Some Key Characteristics of Death-Related Work Systems

First, although primarily concerned with some aspect of the deceased in particular, all death-related work systems have a distinctive interface with the living. Such contact can range from the minimal, such as the coroner office’s contact with the living relatives of the deceased, to extensive contact, such as experienced by grief counselors who have protracted interactions with grieving survivors.

Second, death-related work systems are composed of a wide range of activities that vary according to organizational complexity. Some systems are relatively simple, consisting of just a few differentiated roles, such as those in the funeral home; Salomone (1972) identified the funeral director, the embalmer, the hearse driver, and the receptionist in that context. Others are highly differentiated structures and roles, such as in the U.S. military service branches, which handle the military’s deceased.

Third, death-related work systems also have an interface with legal systems. Most death-related work systems are rigidly regulated and must follow strict regulatory procedures to carry out their tasks. Organ donor organizations, for example, must conform to local and federal regulations while handling and distributing living tissue. State laws regulate where and how dead bodies are prepared, stored, and finally disposed. Even death notification systems have fallen under legal guidelines, as evidenced by a recent court case in which the parents of a son in a drug overdose case were awarded $425,000 in damages when a hospital failed to notify them of their son’s death until 1 month after its occurrence (Lovell 2001).

The full panoply of work systems operating to process dying, death, and the dead is too extensive to articulate in this exposition. The dynamics of such work systems can, however, be better understood by examining several illustrative varieties of death-related work enterprises outside the funeral home, each addressing a different categorical task or purpose. These examples include work systems that seek to prevent death, effectively handle the dead, or provide service for the bereaved living.

Preventing Death

Virtually every society develops a number of techniques and strategies to prevent death—thus the complex organization of the field of medicine and the ever-growing array of technological and pharmacological products intended to extend life or prevent dying. A work system that operates as a form of hybrid within this death system is the organ donor organization. In this case, death is prevented for one individual by the death of another.

An additional work system to be examined under this category is that of the coroner or medical examiner’s office. The coroner’s office consists of a number of specialists who have the function of obtaining an accurate and complete understanding of sudden unexpected deaths, to better understand the causes of these deaths, and by extension, to help reduce the mortality from those causes that are amendable by public intervention (Cordner and Loff 1994). Finally, in the U.S., a considerable number of resources are allotted to suicide prevention. Medical professionals, therapists, and crisis and suicide prevention centers (often staffed only with volunteers) across the nation are responsible for saving lives every day.

Organ Donor Organizations

Organ donation is a hybrid in the death system. It provides a service to the living through contributions from the dead (however, the donation services also deal with living donors); thus it can be described as a work system that attempts to prevent death. Organ donor service is structured through a national organization called the United Network of Organ Sharing or UNOS, which in turn consists of a number of member organ procurement organizations (OPOs). UNOS maintains a national archive of organ needs and matches them to available organs. OPOs are regional structures (serving a particular area as a component of a national system) whose mission it is to account for, record, and procure organs for transplant. For the most part, these organizations are nonprofits operated by paid associates and volunteer assistants, working in close collaboration with hospitals, transplant programs, and transplant centers. The organ donor process is an interface of two primary components: the medical system (in the form of the hospital) and organ donor organizations. Within the medical field, there are doctors, nurses, and technicians. From the organ donor organizations, we have organ placement specialists, procurement specialists, communication coordinators, and compliance auditors. Of course, the medical occupations are concerned with the actual harvesting and transplantation of organs, but they also serve as educators and counselors to potential donors and their families. Tissue specialists are lab technicians who verify the viability and health state of donated tissue.

Within the hospitals themselves are procurement specialists who advise and educate potential donors. They also maintain a record of those who need an organ transplant. Such information is recorded in a national network, where placement specialists match donated organs to those in need. Communication coordinators maintain the network so that the entire nation can make use of donor tissue. An important distinction that can be made within the organ donor organizations is the type of organ a group may specialize in, including heart, kidney, or liver. Given the need for donor organs—in 2001 there were 2,202 cadaveric heart donations but 4,106 people on the waiting list—it is no surprise that the organ donor system had to differentiate by type of organ to manage the load. For an expanded exposition on organ donation, see Joyce and Williamson (2003).

Organ donation also often interfaces with another work system, the legal system. Despite organ transplants being relatively common, it is still a complex surgery in which mistakes happen and death occurs. The tragic events at Duke University Hospital in February 2003 provide a case in point; 17-year-old Jesica Santillan received a heart and lung transplant of the wrong blood type, which resulted in her death. In the wake of this accident, her family and others are wondering how such a mistake could have occurred, and consequently, legal action has been taken. As is common in such events, the issue of responsibility and liability for this tragic accident has moved away from the medical work system and will now be resolved in the legal system (see Adler 2003).

The Coroner or Medical Examiner’s Office

The coroner’s office or medical examiner’s office is a legal entity that represents a work system devoted to determining causes of death. Generally, this office is involved only in those cases involving suspicious or sudden deaths. The expressed purpose is to determine mysterious causes of death in order to prevent future deaths of like kind, but in many cases, coroners and medical examiners are involved with criminal investigations. In the United States, approximately 28 states use the coroner system; 22 states have done away with the coroner completely and moved exclusively to medical examiners (Hanzlick 1998). This has been attributed in part to the coroner’s role being subsumed by that of police homicide units (Cordner and Loff 1994). A key distinction between a coroner and a medical examiner is that coroners are often laypersons elected to the position to act primarily as investigators. Their function depends on the expertise of specialists who provide them with the information they need to determine causes of death. Medical examiners, on the other hand, are physicians (often appointed to their position for a determined period of time) with training in pathology who possess the expertise to perform a function identical to that of a coroner. Despite these differences, the two offices overlap in both origin and function (Geberth 1990:418). Both work systems are composed of interdependent skilled positions, whose expertise falls in a number of areas needed to perform an accurate analysis of the cause of death, often termed a medicolegal examination. Such positions include coroner investigators, forensic pathologists, and a variety of forensic technicians and specialists (including autopsy assistants and forensic investigators). All these actors operate in tandem with the experts providing the necessary information to investigators to solve mysterious deaths. As might be assumed, the coroner’s and medical examination offices are closely linked to law enforcement organizations that often use their expertise for the purposes of guiding investigations and providing expert court testimony. For a detailed account of the evolution of and operation of the offices of coroner and medical examiner, see Downs (2003).

Suicide Prevention

With over 2,000 suicide attempts made every day and suicides accounting for approximately 30,000 deaths in the United States each year, a complex array of medical professionals (ranging from physicians to clinical therapists) and support staff have been trained to recognize and treat those in distress (National Center of Health Statistics 2000). However, given the prolific nature of the problem and that most who attempt suicide never seek medical assistance, it has become increasingly necessary to develop programs that offer suicidal individuals convenient and ready access to hassle-free support (Center for Mental Health Services Web site)—hence the emergence of community-based crisis centers. For a concise but detailed statement on suicide prevention centers, see Palmiotto (2001).

According to the National Hopeline Network, more than 750 crisis centers in the United States have been helping individuals to resolve their personal crises. Typically, these programs are operated by trained volunteer counselors who are available by phone communication. Callers are never to encounter a busy signal or voice mail, with most calls being answered within three rings. It is the counselor’s responsibility to engage the caller and then make a lethality assessment. For those calls deemed to be at low risk of suicide, counselors refer callers to locally available resources.

Should the caller be considered highly at risk for suicide, an on-call supervisor is consulted; typically, information is transferred to a local mobile response team. In most locales, this response team is the local police department. Through the use of location technology, such as caller ID, the suicidal individual is located, and police, emergency medical technician (EMT) units, the fire department, or some combination of these groups is dispatched to render immediate assistance. The general effectiveness of community-based crisis prevention centers has been highly debated, with research results ranging from positive effects to no effects at all (Lester 1991, 1993; Barraclough, Jennings, and Moss 1977). More recently, researchers Mishara and Daigle (1997) concluded that the style of counseling is perhaps the most important variable in determining a crisis prevention program’s effectiveness, but more research will be necessary to make conclusive determinations.

Caring for the Dying

Sudden deaths from industrial and mining accidents, deaths in childbirth, surgical mortality, and deaths from virulent acute disease have all been reduced significantly over the last 100 years. Technological advances, increased use of sanitary practices, and nutritional and health education have made significant contributions in extending our lives, with life expectancies in the United States reaching well into the 70s for men and near 80 for women. Today, it is common for individuals in American society to die from chronic diseases such as heart disease or cancer. The nature of these illnesses (i.e., the high degree of care required to manage the disease) and extended life expectancies (i.e., more care required to maintain a normal life) have made dying a drawn-out process. (Caregiving is explored in detail in Kovacs and Fauri 2003.) To meet the needs of those who are dying, institutions such as hospices and nursing homes have come into being to care for and facilitate the comfort of dying patients. These are complex organizations providing care for the dying, the infirm, and their loved ones.

Hospices

A hospice is a specialized health institution that serves patients with terminal illnesses, providing care in institutional settings and in the home. A hospice represents a complex work system, in which interdisciplinary specialists collaborate to perform a wide variety of services. At the center of all this teamwork is concern for patients’ and their families’ well-being. The first key position in this team is the patient’s own physician. The personal physician directly oversees the patient’s care and provides medical orders when needed (Leming and Dickinson 1998). The next component is the hospice’s medical staff, which includes a complex array of specialists such as physicians, nurses, nurse’s aides, and a variety of therapists. The additional physicians are on hand for immediate emergencies and acute situations; however, the nurses are most responsible for the patient’s day-to-day care, handling most of the patient’s immediate needs. Psychiatrists and psychologists also represent an important component of the medical staff within the hospice system. They provide expert counseling and grief counseling at the families’ and patients’ request. Physical and occupational therapists are also present to help patients maintain optimal daily functioning.

Social workers represent another level of care and comfort within the hospice organization. Their primary function is to tend to the needs of the patient’s family and loved ones, making sure that everyone is comfortable and communicating with each other as the dying process progresses. The social worker also assists in other matters affecting the family, including informing children and grandchildren about the dying process, helping them to better assimilate the fact of a loved one’s dying. The social worker might also assist the family with other problems that are only corollary to the hospice situation, such as drug dependency or marital difficulties.

Another service essential to the hospice team is pastoral services. Large hospices might employ their own chaplain, but in virtually all hospice situations, some form of the clergy are generally available (perhaps from a network of local community clergy members). Clergy are on hand to comfort and counsel patients and their families in spiritual matters. Furthermore, the clergy is also helpful in comforting the other members of the hospice team. Given the grim nature of the work, it is good to have an outlet available for voicing one’s emotional or spiritual questions.

Financial matters are often a serious matter for both the institution of the hospice and the families of those kept within. As a result, a financial counselor is often employed to help families and patients manage expenses. Included among their duties are seeking alternative programs as a method of financing care, helping to reimburse expenses to families who are currently paying for care, and sorting out the complicated procedures required to use government aid programs such as Medicare or private insurance companies. Two other service providers that are also useful to the hospice team are lawyers and funeral directors. Lawyers are often available to help patients handle legal matters such as estate planning. Funeral directors are available to provide information concerning final arrangements such as funeralization and body disposition, thus relieving some of the burden survivors feel after the passing of a loved one. The last component, but an important one, is the hospice’s volunteer force. Government programs require that a minimum amount of volunteer service be met in order to receive Medicare reimbursement; therefore, virtually all hospices use volunteers. In many cases, hospices have extensive programs of training in areas such as confidentiality, listening skills, recognizing symptoms of impending death, working with families, and grief and bereavement support (see the National Hospice Organization Web site at http://www.nhpco.org). Volunteers also perform tasks such as providing transportation, sitting with patients to provide families some free time, and moving equipment. The National Hospice Organization estimated that volunteers performed as many as 5.25 million hours of support in 1997 alone. An added benefit of the volunteer workforce is how they are perceived by the patients and their families; whereas the professional status of the employees of some hospices creates some element of social distance between caregivers and patients, the volunteers are seen as knowledgeable, approachable friends. For other detailed accounts of hospice care, see Brabant (2003) and Leming (2003).

Nursing Homes

A nursing home is a considerably different setting from a hospice in that its expressed purpose is not to care for the dying but, rather, to provide acute care for the elderly and infirm. However, by its very nature, it is a setting in which death is a common occurrence, and hence, it can be considered a death-related work system. Typically, two types of individuals are cared for in a nursing home: the resident and the patient. The patient often has an acute ailment that requires a varying degree of nursing care. The resident usually is not necessarily infirm and may not require nursing care; for the most part, residents are capable of living independently with some assistance. Although there are a number of different staff positions as well as volunteers who work within the nursing home, the work system can be differentiated into two primary categories: the floor staff, consisting primarily of nurses and nurses aides, and the top staff, consisting of administrators, social workers, medical directors, chaplains, director and assistant director of nursing, in-service director, occupational therapist, and activity director (Gubrium 1975). The floor staff typically has the most exposure to death in the nursing home, acting as the primary witnesses to the deaths of residents and patients, whereas the top staff generally may not directly witness these deaths. They are often called in after the fact and either have no contact with the deceased, or they simply supervise the verification of death, calling physicians for official documentation and arranging for removal of the body.

Handling the Dead

All societies must deal with the task of handling dead bodies. At a minimum, this entails the disposal of the body, but “seldom is society content with the minimum,” and thus the emergence of the funeral and memorialization process (Kastenbaum 2001:73). For most, these needs are met by the local funeral home or, more commonly, the mortuary. However, special circumstances or particular organizations require specialized needs. For example, although communities are often prepared to deal with routine deaths, few are prepared for disasters and the unique accommodations required to handle multiple deaths. In such circumstances, the typical funerary work system may have to be transformed or augmented, and new structures (such as disaster reaction teams), behaviors, and procedures may have to be created to meet the new requirements of mass death.

Another unique circumstance involving the handling of the dead are those presented by the military or military actions such as war. Because there are usually multiple casualties to be dealt with, the military has had to develop procedures and occupational tasks that can handle a potentially high volume of deaths in a manner that is consistent and respectful of the victims and their relations. Hence the U.S. military has developed a special organization known as Casualty and Memorial Affairs Operations Center (CMAOC) to handle their needs. The responsibility that military branches have for their deceased does not end at processing the dead. Recognizing the value of the sacrifice of those who have fallen in the service of their nation, the military also provides special units, such as honor guards, that serve to honor and memorialize their fallen comrades.

Mass Casualties and Disasters

In the wake of the September 11, 2001, terrorist attacks on the World Trade Center in New York City and the Pentagon in Washington, D.C., the public has become more cognizant than ever of the resources and efforts necessary to coordinate responses to mass disasters, natural or those intentionally created. In the United States, there is generally an adequate supply of body processing and funeralization resources available, but situations such as some large-scale disasters in times past (Blanshan and Quarantelli 1981) and the events of September 11, 2001, often exceed available resources. In the case of the attacks on the World Trade Center, the recovery of the bodies took months and was made more difficult because the massive explosion and fire had resulted in many bodies being in pieces and fragments. The bodies and body parts were lodged throughout the rubble, and the delay in recovery, rain and the water poured on the rubble to extinguish fires and the heat all caused severe deterioration of the remains. An elaborate search-and-recovery system evolved, with construction workers helping clean the debris and rubble. Firefighters searched for and brought out the bodies and body fragments, and teams from the medical examiners office worked with the remains in an attempt to identify (using DNA analysis among other measures) and, in a few cases, reassemble bodies. The effort to process the massive number of remains was enormous, complex, and sometimes contentious, and the prolonged activities severely taxed all of the resources and energies of the organizations and groups that process death and the dead (Langewiesche 2002).

The response to such disastrous events often begins as a disorganized effort to contain the situation, with an emphasis on recovery of bodies, but this quickly moves to an organized phase, with various organizations and community resources being pulled together to properly handle the deceased. The search and recovery efforts at the site of the September 11 terrorist attacks continued for many months but very quickly evolved into a highly organized and refined initiative not long after the attacks. According to an investigation of disaster responses, Blanshan and Quarantelli (1981) found that although the response is often unplanned, it quickly assumes an organized form, wherein a complex division of labor is formed to process the dead. “While the task structure for a normal death is relatively simple as defined by cultural and professional standards, it is expanded considerably and becomes more complex following a disaster” (Blanshan and Quarantelli 1981:282). In essence, distinct work systems, in the form of agents of the funeral services and community organizations, come together to form a new work system that is able to handle the excessive number of bodies. Other assistance in the form of National Guard or other military branches, the medical community, and volunteers also assist in processing the dead.

The activities that need to be performed by this new work system include the search for bodies, the recovery of corpses, transportation of bodies from the disaster area, cleanup of the cadavers, identification, and finally, processing for burial. Once a victim has been processed and identified, a funeral director is selected and the normal burial process can resume. An important observation made by Blanshan and Quarantelli (1981) is that at all times, despite the potential magnitude of the disaster, every effort is made to continue to personalize the process and maintain the utmost respect for the deceased and their families.

Casualty and Memorial Affairs Operations Center

Under direction of the National Command Authorities and the Chairman of the Joint Chiefs of Staff of the United States, each military department is directed to develop its own service-unique doctrine in regard to the disposition of the military dead. The organization of these services is referred to as the Casualty and Memorial Affairs Operations Center. The CMAOC consist of four divisions: (a) the Repatriation and Family Division, concerned with matters regarding prisoner of war and missing in action cases; (b) the Central Identification Laboratory, concerned with the recovery and identification of soldiers lost in war; (c) the Casualty Operations Division, concerned with death and injury notification; and (d) Mortuary Affairs and Casualty Support Division.

The primary mission of Mortuary Affairs and Casualty Support is threefold: to recover, identify, and return the remains of U.S. military and authorized civilian personnel from an area of operations to the continental United States for final disposition. An important secondary task of this work system is maintenance of a record of those deceased and missing. The U.S. military has designated particular military units and specialists (including embalmers and quartermaster personnel), following strict guidelines and procedures (articulated in military regulation manuals) specific to these tasks.

Although each branch may organize its Mortuary Affairs work system somewhat differently, they all follow the prescribed organizational structure that conforms to military standards, hierarchy (chain of command), and branch requirements expected of all military units. That is to say, that the Mortuary Affairs unit is still a military unit. It is also important to note that Mortuary Affairs units do not act alone in their work. It is understood that every military unit is responsible for the dead under its jurisdiction, but other military units are expected to help with the search, recovery, and identification of the dead.

Although each branch of the U.S. military has its own Mortuary Affairs system that is expected to handle its own fallen, the branches do work together under the directive of the Joint Mortuary Affairs Program (supervised by the U.S. Army) when casualties exceed the capability of their independent efforts. The Joint Mortuary Affairs Program operation is divided into three distinct programs: (a) the Graves Registration Program, that provides search, recovery, tentative identification, and evacuation or temporary burial of deceased personnel; (b) Current Death Program, where remains are shipped to a designated location to be prepared with mortuary services, supplies, and related services; and the (c)Concurrent Return Program which is the preferred method of handling of the dead during periods of active conflict, remains are prepared in mortuary and then shipped to a prescribed location (Mortuary Affairs in Joint Operations 1996:I-2)

In this way, the Joint Mortuary Affairs Program is somewhat similar to disaster and mass casualty burial work systems, in that it is a composite work system created for specific circumstances. The Mortuary Affairs units of the various branches are prepared to assist in mass casualty disasters when the situation calls for it. For a detailed account of the military organizational response to death, see Ender, Bartone, and Kolditz (2003).

Honor Guard

In recognition of the sacrifices made by military personnel, particularly the giving of one’s life for one’s country, the U.S. military branches form military units to honor those who have fallen. These units are maintained to conduct ceremonies, memorial services, and special events. Like Mortuary Affairs, these are military units, but they specialize in symbolically representing the finest traditions and roles the U.S. military has to offer. In many cases, these units are specifically assigned to a particular location or memorial. The Army’s 3rd U. S. Infantry, typically known as “The Old Guard” is one such military unit; it is assigned personally to the president of the United States, but the unit is also responsible for being the Honor Guard of the Tomb of the Unknown Soldier and acting as funeral escort to those buried at Arlington National Cemetery. Those of the 3rd U.S. Infantry who guard the Tomb of the Unknown Soldier are typically described as the unit’s elite and are called the Sentinels of the Tombs of the Unknown. The Sentinels undergo approximately 8 months of training and must pass rigorous examinations to be accepted into the ranks of this unit. Such a position is considered to be a great honor. For a detailed exposition on military funerals, see Wolfe and Bryant (2003).

Providing Services to the Living

It is often said that the funeral and memorialization process is conducted primarily to comfort the living because these tasks are manifestly performed as a service to the living relations of the deceased. All these work systems are intended to function as a service to living survivors in an effort to inform, educate, or comfort. The four work systems discussed here are the death notification system, bereavement work, cemetery groundskeeper and grave digger, and the work of the obituarist. These systems are somewhat related, in that the organization of their work systems is generally less complex than most of the other work systems examined earlier. And with the exception of the cemetery groundskeeper and grave digger, these work systems function as a part of other larger work systems. The interesting point regarding these types of work is that these tasks are often relegated to the status of a corollary role attributed to another work status. For instance, a police officer may have to make death notifications as part of his or her job. Or a staff reporter on a newspaper might be assigned to write an obituary rather than the newspaper’s having a specialized position for that purpose.

Death Notification

The task of death notification generally falls under the responsibility of a multitude of individuals, depending primarily on the context in which a death occurs. In some situations, specific organizations have developed set procedures for informing survivors of deaths in their family. For instance, the branches of the U.S. military designate numerous agents, including casualty assistance officers (CAOs), survivor assistance officers (SAOs), casualty notification officers (CNOs), or notification noncommissioned officers (notification NCOs), to inform living survivors of the death of a loved one. Often, CAOs are accompanied by some member of the clergy to offer support to the family. Other circumstances are far less regimented, and the task falls into the hands of whoever might be present, including law enforcement personnel, chaplains, emergency medical technicians, nurses, doctors, victim advocates, or some type of counselor (Stewart, Lord, and Mercer 2000; Lord 2002). Consequently, “with the possible exception of mental health and mortuary professionals, most persons who deliver death notification have not received curriculum-based education on how to perform this task or how to respond to grieving or acutely traumatized persons” (Stewart et al. 2000:612).

Regardless of who gives a death notification, a core set of activities must be performed. These activities are (a) identifying the victim and survivors; (b) initiating contact with survivors, followed by meeting them at the hospital or the survivors’ home; (c) providing information about the circumstances surrounding the death; (d) telling the survivor that the death has occurred; (e) responding to the survivors’ reaction and providing support; (f) allowing survivors to view the body, if requested; and (g) providing assistance and follow-up care to the survivors at a later point (Stewart 1999:303). How completely these activities are performed is largely based on one’s training and on the resources an organization is willing to provide for death notification. It is important to stress that death notification is a significant opportunity to provide secondary prevention of bereavement-related complications and stress (Parkes 1996; Rando 1993; Stewart 1999). It is also important to recognize that death notification is not limited to contacting survivors. A second kind of notification is informing individuals of fatal illnesses. This type of notification generally falls exclusively under the responsibility of the attending physician who is in the most informed position to know the details of the prognosis, and it is viewed as a duty to his or her patient.

Bereavement Work

Like the practice of death notification, the bereavement work system also varies in complexity. In many cases, the same individuals who are responsible for death notification also offer grief counseling as part of their role, including positions such as a policeman informing a family of an accident-related death or a CAO telling a family about the death of a soldier. Grief counseling can come from a professional, such as a psychiatrist or grief therapist, or from a layman volunteer at a hospice or an EMT present at an accident. Frequently, members of the clergy are called on to offer comfort to grieving individuals. Finally, support organizations (volunteer and nonvolunteer) allow individuals in mourning to share experiences and find comfort among others in similar situations. These organizations range from face-to-face meetings to virtual meetings communicated through e-mail, chat rooms, and electronic messaging software. Simply put, the bereavement work system is an eclectic system, varying in degree of training and organization but, nonetheless, a vital resource for those in mourning.

Cemetery Groundskeeper and Grave Digger

The often forgotten member of the funeralization and memorialization process is the grave digger or cemetery groundskeeper. This work system primarily involves the continued care and maintenance of the cemetery but necessarily involves the digging of graves. Petrillo (1989) indicates that grave diggers are generally male, anywhere from 18 to 85 years of age, and earn an average of $25,000 per year. The actual range of activities performed by cemetery caretakers is considerable, because they are responsible for the whole cemetery. Their duties include lawn care, ranging from simple mowing to the maintenance of elaborate gardens; setting up and removing chairs, greens, and shelters; cleaning headstones; digging and squaring graves; placing and setting gravestones; operating heavy machinery to perform their jobs; and knowing and understanding laws and regulations regarding burial and internment.

The caretaker position can range from a highly formalized position such as listed in federal government’s Job Grade Standards, which differentiates five grades of cemetery caretaker, explicitly determining the wages and duties of each, to a less formalized position sought for a local cemetery. Although the caretaker’s work may seem primarily physical, there is also considerable emotional work involved as well. Petrillo (1989) points out that grave diggers’ work is surrounded with sorrow and that since they are outside the normal grief rituals, they must determine their own conduct, based on the situation, to demonstrate the appropriate degree of mourning. It should be recognized that the cemetery caretaker is a far more complex occupation than myth would have us believe.

The Obituarist

The obituary, also known as a death notice, is a regular feature of the American press, having been published in U.S. papers for well over 200 years (Hume 2000). More than merely a notice, the obituary is viewed as a key to history, recording family, community, and professional histories (see http://www.obitpage.com). Obituaries add to the understanding of American journalism and serve as a tool for understanding culture. “Just like a collective memory, obituaries combine past and present, public and private; they legitimize characteristics of individual Americans to a collective audience, thus adding to cultural values and memory” (Hume 2000:15).

The official term for the writer of obituaries is obituarist. This term is generally used to refer to the professional journalist who specializes in obituary writing, but it can be used by anyone who writes an obituary. We can, then, distinguish between the obituarist as a professional and the obituarist as a role. Large to midsized newspapers, such as the New York Times or the London Times, employ people who exclusively write obituaries. In many cases, these professionals travel to meet the important or famous, interview them, and prepare obituaries in advance. These journalists often consider themselves biographers or storytellers, referring to their work as “creative non-fiction” (Gorman 2002). The writing task of obituaries ranges from the storytelling style of biography to formula-style listings that are short, concise, and impersonal. Obituarists are supported in their work by obit editors and obit clerks who act as fact checkers, archivers of death-related news and facts, and editors of obituaries.

Obituary writing can be considered a role, in that junior journalists are often assigned the task of writing an obituary. This may be considered an assigned task, not a career position, and many journalists think of obituary writing as second-tier work, something akin to an experience-building exercise (Weinberger 2002). Finally, there are also “prebituaries” or “précis,” which are the equivalent of an autobiographical obituary prepared by an individual before death and posted once that person is deceased. In this case, the individual of the pre-bituary becomes an agent of the obituary work system. For an elaborate exposition on the obituary, see Williams (2003).

A Plethora of Work Systems

The preceding examples represent but a small fraction of the work systems involved in death work; any true attempt to enumerate all death-related work systems would require multiple volumes rather than this modest treatment in order to do the topic justice. The primary goal here has been to expose the reader to myriad activities involving death, thus demonstrating the vastness and variety of death work systems active within society. However, to give the reader some notion of the scope of death work systems, we will now briefly denote a number of other work system categories that could also be explored.

Funeral Suppliers

A vast network of work systems involved in the death trade are the funeral material suppliers. Such systems include the floral trade, which provides funerals with decorative and sympathetic floral arrangements; the mortuary supply trade, consisting of embalming and preserving fluids, cleansing chemicals, odor removers, cosmetic materials, and tissue sealers; casket retailers and producers; tomb and memorial construction teams; headstone cutters and retailers; and finally, funeral-related transportation, including hearse rentals and hearse drivers. Positions within each of these industries include skilled craftsman and manufacturers, retailers and salesman, customer service representatives, and specialists, such as floral arrangers or memorial craftsmen.

Law Enforcement

Within the law enforcement work system, a number of occupations are directly related to death and dying. The homicide investigator’s primary task is to investigate deaths and homicides to determine causality, attribute blame, and apprehend criminal perpetrators. Supporting homicide detectives and other police investigations are criminal scene investigators or CSI units. These units consist of numerous technicians and investigative specialists who canvas crime scenes to gather evidence for solving crimes. Specialists include toxicologists, criminalists, pathologists, and other forensic experts. Of late, popular television has somewhat sensationalized CSIs’ work, but they are an important part of homicide investigations and determining causes of death. Yet another work system under the aegis of law enforcement is composed of execution teams and death row attendants. It falls to this group to administer lethal punishment to convicted criminals. Their activities include taking care of death row inmates awaiting execution, preparing for the execution to make sure everything works as planned, and of course, performing the actual execution. Those involved include death row guards, attending physicians, members of the clergy, and the executioner.

Morgue Systems

As previously discussed, a number of practitioners are within morgues, including pathologists and coroners. However, they are not the only workers to be found within. There are also mortuary attendants and people in administrative positions who provide support to technical staff. Some technical positions to be found at the mortuary include forensic toxicologists, forensic anthropologists, fingerprint analysts, and lab technicians.

Mass Disaster Agencies

In addition to those work systems discussed earlier in relation to mass disasters, other organizations and agencies are specifically designed to assist with mass casualties. Such agencies include the Federal Emergency Management Agency (or FEMA), an agency charged with coordinating federal efforts to assist in mass disaster areas; the Federal Aviation Administration (or FAA), which coordinates efforts to investigate aircraft accidents through the Office of Accident Investigation; the National Transportation Safety Board (or NTSB), which supplies assistance through its Transportation Disaster Assistance program; the Red Cross, an international disaster relief organization; and the Centers for Disease Control (or CDC). Each organization consists of numerous administrative, investigative, technical, or medical staff positions, as well as technicians and specialist of all sorts.

Alternate Burial Systems

Burial by way of the funeral home is not the only means of handling the dead. In the United States alone, as many as 30% of those who die are cremated. Thus crematoriums also represent a work system. Other means of laying the deceased to rest are also available, including burial at sea, special forms of scattering ashes (such as in space or at remote locations like mountaintops), and cryonics, or freezing remains. Each represents a specialized work system worthy of investigation.

Specialized Burial or Memorialization

Humans are not the only objects of memorialization; pet internment has been growing for a number of years, with pet cemeteries and pet memorialization becoming more popular every year. In this case, we can include pet cemetery attendants, grave diggers, and veterinarians as elements of these work systems. Witt (2002) asserts that pet internment operations generally consist of small-business owners and one or two attendants, with over 120 such organizations and more than 300 pet cemeteries operating in the United States today (see the International Association of Pet Cemeteries Web site at http://www.iaopc.com). The taxidermist also represents a work system that involves the artistic preservation and presentation of animals (see Bryant and Shoemaker 2003).

Death Artists

These types of work systems include memorial photographers of the past, forensic photographers of the present, floral arrangement specialists, and memorial carvers such as those who did the Mount Rushmore Memorial. Also included in these types of work systems are those artists who specialize in integrating remains into pieces of art such as sculptures or paintings (see, e.g., Memorial Art at http://www.memorialart.com)

Medical Profession

Although certainly too broad a category to be discussed here with any depth, it is important to recognize that virtually all those in the medical field could be considered part of some death-related work system. Doctors are no strangers to death, and some, such as pathologists or oncologists (doctors who specialize in treating cancer) find it a regular part of their day-to-day activities. Nurses, doctor’s assistants, and technicians are often faced with death work, including caring for the dying, bereavement work with a deceased or dying person’s family and acquaintances, and sometimes the initial handling of the dead.

Clergy

It is part of the responsibility of the clergy and those from many of the various religious orders (including priests, rabbis, ministers, etc.) to care for the dying, their bereaved, and the dead. After all, both the spirit and the body are part of their domain. Furthermore, many medical facilities around the world are run by the various religious orders.

Pre-Need Services

Insurance providers and lawyers are an integral part of the dying process. Insurance providers sell life insurance policies that provide funds paid out to the beneficiaries of the dead. They also are an integral part of the health field, providing medical insurance to pay for health care. Lawyers are involved in estate planning and execution of wills and testaments and, consequently, the legal refutation and negotiation thereof.

Archeologists

The whole of the archeologist’s work is steeped in death. They research, analyze, and work among the dead—most often the very long dead. They and all those who work with them must be considered a distinct death-related work system.

Education

Just as there are numerous work systems available, so, too, must there be an infrastructure where professionals and skilled employees can be trained. Trade schools (mortuary programs, funeral directorship programs, etc.), apprenticeship programs, and universities represent work systems involved in death work (for a detailed examination of mortuary science education, see Van Beck 2003).

Advocacy Organizations

Mothers Against Drunk Drivers (MADD), suicide prevention groups, euthanasia support groups, and the like also represent a significant work system that can be explored. Based on their respective positions, these groups make efforts through volunteers and professional experts to publicize and act on their death-related interests.

Postmortem Services “Clean-Up Crews”

Clean-up postmortem services represent janitorial companies that offer services, or specific firms, that “specialize in sanitizing the scenes of homicides, suicides, and unattended deaths” (Fountain 2003:A8). Technicians are sent to sites where law enforcement agents or medical examiner teams have completed their investigations, and they remove all traces of homicides or deaths. Such services can range from $3,000 to $7,000 per incident and can often be completed within 24 hours (Fountain 2003).

Conclusion

When one thinks of death in conjunction with work, the image that most often comes to mind is the funeral home system. However, the funeral home enterprise represents but one facet in myriad occupational work systems present in the death field. Just as in life, where a variety of work systems meet the needs of society, a number of work systems meet our needs in death. This chapter discussed four such death work systems by category, including preventing death, caring for the dying, handling the deceased, and providing services for living survivors and memorialization of the dead. These categories represent but a small fraction of the total number work systems involved in death work. This chapter attempted to demonstrate that despite the near invisibility of death in our society, death and death work surrounds us. Furthermore, there is every reason to believe that the number of death-related work systems will grow, if for no other reason than to meet our quantitatively expanding needs in death.

As we enter the 21st century, several trends make it likely that death work will expand in the future. First, as medical technology, sanitation, and healthy living increase, so does the life expectancy of the members of society. In fact, one of the fastest-growing portions of the population are those 65 and over, with a projection of 40 million people in the United States being 65 and over by the year 2010 (U.S. Bureau of the Census 1998). The implications of an aging population can only mean that death and dying will become an ever more endemic facet of modern life, despite all attempts to resist or obfuscate it. In addition, as new mediums such as the Internet become more popular and pervasive, it is likely that death will find a place there as well. Just as deviance and sexual behavior have found new life on the Internet in chat rooms, bulletin boards, and Web sites (Durkin and Bryant 1995), we also find those of like interest in death and death-related businesses proliferating on the Internet, including online memorials; discussion groups; Web obituaries; fan Web sites; retail Web sites for caskets, mortuary supplies, floral arrangements, and death art; and virtual support groups. In fact, with the development of online games and realities, there is even “virtual death,” where the death of virtual life can have very real implications for those in the real world. In any case, death-related work systems outside the funeral home have played, and will continue to play, a prominent role in society.