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Coffins, Deathbeds, and Funerals; Design Meets Death in Times of COVID-19

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Design for death, dying, and palliative and end-of-life care is a worthwhile emerging field lacking in strategic design contribution and discourse. This article aims to interrogate the core and extremities of the intercourse of design and death; two distinct global contexts i.e. ordinary (2000-2020) and extraordinary times (COVID-19 crisis) are selected and design contributions to a Death Trilogy i.e. Deathbeds, Coffins, and Funerals, are mapped through two rounds of illustrative literature reviews. Emergent design issues in the Death Trilogy are discussed under three categories i.e. Design Interventions, Design Contributions, and Design Potentials. Moreover, a spectrum of emergent themes in the Death Trilogy is mapped according to identified extreme and mainstream scenarios. Findings highlight disproportionate and scarce design contributions to the Death Trilogy during ordinary and extraordinary times, respectively. Design contributions are characterised as interventional, fantastical, object-oriented, and lacking in critical approach. Going forward, priorities for future design interventions and contributions are outlined, and design opportunities around emergent themes are highlighted. The research sets a precedent in navigating strategic contributions and initiating critical conversations between the two fields of design and death, for the first time.
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Coffins, Deathbeds, and Funerals; Design Meets
Death in Times of COVID-19
Design for death, dying, and palliative and end-of-life care is a worthwhile emerging field
lacking in strategic design contribution and discourse. This article aims to interrogate the
core and extremities of the intercourse of design and death; two distinct global contexts i.e.
ordinary (2000-2020) and extraordinary times (COVID-19 crisis) are selected and design
contributions to a Death Trilogy i.e. Deathbeds, Coffins, and Funerals, are mapped through
two rounds of illustrative literature reviews.
Emergent design issues in the Death Trilogy are discussed under three categories i.e. Design
Interventions, Design Contributions, and Design Potentials. Moreover, a spectrum of
emergent themes in the Death Trilogy is mapped according to identified extreme and
mainstream scenarios.
Findings highlight disproportionate and scarce design contributions to the Death Trilogy
during ordinary and extraordinary times, respectively. Design contributions are
characterised as interventional, fantastical, object-oriented, and lacking in critical approach.
Going forward, priorities for future design interventions and contributions are outlined, and
design opportunities around emergent themes are highlighted. The research sets a
precedent in navigating strategic contributions and initiating critical conversations between
the two fields of design and death, for the first time.
coffin, death, deathbed, design, funeral
Design for death, dying, and palliative and end-of-life care is a complex and emerging area,
gaining visibility, momentum, and interdisciplinary interest amongst palliative care
specialists, designers, social and physical sciences experts, and the wider public (Pallister,
2015; IDEO, 2016; End Well, 2017; HELIX, 2017; Reimagine, 2016). Design contributions so
far, however, have been minimal and disjointed, lacking critical knowledge base and strategic
vision (Nickpour, 2019).
Palliative & end-of-life care itself, is delicately and rather uniquely, positioned at one end of
the healthcare provision spectrum. With its holistic and multi-faceted network of
physiological, psychological, social, and spiritual support, and complex patient pathways,
palliative and end-of-life care exposes major challenges as well as unique opportunities for
design interrogations and contributions.
Additionally, arguments around personalised medicine (Lloyd-Williams, 2008),
patient-centred care (Kane et. al, 2015), patient-reported outcomes (Aslakson RA, et. al,
2017), and human centred design (Giacomin, 2015), resonate strongly with wider calls to
reclaim and reimagine end-of-life as a ‘human’, rather than a mere ‘medical’ domain (Davies,
2018). Hence, moving to ‘humanise’ death. Such approach however, requires a wider
transdisciplinary discourse, outlook and collaboration involving design and death (Nickpour,
From a healthcare provision point of view, provided the current mortality trends continue,
by 2040, 160,000 more people in England and Wales will need end-of-life care. This means
an increase of 42.4% in palliative and end-of-life care needs within the next 20 years (Etkind, 2017). Healthcare systems must start to transform, adapt, and prepare now in order to
face the urgent need for well-designed, enhanced, and alternative health and care solutions
towards the end of life. Design driven innovation could play a key role here (Verganti, 2009).
In this paper, design is defined on multiple levels as a physical embodiment, as well as a
process, and a strategy (Design Ladder, 2017). Moreover, it is referred to as an overarching
discipline, spanning Product, Service, Digital, Experience, Graphic, and Strategic Design.
1.1. Death in times of COVID-19
Death has been a definite part of human experience, and a defining part of human condition.
Historically, we are expected to be living longer and experience less mortality and morbidity
(Riley, 2005; Morgan, 2019) and as death has become less common, we have started to
culturally distance ourselves from it (Aramesh, 2016). Hence, when faced with the reality of
death, we are not psychologically well equipped to deal with it. As Feifel (1969) argues “Our
overall socially repressive orientation toward death promotes neurotic concerns about it.”
(p. 292).
However, in the context of a worldwide health crisis, in particular COVID-19 pandemic, we
encounter new, evolving, excessive, and extreme exposures to and manifestations of death.
These include how we can and can not grieve, bereave, and mourn; what difficult
conversations we ought to hold and how; what critical decisions we ought to make; and
choices that expose our ethics as well as esthetics of life and death (Carr, Boerner &
Moorman, 2020; Wallace, et al., 2020; Wang, et al., 2020)
One dominant narrative structure of the 2020 pandemic has been that of a heroic fight
against a villain in the midst of a crisis, where the villain is COVID-19, and the hero is the
human - individually or collectively. In such a narrative, death is the ultimate failure, defined
as a catastrophe and tragedy imposed by the villain. Thus, the signifier of a lost battle,
resulting in a lost life. This helps explain the impressive and varied range of life saving
initiatives and collaboratives within and across a broad range of disciplines.
However, in the face of a pandemic, an immediate and undisputable focus on ‘saving life’ is as
inevitable as is facing and ‘facilitating death’. Nevertheless, this other side of the same coin,
has been less explored, across both design and non-design disciplines.
1.2. Design Meets Death in times of COVID-19
Focusing on the active dialogues between design and death in extraordinary times could help
shed light on both the core of their relationship as well as its extremities; extremes and
mainstreams which might not have been exposed otherwise.
Aiming to interrogate the intercourse of design and death on a foundational and critical level,
while capturing the nature of the COVID-19 pandemic and its extremes, this paper focuses
particularly on the final three stages of death, rather than the whole spectrum of palliative
and end-of-life care. These include ‘deathbeds’, ‘coffins’, and ‘funerals’, and are referred to as
the ‘Death Trilogy’ in this paper.
Three touchpoints of the Death Trilogy have been identified for their universality,
significance socially, culturally, and psychologically, and as this paper argues, for their design
potential. Each touchpoint has many contributing factors; personal preferences,
representatives or next of kin, the wider socio-cultural and professional communities,
religious affiliations, medical recommendations, government requirement, and cost (UK
Government, 2020; Funeral Guide, 2019). Hence, capturing the rich and complex emergent
issues in extraordinary times such as COVID-19 pandemic. Figure 1 outlines the
chronological experience of a non-sudden death, from wide and varying options and
circumstances that converge into the certainty of a deathbed, coffin, and funeral, which then
diverge into the choices and circumstances for final disposition.
Figure 1: Experience of dying converged into the Death Trilogy and diverged into final
2.1. Deathbed
The deathbed is the liminal space where the conscious person becomes the unconscious
body. There has not been a historical focus on the physical deathbed but instead has focused
on the person and their psychological state during death. Psychological fortitude may derive
from subscribed philosophical views such as Stoicism (Bradley, Feldman & Johansson, 2012)
or established religious guidance, such as the fifteenth century Ars Moriendi (Thornton &
Philips, 2009). There are often external rituals performed, such as religious Last Rites (The
Art of Dying Well, 2020a,b,c) or from specific geo-cultural areas and communities. (Donnelly,
Michael & Donnelly, 2006; Frisby, 2014; Hermer, 2017). All of these influences are to ensure
to their best ability that the dying achieves a ‘good death’.
There are no prominent “deathbed designs”. However, there are multiple examples of
designs for comfortable and multi-functional hospital beds (Wiggerman, et al., 2019; Innova
Care Concepts, 2017; OSKA, 2018), hospice beds (Hudson, 2018), and even specific
guidelines for placements of beds within hospices (Verderber, 2014), these designs focus on
the built environment, medical requirements and user interaction design.
2.2. Coffin
The coffin as an object has stayed similar for thousands of years (Lloyd-Smith et al., 2013).
Coffins are the vehicles which remove the body from the living world and to the deceased's
final disposition. Coffins, first and foremost are practical, and must meet certain design and
engineering specifications as a functional and usable transportation device.
The coffin is the first iteration of the deceased as deceased and the opportunity to
demonstrate values and status that sum up their identity and attitude towards life and death
(Richins, 1994). If unplanned, a coffin could also become a source of conflict with the close
family (Parsons, 2003), demonstrating the importance of the deceased identity and this life
encompassing object.
2.3. Funeral
Holloway (2013) describes a funeral as “a physical procedure - disposal of the body -
encapsulated in a ritual social process, which demands a philosophical response on the part
of the individual concerning the relationship between life and death” (p.53). It is a point of
collective grief and remembrance with symbols that can relate to geographic culture
(Geschiere, 2005; Cohen, 1985), memories from close family and friends (Adamson &
Holloway, 2013) and our online networks (Gibbs, et al., 2014; Schaubert, 2019; Elliot, 2019).
As we move further from secular funerals (Holloway, et al., 2013) there is an increase in
innovation, inclusion of technologies, and personalisation according to the Co-op funeral care
trend 2019 report (Co-op, 2019). Participation in funeral rituals seem to have positive
results psychologically in the short and long term (Kaldestad & Danbolt, 1991), as well as
helping individuals move toward acceptance of death and potentially preparing them for
future losses (Hayslip et. al, 1999). Even in cases of ‘pauper funerals' which have been an
increasing trend in England & Wales, a short service is provided by a funeral director (BBC
News, 2019), showing that the funeral is not merely important for those who are close to the
deceased, but also as a society.
Design contributions to death trilogy are used as a starting point to analyse design mindsets,
practices, and gaps in the field (Carlgren et al., 2016). Capturing design contributions in both
ordinary and extraordinary times could help outline both the core and the extremities of the
current landscape of design and death. Hence, an illustrative review of design contributions
to the death trilogy is conducted within two distinct contexts. These include ordinary times
(between 2000-2020) and extraordinary times (COVID-19 crisis - January 2020 to July
2020). For the extraordinary context, both design and non-design contributions are
explored in order to capture emergent extremes and gaps.
The data collection search protocol centred on electronic database searches to identify
evidence of contributions. Search databases included: Compendex, Scopus, PubMed, Web of
Science, Science Direct, Google Scholar, Google Images, and Open Grey. Search strings were a
combination of keywords relating to design and death categories and specific emphasis was
given to capturing grey literature, unpublished fieldwork, and artifacts. Captured design
contributions to death trilogy were classified under the four categories of contributions i.e.
Interventional, Theoretical, Methodological or Empirical (Wobbrock, 2016). Table 1 outlines
the contribution classification system.
Table 1. Classification of Death Trilogy Design Contributions
New or improved products,
services, systems, or artifacts.
I.1 - Intervention was
implemented or
I.2 - Intervention remained a
concept or prototype.
T - Conceptual models,
frameworks, policies,
principles or important
variations on those that
already exist (e.g. death
M - Novel or refined
methods, processes, or
techniques with
sufficient detail to be
replicated by others.
E - Data sets, surveys,
arguments or findings
based on empirical
research which reveal
formerly unknown insight
and analysis of behaviours,
capabilities, or interactions
with interventions.
3.1 Design Meets The Death Trilogy; Ordinary times
Table 2 summarises key findings from the illustrative review of design contributions to the
death trilogy between 2000 and 2020. In total 23 out of 121 designs were chosen as wide
ranging examples of where the death trilogy meets design in ordinary times. Top reasons for
exclusion included; design intervention with no evidence or intention to be commercialised
or to exhibit, replications of an existing contribution, and minor aesthetic modifications to an
existing contribution. Details including Theme, Design Discipline, Year, and Type of
Contribution were captured for each contribution under the ordinary times (Table 2).
Out of the total 23, %92 (N=21) of contributions were classified as Interventional. More than
half of these Interventional contributions (48%, N=11), however, remained as a concept or
prototype and only %44 (N=10) were implemented and commercialised. 4% (N=1)
remaining was Empirical and Interventional, 4% (N=1) was Methodological, and none were
considered Theoretical.
Table 2. Design Contributions towards the Death Trilogy in ordinary times.
Design Discipline
Contribution Type
Latera Thema; bed that tilts for
ease of patient access
Bed mobility / Patient care /
Home aesthetic
Furniture Design
Intelligent system for automatic
movements of a robotic-assisted
hospital bed
Bed mobility / Responsive
Design /
Robotic Bed
Engineering Design
Bed positions for medical and
patient comfort
Bed position / Patient comfort /
Medical efficiency
Engineering Design
Furniture Design
Centrella bed; Human-Centered
Design Process for a Hospital
Care-giver focused / Patient
safety and care / IoT /
Responsive design
Human centred Design
E / I.1
Mesh paneling for side rails
Home aesthetic / Patient
safety / Home vs. hospital bed
Furniture Design
Volka, Vis-à-vis; Bed separates
and inclines into bed and side
Human mobility / Seated
Furniture Design
End of Life Care Machine
Loneliness on the deathbed /
Human interaction
Product Design /
Interaction Design
Voice Actuated Hospital Bed for
Patient Care
Bed mobility
Engineering Design
DIY, or How To Kill Yourself
Anywhere in the World for Under
$399; Book with instructions to
hack IKEA products into a coffin
Instructional / DIY
Flat pack
Graphic Design
Capsula Mundi; biodegradable
Dispersal /
Biodegradable /
Industrial Design
Infinity Burial Suit; biodegradable
full body suit with a mix of
mushroom and microorganism to
aid environmental decomposition.
Dispersal /
Biodegradable /
Textile Design
Ecology Design
Afterlife; Coffin that turns a body's
chemical energy into electrical
energy via a microbial fuel cell.
Energy Transference /
Furniture Design / Product
Design / Electric Design
Biochemical Design /
Tommerup Kister; high design
aesthetic coffin
Aesthetic focused /
Product Design
Shade Ritual, Iefke
Rituals / Emotional /Tactile
Textile Design
"Emergence" Design For Death;
Biodegradable coffin
Dispersal /
Product Design / Material
Kassiewijle; high design aesthetic
Aesthetic focused / Material
Exploration / Self Expression
Product Design / Furniture
Design / Art
Christann; Flatpack coffin made of
Eco Friendly / Flat pack
Furniture Design
Leaves; Ritually woven shroud of
biodegradable rope with
mushroom spores embedded
Biodegradable /
Ritual /
Textile Design
Die Fabulously; high fashion
aesthetic death shrouds.
Self Expression /
Fashion focused
Fashion Design
Natural endings; Ecology focused
funerals and Burials
Customer led / Nature focused
burial / Humanist
Service Design
One Room Streaming;
Online streaming and viewing for
Digitally present / Streaming
and Recording
Service Design
Three Ordinary Funerals,
Common Accounts
Funeral, Disposal, Memorial
Ecology / City Planning /
Digital Memorials
Service Design /
Poetic Endings; Independant
bespoke funerals
Customer led design /
accommodating of
customisation to any aspect.
Service Design
3.2. Design Meets The Death Trilogy - Extraordinary times
Table 3 summarises key findings from an illustrative review of contributions to the death
trilogy during COVID-19 crisis, between January and June 2020. In total, 14 contributions
were chosen out of 39 as wide ranging examples of contributions in extraordinary times.
These were not limited to design contributions only and could be from any field. Top reasons
for exclusion included; non-specific to the death trilogy, and focus on prevention of death.
Details including Item and Summary, Authority and Region, Theme, Discipline (leading and
contributing) and Design Contribution (actual and potential) were captured for each
Unlike ordinary times, the majority of contributions to the death trilogy during COVID-19
crisis are focused on deathbeds and funerals, rather than coffins (Deathbed=6; Coffin=3;
Funeral=5). Reflecting the pandemic nature of the crisis, contributions show an element of
worldwide distribution (International=6; South America=3; Europe=2; North America=2;
Asia=1). Key emergent themes include quick adoption and repurposing of technologies into
disciplines and by communities; high efficiency and control; and digital goodbyes.
Table 3. Design Contributions towards the Death Trilogy in extraordinary times.
Item /Summary
Authority / Region
Discipline (leading/
Design Contribution
Practical etiquette
advice and guidance
during COVID-19
The Centre for the
Art of Dying Well at
St Mary's University
/ International
Research Institute /
Graphic image attached to the
website with important
Emergency Bed
Two pandemic
hospital beds
Research Institute /
Manufacturing Design
Flat pack beds with varying
ergonomic features and options.
Virtual final
Hospital /
Medical / Communication
Service design /
Refined experience design and
Cardboard hospital
bed convertible into a
ABC Display/
Engineering Design /
Manufacturing Design
Invention of a new product
combining two existing products
together. / A way to add value,
ritual and identity to the coffin.
Patient medically
isolated from hospital
to grave
Hospital/ Indonesia
Raised a design issue
Solutions for
combating loneliness
and improving health
during isolation;
digital connections,
use of PPE or pet
Hospital /
Phycology / Service Design
Contribution of a novel solution
to deathbed loneliness. / Pets
as part of a service looking to
enhance a sense of connection
during isolation.
Airtight steel coffin
Platinum Casket
Company/ Mexico
Engineering Design /
Manufacturing Design
Living focused coffins with the
health of the living brought
forward. /
Co-designing with medical
experts and customers to reach
a marketable and medically
sound product.
Increase in mass
New York State /
City planning
Raised a design issue. /
Funeral service for those
unclaimed and a public
memorial in dedication
Cardboard coffins
being issued by the
Government Policy
Emergency system acceleration
Increased capacity for online
and in person registry for deaths
and community collection of
Digitally streaming
Funeral Directors /
Funerary / UX Design
Adopting technologies and
combining them into a service. /
Growth in streaming services
specifically for funerals e.g one
room streaming
Experimentation with
Individuals /
UX Design
Adapting technology and
services for the purpose of
funeral and mourning rituals. /
Demonstration, opportunity for a
framework and dedicated
platform for digital rituals
Banning of funerals
(March 9th - May 4th)
Government / Italy
Government Policy /
Raised a design issue /
Digital solutions and
Government led memorial for
those whose funerals could not
be attended.
“Drive-in theatre”
service experience
adapted to a funeral
Funeral Directors /
Funeral Services / Creative
Adapting a cultural
entertainment service. /
Advancement of funeral
In-game funeral held
for a player of a
Individual /
No discipline
Facilitation of online
communities that suffer physical
loss are able to commemorate. /
Advancement of online funerals.
An illustrative review of design contributions to the deathbed trilogy during both ordinary
and extraordinary times helped uncover certain design issues, gaps, and questions. Emergent
themes based on the interrogation of data are discussed under three categories i. e. Design
Interventions, Design Contributions, and Design Values. Moreover, a Map of Design Extremes
and Mainstreams in Death Trilogy is devised through a comparative analysis of emergent
themes during COVID-19 pandemic and in ordinary times, and discussed in the Design
Values section 4.3.
4.1. Design Interventions
An illustrative review of design contributions to deathbeds, coffins, and funerals renders an
imbalanced and polarised presence in the death trilogy, as the design contributions are
predominantly focused on coffins, in both ordinary and extraordinary times. Designers’
fascination with, and fantastical approach to coffin is in contrast to the scarce and limited
design discourses and contributions around funeral and deathbed space. If design is to
rigorously embrace and critically meet the death trilogy, there needs to be a push beyond the
‘designer death’ and aspirational coffins, into the complex psychosocial and physiological
domain of palliative and end-of-life care i.e. design for better more meaningful deathbed
experiences and funeral services. This is well echoed through the shift of priorities and
contributions during
4.1.1. Deathbed experience
There is little evidence of design engagement with deathbeds beyond a speculative and
critical design stance, e.g. “End of Life Care Machine” installation critiquing technology within
intimate moments (Chen, 2019). Understanding that hospices care for those with a terminal
illness, hospice beds could act as a deathbed although not explicitly stated.
Interior design recognises the importance of space and family presence but hospice bed
designs are still primarily focused on comfort, home furniture aesthetics, medical
accessibility, mobility of the person in and out of the bed, and of the movement of the bed
itself within a building (Innova Care Concepts, 2020; Medisave, 2020; OSKA, 2020). Hence,
the design focuses one a combination of hospital bed (body positioning, safety rails, ability to
easily move around a building) and familiar home aesthetic (wood, lawn chair mesh, etc.).
These hospice beds, therefore, neither recognise death, nor are designed around the dying
process. They prioritise the physiological norms and processes of life and the living, instead.
While the physical design of deathbeds has been reduced into cheap and efficient material
and the bare minimum during COVID-19 pandemic, there has been a sustained, if not
increased, need and want for deathbed conversations and final connections. Digital
technology has helped facilitate such virtual conversations and ‘digital goodbyes’ is a
recurring theme, in particular. Nevertheless, this raises a fundamental question around the
definition and role of a deathbed beyond an object and as an experience defined by the
context (time, place, and interactions), the people, and the object (bed itself). Accordingly,
the design contributions should not necessarily aim at the physical bed itself, but towards
the multitude of deathbed experiences, such as final conversations.
4.1.2. Coffin Obsession
Design has kept death at an arm's length, dealing with the inanimate part of death and dying
by re-inventing the coffin or other death-related objects (Turner, 2009; Sturkenboom, 2012).
The common design themes include ecological concerns where the focus is designing the
dispersion of the self rather than disposal (Capsula Mundi, 2003; Coeio, 2008; Rumble et al.,
2014; Garfield, 2019), and ideological concerns to facilitate final self-expression (Yalcinkaya,
2019; Bragado & Gertier, 2017).
The obsession of the design world with the coffin could be interrogated through multiple
angles. Taboo creates easy notoriety, novelty, and shock, which could be a playing ground for
design. Moreover, coffins and designers stay conveniently close because of familiarity with
“the object”. The coffin could also be considered the focus of a funeral, in a way it is the root,
the base to all other aesthetic symbolisms as well as socio-economic status.
Similar to the common notions of ‘designer clothes’ and ‘designer bags’, ‘designer death’
portrays a rather high-end, elitist, and fantastical approach to death and dying, with a heavily
stylised material culture and design language. This approach is evidenced in coffin designs
where themes of ecological moral ground, dispersion, and self expression (aesthetics and
ritual focused) are most evident. As coffins are the most representative design contribution
within the death trilogy, both in terms of volume and visibility, ‘designer death’ could be
argued as representing the totality of design presence in and approach to the death trilogy.
Coffins during ordinary times are objects of identity, expression, and status. During
extraordinary times of extreme mass death, however, they can be devoid of this and stripped
to their basic function. Accordingly, one design response in Central America seeks to support
an overwhelmed system unable to keep up with the demand, through distribution of
cardboard-designed coffins. A clear shift in the ‘designer death’ approach is observed during
COVID-19 pandemic with no prominent coffin interventions focusing instead on
transmission prevention.
4.1.3. Funeral services
Funerals demonstrate the least notable design contributions, and the most notable
opportunities for service design interventions. Designers have engaged with final moments
of life, including prominent moments from IDEO and the Design Council to work towards
design solutions (IDEO, 2016; Mooallem, 2016; Pallister, 2019), however, it is not directly
focused on funerals.
Trendwise, there is an increase in individuality and inventions with symbolic meaning to the
socio-cultural community. Customer led, digital, and ecological funerals are amongst the
most common themes, highlighting great potentials for funeral services benefiting from
design input. Although, while secularism deceases we find symbolism and the psychological
support of a funeral still important as it morphs to apply meaning to location and
Denying funerals could create a lot of grief and even a marginalised funeral could create
complicated grief (BBC, 2020). Wallace, et al. (2020) argue funerals in times of extreme can
be a time of flourishing creativity to those with the tools to do so, otherwise they could be a
source of complicated grief. Furthermore, the distress associated with bereavement is
compounded by older adults’ social isolation, co-occurring stressors, and loss of face-to-face
mourning rituals (Carr, 2020; BBC, 2020)
Digital technology is one major theme during COVID-19 pandemic, facilitating virtual
funerals and creating new digital rituals and memorials to express emotions during and after
funerals. As such, these extraordinary times have highlighted the significance of being
present at a funeral, even digitally, as well as relying on digital networks for support, that
traditionally would be made up of local communities.
4.2. Design Contributions
Contributions to a certain topic could range across four overarching categories i.e.
Interventional, Theoretical, Methodological or Empirical (Table 1). In the case of design
contributions to the death trilogy however, there exists a stark disproportion where more
than 90% of design contributions are interventional with no theoretical and extremely
limited methodological or empirical contributions. Moreover, more than half of these
interventional contributions have remained as concepts or prototypes and did not make it to
the market.
This raises the fundamental question whether potential theoretical, methodological, and
empirical contributions of design to death are left unacknowledged from the outset, hence,
neither investigated nor documented. Such rush into interventional and operational design
contributions, is archetypal of design’s ‘problem-solving’ approach, and would risk obscuring
the broader and potentially significant theoretical, methodological, and empirical design
contributions to death (Nickpour, 2019).
In the context of ‘problem framing’ however, design contributions to death could focus on
interrogating and reimagining dominant and alternative societal narratives, sociotechnical
imaginaries, and genres (Venditti et al., 2017; Taylor, 2003; Jasanoff & Kim, 2013) of death.
Such theoretical contributions could be further enhanced through methodological design
contributions adopting methods of designing for alternative future contexts such as
Speculative and Critical Design, and Design Fiction (Dunne & Raby, 2013). Design
contributions to death should move beyond being interventionally-focused by placing
greater value on theories, methodologies, and empirical research. This in turn could
stimulate and inform interventional contributions through helping critique, alter, and
reinvent the material-discursive world of death through design (Hamraie, 2017).
4.3. Design Themes/opportunities
Figure 2 maps the spectrum of emergent themes for deathbeds, coffins, and funerals, through
a comparative analysis of contributions during ordinary and extraordinary times. The
horizontal axis is representative of the breadth of these themes occuring in contrasting times
and a summation of contributions that have occurred in those extremes.
Each theme helps inform definitions and dimensions of the Death Trilogy and could be
explored as a design potential, summarised below.
-Deathbed; Design for digital and physical goodbyes; Deathbed conversations;
Deathbed etiquette; Multi-sensory connections
-Coffin; Design for respect and status; Self expression; Ethics and aesthetics;
Symbolism and meaning; Materiality
-Funeral; Design for loss, grief and bereavement; Rituals; Digital and physical
Figure 2: Spectrum of Emergent themes in the Death Trilogy in Diverse Times
This research sets a precedent in navigating strategic contributions and initiating critical
conversations between the two fields of design and death for the first time, through
interrogating design contributions to coffins, deathbeds, and funerals during ordinary
(2000-2020) and extraordinary (COVID-19 crisis) times. Findings highlight disproportionate
and scarce design contributions to the Death Trilogy during ordinary and extraordinary
times, respectively. Current design contributions are characterised as interventional,
fantastical, object-oriented, and lacking in critical approach. Table 4 summarises current
approaches to and future suggestions for Design Interventions, Contributions, and Potentials,
where design meets death.
Table 4. Design meets the Death Trilogy; Interventions, Contributions, and Potentials
Design Interventions Current Future
Function and Comfort
Interaction and Meaning
Designer death
Human-centred death
Accessible and viable
Market release
No design
Process centred
Service design
Human centred
Design Contributions Current Potential
Products & services
Narrative and social
Products & services
Design Potentials - emergent themes
- Deathbed conversations
- Digital and physical goodbyes
- Deathbed etiquette
- Multi-sensory connections
- Respect and status
- Ethics and Aesthetics
- Symbolism and meaning
- Materiality
- Digital and physical goodbyes
- Ritual design
- Design for grief and bereavement
5.1 Limitations & Future Research
The literature review had a global remit, however, the single-language search protocol meant
the non-English literature was excluded. Furthermore, despite attempts to go beyond a
euro-centric geographic and cultural perspective, both elements of data collection and
analysis could be further interrogated to reflect a truly global perspective. There was an
explicit focus on the last three touchpoints of death for reasons previously stated. Further
research could enhance the initial scope beyond the Death Trilogy.
Future design interventions, potential design contributions, and emergent design themes
identified in Table 4 could help significantly inform and steer future research in the field;
acting as a blueprint to establish and facilitate a theoretically and empirically informed
research agenda within this fascinating emerging field.
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... Death has rarely been discussed in design studies, and design contributions are extremely rare. Farnaz Nickpour (2019), a design scholar who is interested in the design for the end of life, notes that the design for death proposals is "interventional, fantastical, object-oriented, and lacking in a critical approach" (Tibbles & Nickpour, 2020) and that "design contributions in end-of-life are rather limited in scope and depth, disjointed, and mainly operational and incremental, in form of interventions and initiatives" (Nickpour, 2019). ...
... It should situate critical discourses and restructure the materialdiscursive world of death. Design is still underdeveloped in terms of understanding and interrogating the taboo topic of death, and it still focuses on object-oriented design approaches, as Tibbles and Nickpour (2020) identify: (a) the design of the deathbed, (b) the design of the coffin, and (c) the design of the funeral. ...
What alternative narratives can be imagined for the future of death? This essay aims to conceptualize the term “More-Than-Death” depending on an urgent concept of “More-Than-Human”. By revisiting “tabooed death” from a speculative design, the authors consider the possibility to release the death argument from “life exceptionalism,” reconsidering the meaning and relationship of life and death and, more broadly, death and others’ life and earth. It is true that discussing death itself can be naïve, and the relationship between death and life must be discussed carefully. However, it is also necessary to consider the various negative possibilities of turning away from the discussion of death and stopping to think about it. We propose a speculative design perspective because it is concerned with the consequences and implications of today’s actions on the future of humanity. Consequently, this paper attempts to interrogate the tabooed topic of death from critical and speculative standpoints and to cross the boundaries of controversy between death and life in design.
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COVID-19 fatalities exemplify “bad deaths” and are distinguished by physical discomfort, difficulty breathing, social isolation, psychological distress, and care that may be discordant with the patient’s preferences. Each of these death attributes is a well-documented correlate of bereaved survivors’ symptoms of depression, anxiety, and anger. Yet the grief experienced by survivors of COVID-related deaths is compounded by the erosion of coping resources like social support, contemporaneous stressors including social isolation, financial precarity, uncertainty about the future, lack of routine, and the loss of face-to-face mourning rituals that provide a sense of community and uplift. National efforts to enhance advance care planning may help dying patients to receive care that is concordant with the preferences of them and their families. Virtual funeral services, pairing bereaved elders with a telephone companion, remote counseling, and encouraging “continuing bonds” may help older adults adapt to loss in the time of pandemic.
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The COVID-19 pandemic is anticipated to continue spreading widely across the globe throughout 2020. To mitigate the devastating impact of COVID-19, social distancing and visitor restrictions in healthcare facilities have been widely implemented. Such policies and practices, along with the direct impact of the spread of COVID-19, complicate issues of grief that are relevant to medical providers. We describe the relationship of the COVID-19 pandemic to anticipatory grief, disenfranchised grief, and complicated grief for individuals, families, and their providers. Further, we provide discussion regarding countering this grief through communication, advance care planning, and self-care practices. We provide resources for healthcare providers, in addition to calling on palliative care providers to consider their own role as a resource to other specialties during this public health emergency.
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End-of-life is a profound and inevitable part of life, and thus, human condition. It raises significant and critical questions around the meaning, purpose, fairness and quality of life, on multiple individual, inter-personal, and societal levels. Design for end-of-life is an emerging area, gaining visibility and interdisciplinary interest. Current contributions around design and end-of-life are however, limited and disjointed, lacking in critical knowledge base and strategic vision. While valuable, such rush into interventional, operational and incremental contributions, is archetypal of design’s ‘problem-solving’ approach, and would risk obscuring the broader and potentially significant theoretical, methodological, and empirical contributions between design and end-of-life. This paper argues the case for adopting a ‘problem framing’, 'transdisciplinary', 'systemic' approach to this fascinating emerging field. By initiating, for the first time, a theoretically and empirically informed critical discourse between the two fields of design and end-of-life, critical questions, strategic opportunities, and significant contributions between the two fields could be identified and outlined.
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Objectives Although many well-known poems consider illness, loss and bereavement, medicine tends to view poetry more as an extracurricular than as a mainstream pursuit. Within palliative care, however, there has been a long-standing interest in how poetry may help patients and health professionals find meaning, solace and enjoyment. The objective of this paper is to identify the different ways in which poetry has been used in palliative care and reflect on their further potential for education, practice and research. Methods A narrative review approach was used, drawing on searches of the academic literature through Medline and on professional, policy and poetry websites to identify themes for using poetry in palliative care. Results I identified four themes for using poetry in palliative care. These concerned (1) leadership, (2) developing organisational culture, (3) the training of health professionals and (4) the support of people with serious illness or nearing the end of life. The academic literature was mostly made up of practitioner perspectives, case examples or conceptual pieces on poetry therapy. Patients’ accounts were rare but suggested poetry can help some people express powerful thoughts and emotions, create something new and feel part of a community. Conclusion Poetry is one way in which many people, including patients and palliative care professionals, may seek meaning from and make sense of serious illnesses and losses towards the end of life. It may have untapped potential for developing person-centred organisations, training health professionals, supporting patients and for promoting public engagement in palliative care.
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Background Current estimates suggest that approximately 75% of people approaching the end-of-life may benefit from palliative care. The growing numbers of older people and increasing prevalence of chronic illness in many countries mean that more people may benefit from palliative care in the future, but this has not been quantified. The present study aims to estimate future population palliative care need in two high-income countries. Methods We used mortality statistics for England and Wales from 2006 to 2014. Building on previous diagnosis-based approaches, we calculated age- and sex-specific proportions of deaths from defined chronic progressive illnesses to estimate the prevalence of palliative care need in the population. We calculated annual change over the 9-year period. Using explicit assumptions about change in disease prevalence over time, and official mortality forecasts, we modelled palliative care need up to 2040. We also undertook separate projections for dementia, cancer and organ failure. ResultsBy 2040, annual deaths in England and Wales are projected to rise by 25.4% (from 501,424 in 2014 to 628,659). If age- and sex-specific proportions with palliative care needs remain the same as in 2014, the number of people requiring palliative care will grow by 25.0% (from 375,398 to 469,305 people/year). However, if the upward trend observed from 2006 to 2014 continues, the increase will be of 42.4% (161,842 more people/year, total 537,240). In addition, disease-specific projections show that dementia (increase from 59,199 to 219,409 deaths/year by 2040) and cancer (increase from 143,638 to 208,636 deaths by 2040) will be the main drivers of increased need. Conclusions If recent mortality trends continue, 160,000 more people in England and Wales will need palliative care by 2040. Healthcare systems must now start to adapt to the age-related growth in deaths from chronic illness, by focusing on integration and boosting of palliative care across health and social care disciplines. Countries with similar demographic and disease changes will likely experience comparable rises in need.
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In his seminal book on the historical periods of Western attitudes toward death, Philippe Aries describes four consecutive periods through which these attitudes evolved and transformed. According to him, the historical attitudes of Western cultures have passed through four major parts described above: “Tamed Death,” One’s Own Death,” “Thy Death,” and “Forbidden Death.” This paper, after exploring this concept through the lens of Persian Poetic Wisdom, concludes that he historical attitudes of Persian-speaking people toward death have generally passed through two major periods. The first period is an amalgamation of Aries’ “Tamed Death” and “One’s Own Death” periods, and the second period is an amalgamation of Aries’ “Thy Death” and “Forbidden Death” periods. This paper explores the main differences and similarities of these two historical trends through a comparative review of the consecutive historical periods of attitudes toward death between the Western and Persian civilizations/cultures. Although both civilizations moved through broadly similar stages, some influential contextual factors have been very influential in shaping noteworthy differences between them. The concepts of after-death judgment and redemption/downfall dichotomy and practices like deathbed rituals and their evolution after enlightenment and modernity are almost common between the above two broad traditions. The chronology of events and some aspects of conceptual evolutions (such as the lack of the account of permanent death of nonbelievers in the Persian tradition) and ritualistic practices (such as the status of the tombs of Shiite Imams and the absolute lack of embalming and wake in the Persian/Shiite culture) are among the differences.
The modern hospital bed is a sophisticated medical device, and its users represent a diversity of abilities and needs. To develop a new bed, Hill-Rom studied these users in nearly 500 hr of observation across 29 hospital units. Focus groups were used to evaluate early concepts, and formative usability testing included over 130 users to evaluate design prototypes. This research and testing resulted in the development of the Centrella bed, which includes new features to address patient satisfaction, patient safety, and caregiver efficiency. The resulting design is the winner of the 2017 Stanley Caplan User Centered Design Award.
Context: Assessment tools are data collection instruments that are completed by or with patients or caregivers and which collect data at the individual patient or caregiver level. Objectives: To (1) summarize palliative care assessment tools completed by or with patients or caregivers, and (2) identify needs for future tool development and evaluation. Methods: We completed: (1) a systematic review of systematic reviews; (2) a supplemental search of previous reviews and websites, and/or (3) a targeted search for primary articles when no tools existed in a domain. Paired investigators screened search results, assessed risk of bias, and abstracted data. We organized tools by domains from the National Consensus Project Clinical Practice Guidelines for Palliative Care and selected the most relevant, recent, and highest-quality systematic review for each domain. Results: We included ten systematic reviews and identified 152 tools (97 from systematic reviews and 55 from supplemental sources). Key gaps included: no systematic review for pain and few tools assessing structural, cultural, spiritual, or ethical/legal domains, or patient-reported experience with end of life care. Psychometric information was available for many tools, but few studies evaluated responsiveness (sensitivity to change) and no studies compared tools. Conclusion: Few to no tools address the spiritual, ethical, or cultural domains or patient-reported experience with end of life care. While some data exists on psychometric properties of tools, the responsiveness of different tools to change and/or comparisons between tools have not been evaluated. Future research should focus on: developing or testing tools that address domains for which few tools exist, evaluating responsiveness, and comparing tools.
This paper explores concepts of good and bad deaths, social death and anticipatory grief through an ethnographic exploration of the processes of preparing for death in Lihir, Papua New Guinea. Lihirians shape their dying process through the preparation and care of the aged and dying person, ritually, practically and emotionally. Without this process of preparation, grief and the mourning period has a different character to it, and can be much more difficult for mourners. In this preparation, care for the person is emphasised. This does not constitute withdrawal from the ageing person or a form of social death; rather, a social death is indicated and constituted by a lack of care provided to the person or to their gravesite, rather than the completion of ritual processes. Reflecting more broadly, the paper suggests that the concept of anticipatory grief needs to be reconsidered as it often conflates physical and social deaths, and hence conceptually divides grief into pre- and post-physical death phases. Also, conceptually, anticipatory grief tends to deflect attention from the processes of care for the ageing and dying.