of interdependent solutions to create more equity in this area.

10.5.1 POLST

10.15 POLST: When is the Right Time? [YouTube Video]. It describes one person’s experience with using an advanced directive and a POLST form.

 How might having this form filled out change the experience of death or dying for you or your loved ones?

The state of Oregon is once again an innovator. In the early 1990s, health care professionals and the state legislature created the POLST or Portable Orders for Life-Sustaining Treatment®. The POLST allows for patients to describe what measures they want doctors to use to sustain their life. These orders are really useful when patients are too sick to speak for themselves. The POLST form is in addition to an advanced directive, a legal document that states a person’s wishes about receiving medical care if that person is no longer able to make medical decisions because of a serious illness or injury. An advance directive may also give a person (such as a spouse, relative, or friend) the authority to make medical decisions for another person when that person can no longer make decisions. Unlike an advance directive, the POLST focuses on what a doctor can or cannot do for the patient, including providing CPR or assistance with breathing.

The POLST process is now widely used in all US states, although state regulations vary (National POLST, n.d.)

10.5.2 Green Burial

Figure 10.16 Die as You Lived: What is Green Burial? [YouTube Video] As you watch this 2.18 video that describes a green burial. How is this style of burial consistent with environmental values?

In Chapter 5 we looked at some of the ways that environmentalists are acting to heal the earth. These efforts don’t stop with living people. They continue until after death. Until the 1930s in the United States, most people died at home. Their loved ones took care of their body. They were buried in home or city cemeteries. After this time, however, many states required that trained morticians reported the deaths, embalmed the bodies, and buried them in cemeteries with caskets. Often these caskets were covered in cement, preventing the normal decay of the body.

This style of burial adds toxic chemicals to the environment, risking the health of funeral workers. It also contributes toxins to the cemeteries. As an alternative, eco-death activists agitate for green burials. A green burial is a way of caring for the dead with minimal environmental impact that aids in the conservation of natural resources, reduction of carbon emissions, protection of worker health, and the restoration and or preservation of habitat. Instead of embalming the body with toxic chemicals. If a body is buried without these chemicals, in a wooden box, the decomposing body can eventually nurture plants.