HBO’s New Documentary Asks You to Talk About Death

Alternate Endings explores how a new generation of elderly Americans is making dying more personal and more open.

More people like Guadalupe Cuevas (right) are holding living wakes and approaching death in an untraditional way, as the new documentary Alternate Endings attests. (HBO)

Dick Shannon knew he was dying. He had been living with a terminal-cancer diagnosis for two years. He had discussed options with his doctors and his wife, Deleaua, and he’d accepted that “there’s nothing I can do to stop it,” he says in HBO’s new documentary Alternate Endings: Six New Ways to Die in America. That acceptance gave rise to different sorts of discussions: conversations about how his life would end. “My observation about the way people die, at least in America, is they … are not allowed the opportunity to be part of the process,” Shannon says in the film. “The part that bothers me just immensely is not being allowed to be part of that process. It’s my death … Don’t tell me what I have to do.”

Shannon and his family thoroughly researched what he could do to plan out his final moments, Deleaua recalled in June during a panel at the Aspen Ideas Festival, which was co-hosted by the Aspen Institute and The Atlantic. The Shannons consulted with a “death doula”—essentially, a midwife for the process of dying. They visited a local crematorium. And they requested and received a box of “end-of-life medication,” along with instructions for how Shannon should administer the morphine cocktail when he decided it was time. He and Deleaua kept the drug in their bedroom closet until the day he used it.

Alternate Endings, co-directed by Perri Peltz and Matthew O’Neill, follows the Shannons and the families of five other people making preparations for their approaching deaths. The documentary shows their efforts to make dying into something more personal and less foreign—something that can be discussed openly in the regular course of life. Something that can be the province of familiar places and loving communities rather than of unknown experts and strange facilities. In many ways, Peltz observed at the panel, Shannon and the film’s other subjects reflect how America’s “death industry is being disrupted” by a new generation of people.

The movie begins with a broader view of this trend, presenting the latest mourning accoutrements being sold at a funeral convention. The cameras move between exhibits of prerecorded video eulogies, or “life legacies,” delivered by the deceased themselves; eco-friendly caskets; funeral webcasts; cremation urns carved into personalized busts; and “handfuls of home”—canisters of dirt from Ireland that can be spread over far-flung graves to connect them to an ancestral homeland.

Funerals are changing in the U.S., as these displays attest. In 2005, less than a third of Americans opted for cremation over burial; by 2016, more than half were making the same choice. Some families are now holding ceremonies celebrating the deceased’s life in meaningful spaces like parks or bars, rather than seeking out traditional funeral-home services. Death doulas are becoming more popular, and some burials are designed to be environmentally friendly.

Even before his diagnosis, Shannon and his wife were already working to reform the country’s approach to mortality. They lobbied for the passage of California’s End of Life Option Act, which permits doctors to prescribe aid-in-dying medication to terminally ill patients, thus allowing the latter to control the time and manner of their passing. The act was signed into law in June 2016; the Shannons didn’t know at the time how relevant it would become to their own lives, or how quickly.

The family’s advocacy efforts soon took on a more intimate form. Shannon built his own coffin, for instance, and held a life-celebration party for himself. The family also decided, as Deleaua described at Aspen, to keep his body at home for three days after his death for a final viewing without first embalming it. The whole process revolved around the community and the home, involving outside spaces like the hospital and the crematorium only peripherally. And most of all, it was centered on Shannon himself, because he insisted on taking ownership of it.

Every scene in Alternate Endings is weighted with the knowledge that death is coming. But Shannon resists any melodrama, and the documentary shows him being earnestly and routinely alive up until the moment when he isn’t anymore. He jokes with his loved ones; reflects, almost offhandedly, on his choices; even comments on the taste of his end-of-life medication after he drinks it. His verdict: “not bad.” “I think that he’s passed, whatever that means,” Deleaua says in the movie after her husband falls still and silent. “I think that he’s gone.”

There are no euphemisms here, no “died at home” or “succumbed to a long illness.” Instead there are tears and hard questions and breaking-down bodies—the things that are usually only witnessed through real closeness with the dying. “We have mediators we put between ourselves and the process,” O’Neill said at Aspen. “We have a distance and a fear.” But, he concluded, that doesn’t have to be the case, and the first, most essential step toward changing the way that people deal with death is a simple one: “Talk about it.”