Ashes to Ashes, Outer space to OceansWho Gets to Have an Alternative Death in America?

two Latinx men, one wearing oxygen, embrace in HBO's Alternate Endings documentary

A relative, left, hugs Guadalupe Cuevas in Alternate Endings: Six Ways to Die in America (Photo credit: HBO)

Alternate Endings: Six Ways to Die in America, Perri Peltz and Matthew O’Neill’s recent HBO documentary, purports to explore how the funeral industry is evolving to accommodate the myriad ways that people want to die. The hour-long film opens on a National Funeral Directors Association conference where mainstream death-industry gimmicks and gadgets, like urns in the shape of presidential busts, hologram eulogies, and tricked-out caskets that stave off worms, are presented before pivoting to six new and innovative approaches to funerals. Goodbye kitschy urns and somber hearses rolling into drive-through funeral homes; hello handmade coffins and graves dug by friends of the deceased.

Sending cremated remains to outer space, as seen in the film, is a costly idea, and there can be a considerable amount of legal knowledge required to handle a death at home, another “alternative ending” shown, but the film’s insistence on following deaths as they happen, without context or commentary, overlooks these obstacles. One woman, Barbara Jean, is shown animatedly and cheerfully picking out a site at Eloise Woods, a green burial park in Texas whose mission is to “provide natural burials in harmony with nature” and where plots run upward of $3,000. Her friends dress in purple in her honor when they bury her there. Dick Shannon, a terminal cancer patient in California, elects for physician-assisted suicide because he wants to die on his own terms.

Before he dies, he throws a big party with friends and family. On the morning of his death, his family joins him at home as his coffin awaits him in the living room. Yet for all its focus on upending the deathcare industry’s status quo, Alternate Endings fails to explore the complex politics around physician-assisted suicide, especially for communities of color and disabled people, some of whom feel pressured into this “choice” because of a number of factors, including economic hardship and the desire to “avoid being a burden.” These are tremendous concerns for low-income people who worried about how their families will afford their care, with nearly 50 percent of people in Oregon who elect to die by physician-assisted suicide citing this very issue. Dick’s choice to “go out with a quality of life” is Dick’s choice, but it’s troubling to see physician-assisted suicide treated as value-neutral.

Guadalupe Cuevas, a Latinx man with dementia—and the only non-white person in the film—has a noisy, life-filled living wake. He is feted like a king at a birthday celebration, surrounded by his favorite foods and his beloved friends and family. Though the event is tinged with sadness, it’s also loving and warm. Not all of Peltz and O’Neill’s subjects have living wakes: Elsewhere in Alternate Endings, an ocean-loving father is buried inside an artificial reef; the ashes of a beloved university professor nicknamed “Tuna” are shot into space; and the memorial service for a child who died of cancer (and whose obituary memorably ended with “See ya later, suckas!”) gets a “celebration of life,” complete with five bouncy houses—one for each year of his life—Batman, face painting, and fireworks.

These celebrations challenge our cultural ideas about death, dying, and burial rituals: They’re filled with people smiling and laughing. Dick even jokes with his wife as he swings his legs up on the couch (strategically draped with a sheet) before he lies down for the last time. People also cry and experience conflict, but Alternate Endings shows that death doesn’t have to follow a regimented procession. Everyone should be able to live and die in ways that fill them and their families with comfort and affirmation, but part of ensuring that happens involves confronting things like the overwhelming costs of funeral services and the growing use of crowdfunding to cover even basic burial expenses.

Alternate Endings also fails to explore how regulatory pressures can affect end-of-life plans and decisions, particularly in communities with death practices that white policymakers have deemed “other.” Some states, for example, make it difficult to care for the dying and dead at home by forcing families to employ funeral directors, mandating refrigeration or embalming, and imposing bureaucratic requirements around death certificates, disposition permits, waiting periods, and similar matters. This can be especially harsh for Indigenous communities who are trying to retain cultural traditions, as well as some immigrant communities bringing their own death traditions to the United States. Meanwhile, dying patients on Medicaid and Medicare may find it extremely challenging to get home hospice care in some areas thanks to provider shortages and pressure to die in a hospital or nursing home instead. The Medicare requirement that patients on hospice waive curative care may also deter some patients.

Death is inevitable; dull funeral services and grim hospital rooms are not. But by focusing on a narrow band of humanity, Alternate Endings ignores the cultures whose attitudes toward and traditions of death have long been “alternative.” After all, humans have been dying at home and caring for their own dead for millennia. As Jessica Mitford pointed out in her 1963 exposé The American Way of Death, the transition to hospital deaths and more regimented funeral home care is a relatively recent development. As someone who has followed what, for lack of a better phrase, has been termed the “alternative death community” for years, it’s been exciting to see it expand into the public consciousness, and to see more options becoming available to those who want more control over their death experience.

Yet these options are too often presented within a limited social context and predictable, if sad, deaths to cancer and dementia rather than more socially and politically challenging causes like gun violence or freak workplace accidents. The unbearable whiteness of Alternate Endings surely wasn’t intentional, but it nevertheless offers an interesting inadvertent commentary: Many of the faces of the “alternative death” movement are white, and there’s much less engagement with the cultural, community, and social traditions of communities of diverse color and faith in America. Some people had never heard of the Black Christian tradition of homegoings, for example, until Aretha Franklin’s death in 2018. One in 1,000 Black men will be killed by police: Where are their alternative deaths?

Alternate Endings’ focus on a small subset of people with socioeconomic advantages makes it hard to take seriously as a thoughtful look at the way people live and die in the United States. Exploring a broader spectrum of humanity—from Sudanese refugees trying to preserve their traditions to descendants of enslaved families that have been caring for their own dead for centuries to Indigenous communities—would have made for a much more lively and engaging survey. The documentarians, who relied on a “series of networks” for subjects, may have had difficulty locating a more diverse group of participants willing to give them access to extremely intimate moments when there is such a long history of cultural exploitation. And yet it seems they made no efforts to offset this problem by collaborating with a Black or Indigenous filmmaker or widening their pool of subjects.

One in 1,000 Black men will be killed by police: Where are their alternative deaths?

Tweet this

While middle-class whites may have recently discovered that there’s an alternative to a funeral home and disposition six feet under, some people have been practicing funeral traditions uninterrupted in the United States for thousands of years or have brought their own ancient funeral traditions with them. The practice of burying people quickly and with minimal preparation is familiar to both Jews and Muslims, for example, yet it is presented here as a novel alternative practice or a return to “tradition” without acknowledging that it is part of living tradition and contemporary death practices.

And those drive-through funeral homes subtly scorned in the film’s opening scenes? Most are Black funeral homes, located in Black neighborhoods, responding to the expressed wishes and needs of their community, like elders who have difficulty walking for visitation and appreciate the availability of another option. The decision to present them with a lack of context or compassion displays the overall lack of cultural competency reflected in Alternate Endings, which is a great pity: A deep look at the incredibly diverse ways people live and die would have been fascinating and informative.

Some practitioners within the alternative death community do attempt to practice diversity and inclusion not just among its members but among the services they provide. The Collective for Radical Death Studies works to decolonize this space, for example, while 2018’s Death Salon Boston included a mixture of practitioners that went well beyond white faces, including sessions on Black cemeteries, funeral traditions, and feminist death work. It’s an issue the community must, urgently, reckon with in order to better serve dying people and their families, and Alternate Endings’ narrow focus highlights why. Even as it stresses notions of independence and edgy alternative options, most echo very specific sociocultural frameworks rooted in whiteness and betray little interest in considering that while death comes for us all, the way we deal with it is not simply individual but cultural.


s.e. smith's headshot. they are wearing blue and their short, curly brown hair halos their head.
by s.e. smith
View profile »

s.e. smith is a writer, agitator, and commentator based in Northern California.