A new documentary shows how attitudes to death are changing in America

By E.H.

LESS THAN ten minutes into “Alternate Endings: Six New Ways to Die in America”, a brief conversation between the widow and the sister of a man who is about to have an unconventional funeral highlights just how much attitudes to death, dying and grieving are starting to change in America. The sister begins by saying that she and her brothers used to hate going to funerals; they were always big old-fashioned affairs on a Sunday in the family plot in a Brooklyn cemetery. “We just didn’t like it,” she says. “So this is a very different way to honour somebody. It’s a very good thing to do.”

“Absolutely,” answers the widow. And then, speaking of her daughter Leila, she adds, “it’s going to be very good for her. She hasn’t had time to grieve.” The “different way” they are honouring their dead is by placing his ashes in a “memorial reef” and planting it at the bottom of the seabed. The cremated remains are mixed with cement, and then placed inside a man-made reef in the Gulf of Mexico. The last shot of the segment is of Leila cradling the memorial underwater, her face obscured by the deep-sea diving equipment, her arms hugging it close.

It is one of many quietly moving moments in this documentary from HBO, which takes a subject most people are wary of thinking of, are keen to avoid—death—and looks at it straight on. The starting point of the film is that, in 2018, cremations overtook ordinary, mostly very expensive burials in America. Increasingly people want to have more control over how or when they die; or, once they are dead, their relatives want to celebrate their lives in ways that do not conform to the notion of a traditional funeral.

Guadelupe (pictured), a terminally-ill man, has a “living wake” with all his family and friends surrounding him several months before he dies. Barbara Jean, who has pancreatic cancer, goes with her best friend TJ to see the “green burial” (ie, environmentally friendly) plot where she will be laid. As they view the site in a golf buggy, the woman who works at the burial ground tells her that people, when viewing their prospective plots, tend to lie on the ground and look up at the sky, to take in their burial view. Soon after, the film shows TJ and Barbara’s other friends washing her body and interring her at the spot she has chosen, planting a tree in the grave at the same time.

The film also follows families who send the cremations of their loved ones into space on a rocket. Emily and Ryan Matthias, a couple whose five-year-old son Garrett died of cancer, are interviewed too: he asked for bouncy castles and superheroes to be at his “life celebration”, rather than having a “sad” funeral, so after his death they followed through with his wishes.

The most striking episode in the hour-long documentary, however, is the segment following Dick Shannon, a former Silicon Valley engineer whose cancer has stubbornly remained despite treatment, and has now metastasised into his lungs. He wants to end his life on his own terms, and lives in California, a state with a “death with dignity” law which allows him to do so. In the first shot of him, he is with his wife of 57 years, visiting the doctor who runs through how he is to take the end-of-life medication: the lethal cocktail needs to be prepared somewhere which is not a public place and, although it can be mixed by someone else, he has to take it without assistance. Usually, the doctor explains, people slip into a coma and then die within half an hour of taking it. With tears in her eyes his wife says that “it’s a really difficult process, but it feels like the right decision”.

Afterwards, Dick and wife take down the end-of-life medication from the top of their closet—next to a box marked “dressy clothes”—and go through its contents for the camera. Later he constructs his casket with his son-in-law, who quips that he hopes Dick is not going to lie down in it there and then. And then, six months later when the cancer has got much worse and his lungs are failing, he throws a party for 40 guests. One friend toasts his drink with Dick’s, and says, “cheerful checking out”. Another asks: “No time soon I hope?” To which Dick replies: “I’m checking out Tuesday morning.” When his friend looks mildly shocked, he explains further: “I want to go out with a quality of life. I can feel it deteriorating. I know what’s happening. I want it to be on my terms. Tuesday morning is it.”

The film follows Dick and his family as they have their “last supper” together. Afterwards they all cry listening to “Amazing Grace”, the hymn which will be played at his funeral. The next day, he drinks the cocktail, tells his family around him that he loves them, and lies back on his sofa. As he slips into the coma, and as his body makes its death rattle, his wife explains to their children that it is all perfectly normal. This is death: a sleep from which there is no waking.

The moment is incredibly moving: a man dying, on his own terms, in his own home, surrounded by his wife, children and in-laws. The strength of the documentary, which offers little by way of commentary, is that the camera does not feel overly intrusive; there is no presenter providing a morbid narrative. Instead, the words of the dying and the grieving are given their due space and time. They deserve to be listened to.

“Alternate Endings: Six New Ways to Die in America” is released on HBO on August 14th