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Death education country signpost: United States of America
Death education in the States embraces subject matter such as meanings and attitudes toward death, processes of dying and bereavement, and care for people impacted by death. It can be formal or informal (when occasions arising in social settings become ‘teachable moments’).
Structured death education may be didactic – intending to improve knowledge – or experiential; focusing on feelings and the sharing of experience. Most US educators use a combination of the two.
Approaches differ between health professionals, universities and schools and the general public, but death education courses for all groups share the aim of changing behaviours and promoting quality of life for the living. New curriculums have capitalised upon heightened public awareness about death following the COVID-19 pandemic.
History of death education
The US death awareness movement began with Herman Feifel's book The Meaning of Death (1959). His scientific studies led the way while other pioneers focused on the care of the dying and the experience of grief.
Courses on death and dying were developed by university scholars Robert Kastenbaum, Robert Fulton, Dan Leviton and James Carse. In 1969 Fulton set up the Center for Death Education (now the Center for Death Education and Bioethics at the University of Wisconsin). The subject entered a so-called ‘Period of Popularity’ from 1968–1977.
In 1970 Robert Kastenbaum founded Omega: The Journal of Death and Dying, the first professional journal in the field. And in 1977 Hannelore Wass established the journal Death Education (later renamed Death Studies). Several other professional journals deal with grief, including Illness, Crisis and Loss and Journal of Loss and Trauma.
Information about end-of-life issues has informed citizens' advocacy groups, and there has been a public debate regarding patients' end-of-life rights and experiences. The 1994–1997 Project on Death in America at the Open Society Foundations aimed to ‘understand and transform the culture and experience of dying and bereavement in America’. The National Public Radio series The End of Life: Exploring Death in America and the PBS television series On Our Own Terms: Moyers on Dying in America have also explored death-related issues for the lay person.
Schools and colleges
In the 1970s Daniel Leviton and Eugene Knott pioneered the education of children in death matters in public schools.
In 2011, Peter Clark’s book Death with Dignity proposed that young people should be better equipped to deal with the final stages of life. Peter Clark also led the study Death Education: An Educational Approach to Death and Dying
Education on death, dying, and bereavement is a controversial issue today in schools: Some are concerned that such study can lead to anxiety in students. But proponents of the subject point to death education’s ability to promote feelings of being in control and enhance quality of life. The 2020 study Beyond the Wall: Death Education at Middle School as Suicide Prevention suggests that death education may prevent young people taking their own lives.
Multidisciplinary college courses on death education covering historical, cultural, ethical and social aspects have proliferated at universities in the USA. The Chimes newspaper has a 2014 article on how death education is rising in popularity among young adults.
Medical and nursing programmes
Medical schools and textbooks were found to be lacking in educational topics on death by one study in the mid-1990s.
In 1996 the American Academy of Hospice and Palliative Medicine (AAHPM) developed a training programme for physicians. A similar programme, the National Internal Medicine Residency Curriculum Project in End-of-Life Care, is now a requirement for internal medicine residency training.
In 1998 the American Medical Association (AMA) announced the Education for Physicians on End-of-Life Care Project. The American Academy of Family Physicians (AAFP) produced ‘Recommended Curriculum Guidelines for Family Practice Residents on End-of-Life Care’ (2001).
The USA is Many nursing schools offer courses at undergraduate and graduate levels. The American Association of Colleges of Nursing (AACN) promotes an End of Life Nursing Education Consortium (ELNEC) Training Program, while the Tool-Kit for Nursing Excellence at End of Life Transitions for Nurse Educators (TNEEL-NE) also fosters appropriate learning.
Grief counsellors and mental health practitioners typically attend continuing education seminars, workshops, and institutes. The Dougy Center for Grieving Children and Families in Portland, Oregon, is a model for counsellors interested in supporting bereaved children.
Hospices and palliative care
Jeanne Quint Benoliel was a pioneer in the footsteps of Cicely Saunders. She designed a graduate course for nursing students in 1971 which became a model for other programmes.
Hospices were widely influenced by the International Work Group on Death, Dying, and Bereavement (IWG) which published influential papers in the 1970s.
The National Hospice and Palliative Care Organization (NHPCO) was founded in 1981. Other professional organizations with an educative purpose include the Hospice Foundation of America, the International Association for Hospice and Palliative Care (IAHPC) and the American Academy of Hospice and Palliative Medicine (AAHPM).
Studies
A perspective on the current state of death education in 2003 looks at the role of health professionals and grief counsellors. The emergence of thanatology and current practice in death education in 2012 examines the interdisciplinary nature of death education. In 2021, Death education’s ‘period of popularity’: Lessons for contemporary P-12 schools in the United States during the Covid-19 pandemic takes a retrospective approach.
Institutions
The Association for Death Education and Counseling (ADEC) was the first organization to develop professional standards and certificates in the subject. ADEC established that academic courses in death education are typically ‘Death and Dying’, ‘Introduction to Thanatology’, or ‘Survey of Thanatology’ courses. ADEC is currently revising its certification programmes and developing training standards for death educators.
The School of American Thanatology was founded during the global pandemic to provide progressive and inclusive education that values lived experience. The organization offers educational options in Thanatology, Thanabotany (the intersection of plants and people with death, dying, grief and loss) and Deathwork, and supports research and writing opportunities for its community.
For those interested in training in the death industry, The Order of the Good Death is a useful resource: topics include how to become a mortician, the alternative death industry and training as a death doula. The organization seeks to influence legislation in the area of death and dying, and is creating comprehensive LGBTQ+ end-of-life planning guides for every US state.
The Portland Institute for Loss and Transition offers a comprehensive, multifaceted and professional programme of continuing education of professional training in grief counseling and bereavement support.
Since 2017, End Well has created a community, including an online repository of presentations, to address its mission ‘to transform how the world thinks about, talks about, and plans for the end of life’.
Books
‘Changing Death Attitudes through Death Education’ is a chapter in the 1994 book Death Anxiety Handbook: Research Instrumentation and Application. It focuses on the impact of death education programmes, theories and techniques. Written in 2016, The Good Death: An Exploration of Dying in America examines legal, religious and ethical aspects. The Handbook of Thanatology: The Essential Body of Knowledge for the Study of Death, Dying and Bereavement (2013) leads the way in addressing scholarship, research and practice.
Updated by Plenna, February 2024