On the morning of Valentine’s Day four years ago, a group of doulas at the end of their lives arrived at the home of Barbara Hazilla in Northern California, just hours after her death.
The volunteers cleaned Barbara’s body, used dry ice to slow decomposition, and then wrapped her body in a shroud of scarves and blankets.
Barbara succumbed to a rare form of breast cancer, diagnosed in 2010. After more than 30 years as a doctor seeing patients die in hospitals, later turned over to funeral homes that have dominated the American death experience for 150 years, Barbara decided to seek treatment at home.
Barbara’s younger siblings, Marya and Jon Hazilla, visited her in Grass Valley on the day of her death. With coffee in hand, the siblings sat at Barbara’s bedside and whispered stories from their childhoods. Barbara lay with her eyes closed, her cheeks sunken and her arms folded.
“Barbara told me that after she died, she wanted privacy for three days,” said Marya Hazilla, 73. “The first thing I asked was, ‘Is this even legal?'”
This summer, a federal judge in Northern California is scheduled to bring clarity to that very issue.
The same nonprofit end-of-life doula organization that helped bury the Hazillas at home is embroiled in a legal battle with the California Cemetery and Funeral Bureau over a nearly century-old law governing funerals.
The dispute began with a subpoena filed against the doulas, which was eventually dropped, prompting them to file a civil suit alleging violation of their constitutional rights. The outcome of the litigation will have major implications for what doulas can legally do in the future and whether doulas need to become licensed undertakers if they are to continue some practices.
The California funeral industry has been regulated by the state since 1939 after a court ruling declared that unlicensed practice in the profession posed a threat to people’s health, welfare and safety. The state Undertaker and Embalmer Act, which has been amended over the years, defines undertakers as businesses that prepare, or direct and oversee the burial or disposal of burial or disposal of dead human bodies, court documents show.
Over the past century, the law has protected consumers who might otherwise fall prey to business schemes or unlicensed funeral homes.
The Times spoke to several funeral homes who believe the industry should and is welcoming new practices, including doulas, and that it is their responsibility to advocate for the transition to a more holistic approach to death care in the United States to arm. However, some doulas said they believe licensed funeral homes perceive doulas as a threat to the longevity of their business and may dissuade families from traditional funeral homes.
Aspiring funeral directors must meet a variety of requirements in order to practice, including earning an associate’s degree, usually followed by training, and maintaining a clean criminal record. From there, individuals can apply for a license through the Cemetery and Funeral Bureau.
Death doulas, also known as end-of-life doulas, focus on the non-medical needs of people near death. Beyond pre-planning, these laypeople—mostly women—also assist with home burials and counsel families and the terminally ill, often educating them about alternative burial practices such as green burials or cremation, rather than more costly services factored into a traditional coffin burial.
The funeral home acts as the supervisory authority and is responsible for issuing licenses to prospective undertakers.
When the Bureau investigated the doulas in September 2019, it found that they were advertising services on their website that it claimed only a funeral home could legally offer. These services include dressing, washing and cooling the body, and scheduling visits and wakes. according to complaint Documents and Transcripts Filed in United States District Court in Sacramento.
“A significant portion of what the plaintiffs have done is illegal,” Diann Sokoloff, a US Department of Justice attorney, said in November 2020.
But a judge issued an injunction, allowing the doulas to practice.
The doulas were then told that if they wished to continue practicing, they would need to obtain a funeral director’s license. Full Circle doulas said they also had to go through the procedural steps to become licensed undertakers, including renting a separate building space for the preparation and arrangement of the bodies. However, Full Circle and doulas across the country do not embalm or treat human remains. If they need a license, they could cost thousands of dollars, they say.
“We’re not funeral homes and we don’t intend to be,” said Akhila Murphy, founder of Full Circle, who is not seeking damages in the case. She and her co-founder Donna Peizer, a retired attorney and joint plaintiff on the case, say they have no interest in going through the funeral director licensing process if it isn’t necessary.
By November 2019, the bureau alleged that Full Circle violated agency regulations, filed a subpoena against them and ordered the nonprofit to halt advertising services until licensed. But in January 2021, the bureau dropped the complaint, calling the investigation “procedurally defective” and containing “inconsistencies,” according to court documents.
Bureau Chief Gina Sanchez confirmed during her testimony in early 2021 that pre-planning end-of-life care does not require a license under current California law.
Funeral home officials declined to comment on the case.
Nonprofit doula certification organizations and universities across the US have been training people to be death doulas for years. Washing and wrapping are not cornerstones of doula practice, but there are doulas who will help with these services or perform these services when a family asks them to, according to several experts and doulas in the field who spoke to The Times.
Kris Kington-Barker, a San Francisco-based instructor with the International End of Life Doula Assn., told The Times that the ceremonial washing and dressing “is not a funeral practice, it is a doula support practice. Your neighbor might do that.”
In 2003, the first end-of-life doula training program in the United States was started by a former New York City hospice worker, Henry Fersko-Weiss, who said he saw what doulas and midwives do for women after childbirth asked why the same care was not offered to the dying. In 2015 he co-founded the International End of Life Doula Assn., which trains doulas across the country. Today there is no official census of doulas in the United States, but experts estimate there are thousands.
Fersko-Weiss told The Times that home burial practices have been going on “since the beginning of time”.
“Doulas are sometimes perceived as a threat,” said Fersko-Weiss, who retired last year. He added that traditional practitioners such as funeral homes or hospices “perceive a home burial as a loss of income.”
“The funeral industry needs an overhaul,” he said. “Doulas can be a real bridge between a family and a funeral home, and in that way, quite frankly, they become a source of referrals.”
Until the 1860s, it was common for Americans to hold funerals indoors. Relatives brushed the hair of the deceased and dressed them while neighbors or churchmates dug graves outside orbuild wooden coffins, according to New Hampshire Funeral Resources, Education and Advocacy, a nonprofit organization dedicated to supporting informed consumer choices about funerals. By 1882, the National Funeral Directors Assn. was founded when Americans began to rely more on professionals to deal with their deceased loved ones.
Home burials are legal in all 50 states, and in recent years, more Americans are dying at home than in hospitals. according to on a 2019 report in the New England Journal of Medicine. Researchers expect the home burial movement to continue to attract public interest as conversations about end-of-life care emerge into the mainstream.
In 1984, the Federal Trade Commission enacted rules that enforced cost transparency between funeral homes and consumers and empowered families. Families no longer had to embalm their loved ones — a service that can cost anywhere from $500 to $1,000. Consumers are finding affordable, creative alternatives to reduce funeral expenses, including purchase Buy caskets from Amazon or even build them from scratch.
“There’s room for everyone,” Rick Woody, Legislative Chairman of the California Burial Authority, told The Times. “We don’t want to force people to use just one type of cookie cutter. We don’t feel threatened by it at all.”
Eddie Tkachuk, 29, the manager of Lassila Funeral Chapels in Auburn, Calif., said his clients are interested in alternative burial methods, such as green burial and cremation, and are interested in pre-planning services such as those offered by doulas.
That interest “went through the roof,” Tkachuk said. “The thing we hear most often is this [customers] feel like you’re in a car dealership’, relating to the relationship between funeral homes and families.
Marya Hazilla said the dignity and serenity of her sister’s funeral at home was a stark contrast to the final days of two other siblings who have died in the past decade. Her older brother Michael spent 84 days in hospital with stomach cancer until he died in 2010 and years later her older sister Paulette, who suffered from dementia and fell in their home, died in hospice care.
“Barbara’s funeral helped heal the trauma of her death,” Hazilla said.
Now in her 70s, Hazilla hopes that when her day comes she will be at her home with her daughter and two remaining siblings. And a doula.
https://www.latimes.com/politics/story/2022-08-30/how-a-decades-old-law-led-to-death-doulas-lawsuit-against-californias-funeral-bureau How a decades-old law led to death doulas’ lawsuit against California’s funeral bureau