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Cremation, Conflicts, and Directives

by Dawn Vogel

 Centenarian - how will end of life be lived?

Image of Centenarian*

More people live longer today than ever before. This is largely due to advances in medicine and in public health. Not only are people living longer, more people are staying healthier as they grow older. That is the good news. But how does this affect end-of-life care and associated issues?

The U.S. has the largest number of people aged 65 and over among the developed countries. According to a 2014 U.S. Census Bureau publication, Current Population Reports, “in 2050, the population aged 65 and over is projected to be 83.7 million, almost double its estimated population of 43.1 million in 2012.” With Americans living longer, concerns include:

  • More elderly are hospitalized or incapacitated at the end of life.
  • They have increased living costs for longer periods of time.
  • Their cognitive capacities are greatly reduced resulting in challenges when faced with end of life issues and decisions.
  • They have less financial resources that might enable them to die according to their preferences.
  • Decisions and unexpected situations create potential for conflict between family members.

Longevity doesn’t exempt anyone from dying and facing difficult issues. The emotional turmoil and material costs that accompany dying must still be considered. When someone you love is dying, you are faced with questions. Perhaps the issue of whether or not to provide artificial nutrition or a ventilator confronts you. Whether to choose a traditional burial versus cremation. Is a headstone or a native shrub appropriate to soften the memorial site? Are you faced with the decision whether a scattering urn or biodegradable urn is an appropriate choice to memorialize your loved one?

Continuum of choices concerning end of life 

The optimum time to be proactively informed about options concerning end of life is when we are healthy and alert. Fortunately, a growing number of resources are available. Practical suggestions, as well as emotional support around expected and unexpected end of life decisions can be obtained. 

At the beginning of the continuum of choices is a legal document called an advanced directive. It goes into effect only if you are incapacitated and unable to speak for yourself. The advanced directive informs others about the type of medical care you want and do not want. It can include your values and desires related to end of life care.

Conflicts around end of life 

Even with an advanced directive conflicts arise. In July 2015, Anderson Cooper of CBS reported a complex story that illustrates conflicts in spite of wishes being known. Barbara Mancini was prosecuted for allegedly helping her 93-year-old father kill himself by handing him a bottle of morphine. Her father was terminally ill and in pain. He made it very clear in writing that he did not want his life prolonged by artificial means. After taking an entire bottle of morphine, he was taken to the hospital, given a drug that reversed the effects of the morphine and kept him alive against his wishes. 

Sadly, Barbara’s father did not have his end-of-life wishes honored. The case, however, paved the way for others by bringing this controversial issue into the public eye.

Memorial choices: burial or cremation

On the other end of the continuum is the question of burial or cremation. Our planning guide “Working with a Funeral Home or Crematorium” points out what to expect from each service provider and the differences between the two. A traditional burial may be your preference, or that of a loved one. And, due to rising costs for traditional burials, you may be financially forced to go against your loved one’s wishes, and perhaps consider cremation. 

A 2015 Waikato Times article states that “interment costs for a single depth burial went up more than 120 per cent“ in the month of June in Australia. The article stated further that “this has forced some families to opt for cremation of dead relatives, even if it is against their religion.”

A growing number of people are choosing cremation or green burial, because it aligns with environmental or spiritual values. According to a recent announcement by the Cremation Association of North America (, nearly half of Americans now choose cremation, surpassing burials for the first time. Green burials, “which is a way of caring for the dead with minimal environmental impact,” have grown considerably in recent years.

To minimize potential conflicts with loved ones:

  • become informed about your memorial options
  • talk with family/friends about your wishes and make sure they understand
  • be proactive about legally getting your wishes in writing, and
  • make things as simple as possible for those left behind

Doing these few things will minimize stress and conflict, and allow you to express your deepest held values with regard to end of life.

*Image by St Kitts and Nevis Photo Stream:

Dawn Vogel is a photographer, video producer, writer and founder of Luminous Concepts Productions. After experiencing a few sequential deaths of friends and being introduced to a growing end of life movement, she became passionate about increasing public awareness and conversation about end of life and death & dying.