After many years as a social activist, writer and researcher on reproductive choice and the right to control one’s reproductive life, as I have gotten older (and with the death of both of my parents), I have found myself delving into control at the end of one’s life in our society. Or the lack of it. Like many countries, the United States does not make it easy for its citizens to have end-of-life choices. But that is another story.
My questions brought me to books like Doctor, Please Help Me Die by retired cardiologist, Tom Preston, which discusses how cultural and professional customs have led many doctors not to help their patients die when it’s time. I have also been drawn to books that tell candid end-of life stories, such as There at the End: Voices from the Final Exit Network. Of late I have been learning about a broader picture of the right to die with dignity for all people from all walks of life. The book, The Unclaimed: Abandonment and Hope in the City of Angels, by Pamela Prickett and Stefan Timmermans opened my eyes wide to the death and burial disparities in our society.
Not long after finishing The Unclaimed, I was contacted by Amy Shea, who has a new book, Too Poor to Die: The Hidden Realities of Dying in the Margins. I took it as a sign to go further into end-of-life realities for all.
Written as creative nonfiction, Shea pulls no punches in illustrating the “raw reality of poverty and homelessness in death” so that we can better understand the inequities and disparities, and inspire change. With heart and detail, she takes us on her journey of first-hand learning about the social and cultural problems associated with who is ‘deserving’ of dignity, close to death and once dead.
She begins with a visit to the potter’s fields, where unclaimed and claimed bodies with no burial funds are cremated and buried in mass burials. Never heard of it? Neither had I. With raw specifics, readers learn how these places reflect a branch of social injustice that rattled her deeply. As she writes:
“[There is such] indignation at how our society treats certain people in death— if you are not economically valuable in life or if you are seen as deviant in some way, then you are not worthy of being treated with value in death either. The injustice of it all is so explicit; these are people forgotten about, discarded, left for the bugs to feast on until the smell of their decaying bodies interrupts the lives of those around them and the county is left to claim them, clean up after them, record and process them, and then file them away. For me, the sadness I experienced from that first viewing grew and morphed into anger.”
Shea discusses the documentary, A Certain Kind of Death, which takes a full look at the potter’s fields and brings home this quote by William Gladstone, “Show me the manner in which a society cares for its dead, and I will measure with mathematical exactness, the tender mercy of its people.”
She also dissects the death positivity movement, and how and why it comes from privileged white class. Seeing the need for it to relate to all, we learn about her organization, the Equitable Disposition Alliance, which has the vision of more equitable and accessible death practices in our capitalist society. Continuing to not being shy about making points readers might feel hard to admit or think about, Shea goes into underlying reasons we don’t have this, and the challenges for creating it, including social and cultural behavior as it relates to the homeless.
In her personal stories, readers learn about Shea’s experience of the death of her own grandmother juxtaposed with the lack of county and state procedures for burial of the poor and unclaimed. From this, we better understand the tragedy of “when someone dies who is homeless, in poverty, disenfranchised from society, or without family or friends, there isn’t necessarily an easy route to resting in peace.”
Societal attitudes, stereotypes and how we want to look away from the homeless stare at us up close and personal in Shea’s narrative. From real stories, readers learn what it’s like to be in the final stages of life when unhoused, ill or with health issues. She shines light on medical respite units which provide homeless a place between the hospital and the street or a shelter, and hospice for the unhoused, of which there are too few. And there is street hospice, which is a service desperately in need of more around the country as well.
The book ends with a creative poem, “Indexing the Life & Death Experience of Homelessness” which brings Shea’s message home that while we all die, “not all deaths are created equal.” Too Poor to Die is for anyone who is interested in social injustices in our society. It is for those who want to explore more deeply why our society has strong assumptions about who is ‘deserving’ of dignity during and at the end of life, and see the humanitarian value of moving past this for all to live and die with respect.