The Hispanic Way of Death and Dying
The sun was searing as we walked down the dusty road toward the cemetery. The procession was led by the local priest, followed by the dead woman’s husband, children, other family members, a large portion of the village in which she had lived her whole life, and me, the accidental guest who was staying in the village as a visitor to distant members of the family. A group of the older male members of the community played mariachi music as the procession wound its way from the woman’s cement block home toward the grave where her body would return to the earth. In addition to the music wails from the women mourners shattered the afternoon heat.
We all collected around the grave to listen to the priest. When the time came to lower the casket into the earth, the woman’s husband threw himself across the top of the casket to keep it from being lowered. His cries of anguish tore at my heart. After a minute or so, some of the men grabbed the husband and held him back while the casket disappeared into the ground. The men had to hold the husband up, he was so weak with grief.
This was my first experience of a Mexican funeral. I was very moved by the open outpouring of grief, so different from the more restrained funerals I have experienced in my own family, which is more typical of a white, North American funeral—no matter what religion the people belong to.
The picture painted above is true of the way other Hispanic groups conduct funerals. And the funeral is only one aspect of the way Hispanic culture approaches death and dying. Since Hispanics are the largest ethnic group in the U.S., with a population of 57 million as of 2015, according to the latest Census Bureau statistics, it’s important for doulas to be familiar with some of their cultural standards. Of course, we must always remember that just being a member of a cultural group doesn’t necessarily dictate how closely a particular person adheres to those cultural attitudes and behaviors.
One of the cultural influences we as doulas need to understand is how healthcare decisions are made in a Hispanic family with a dying person. Hispanic culture values the family above any one individual in the family. Thus, decisions about approaches to treatment, the use of medications, the decision to go on hospice, and looking to work with doulas will be made by the family in some fashion, not by the ill person alone. The sense of family may extend beyond parents, grandparents, aunts and uncles, to even close friends. So as a doula, you must be careful to include those individuals that the family identifies as family. Building trust in such a family constellation means soliciting opinions from all family members who are present when decisions or wishes are being discussed. It also means allowing time for the family to reach out to extended family for their thoughts before they come to agreement on how things should unfold.
A related cultural value that impacts decision making in the Hispanic family is the respect Hispanic people give to people in positions of authority—which might come from age, gender, education, or title. This respect for a person of authority may be extended to doulas, as they will be considered experts in the field of death and dying. This plays out in people sometimes nodding in ways that seem like agreement or acceptance, but might only indicate that the person is listening. That means that doulas must be careful to ask what people heard and how they feel about it. It also means using reflecting back to make sure you know what you’re hearing is an accurate understanding of what the person was conveying.
The value of respect also means that doulas have to offer respect to the person they are working with. If the dying person and immediate family caregivers are older than the doula, the doula must show respect through how they talk with the person and the language being used. That means using formal titles, like Senor and Senora. Americans tend to be very informal, using first names right away. This can be considered rude in a Hispanic family. This value of respect also relates to position in the family. The oldest male in the family holds the highest authority and may make healthcare decisions for the rest of the family. This very hierarchical structure also means that children should not be utilized as translators if adults in the family don’t speak English—it distorts the traditional hierarchy in a way that limits a parent’s openness about what they are feeling and the concerns they have. Of course, sometimes using an older child to translate can’t be avoided, but the doula has to be cautious about what they are asking and look to other adults in the family, when possible, to do the translating.
In my experience with Hispanic families I have found an aversion for making decisions that might be thought to bring on death more quickly. In many cases that means refusing to sign a DNR, offer sacraments of the sick until the very end, and to make final arrangements with a funeral home. As doulas, this means that we must honor the cultural ideas around these decisions and support the family in their beliefs, even though they might seem superstitious and may even make things more difficult for family emotionally in the last days of life.
When planning for the atmosphere in the room of the dying person, doulas should know that it is important for family to place small statues, multiple rosary beads, charms of a favored saint, candles, prayer cards, images of Christ, Mary and saints on and around the bed. In my experience, some families like to make sure that religious programs—generally in Spanish—are playing as often as possible on the TV in the room.
Interestingly, even though Hispanics don’t generally like to talk about dying, and may even hold that information back from their ill loved one, they are very open after the person dies in dealing with the dead. Although cremation is permitted, most Hispanics will follow the Catholic belief that burial allows the person’s body to return to dust and will insure their resurrection in the afterlife. This is true even for families that aren’t Catholic.
After a person dies, the family may hold a wake that goes on for a couple of days. The casket will be open and often holds a photograph loved by the family as a tribute to the person who died. During the wake food may be served in another room. Sometimes there are even card games or dominos played by older members of the family. Wakes are not quiet affairs, they are often loud with conversation, stories, children playing, and emotions being expressed. Children are usually included in all the funeral rites because honoring the person is important for the next generation who will have some responsibility in caring for the dead by visiting their grave each year.
A rosary might be said in a Catholic church for the person who died. Anyone is welcome to join in by kneeling and following along with the rosary. Saying the rosary is a way to help the dead person secure his or her place in heaven. When it is finished people will leave in silence.
The day after the wake ends a high mass will be conducted to honor and celebrate the person who died. Communion will be offered during the mass. Flowers and gifts will be placed on top of the casket to show people’s love for the dead person. Gifts may also have been placed inside the casket during the wake. So many Hispanic families like to purchase caskets with memory drawers, so photographs, jewelry, keepsakes, letters to the dead person, and gifts can be taken into the grave. As a sign of respect, doulas should when possible attend both the wake and the funeral. For some Hispanic families, the wake is truly a family affair, and outsiders may not be welcomed. But the funeral is a community affair, and the presence of doulas will be greatly appreciated. Doulas should ask if they can attend either or both of these events. That formal request is also a sign of respect.
As I experienced in that small village in Mexico, processions from the funeral home to the grave site are common when possible, and will occur at least in the cemetery. After the casket is lowered into the ground, family members will take turns throwing a fist full of earth onto the casket, and perhaps offer personal words to the dead person. The grave site is a place of pride for Hispanics, and is often decorated with candles and flower arrangements. For the nine days after the funeral, family members will light candles in their local church to offer prayers for the soul of the dead person and recite the rosary each night. After the nine days, the family will recite the rosary at least once a month throughout the first year following the death, and then annually after that. If the family is Catholic, a mass will be said for the person who died on the third, seventh, and thirteenth day after the death.
In addition to prayers and a visit to the grave each year on the date of the death, Hispanic families celebrate their dead on All Souls Day, November 2. This is the day when they will visit the graves of those who have died, bringing food the person may have loved, along with flowers, and pictures of the person. Many spend the day there, talking about the dead, eating, and celebrating their life.
Since I began this article with my experience of a Mexican death, I will conclude it with a discussion of the Day of the Dead (Dia de los Muertos) ceremonies in Mexico. This occurs starting on November 1, when souls of deceased children are thought to return to the world of the living, followed on November 2 by the return of the souls of adults. Marigolds are often used to decorate the grave because that flower blooms at that time of the year and its scent is thought to help the souls find their way home. Alters are set up in the home with favorite foods of the deceased, along with photographs, sugar skulls with the name of the deceased on them, and pan de Muertos, which is a special bread. Incense is lit to help the spirits find their way back to visit the living. Catrina figures, or dolls with a skeleton face are also favorite altar decorations.
People go to the cemetery and may even spend all night there, eating, drinking, playing cards, and listening to music. Many people like to wear makeup or a mask that looks like a skull and will wear clothing that has the images of skulls on them. This way of celebrating is meant to be joyful as well as humorous. Even the different colors used have meaning. It is a way to welcome the dead back, honor them, and to show that death isn’t to be feared. This way of honoring the dead is a mixture of Catholic and indigenous Mexican beliefs. For the Aztecs, the skull was both an image of death and rebirth. At the end of the festivities, the images of skulls are meant to scare the spirits away so they return to the afterlife.
Again, it’s important to remember that each Hispanic family may have its own variation on caring for the dying and how they deal with the after-death ceremonies. As doulas, we know how important ritual can be at many points in the process of dying. It will be important for you to know some of the common traditions, so the family sees that you understand what they may want and how to help them carry those traditions out. You will need to ask about all of these aspects of honoring the dying and dead, so you understand how a particular family wishes to honor their traditions. When families have lived in the U.S. for generations, they may follow traditions much more loosely. But don’t be surprised if old ways come back to people and become more important as a person approaches death.