Waiting for a Death Revolution: A Review of HBO’s <em>Alternate Endings: Six New Ways to Die in America</em>

Waiting for a Death Revolution: A Review of HBO’s Alternate Endings: Six New Ways to Die in America

I can’t decide what to do with my corpse. Embalming, the bread-and-butter of the American funeral industry, feels wrong. Is cremation a better option for me? Do I want a funeral service where everyone can cry (or celebrate) my departure? Or is it better to just let things go quietly, no ritual required?

The fact that I have a choice at all suggests that I’m part of a new generation of Americans willing to ask difficult questions about the end of life. This shift is the subject of HBO’s new documentary, Alternate Endings: Six New Ways to Die in America (2018, dir. by Matthew O’Neill and Perri Peltz). The film, which runs a little over one hour, introduces viewers to a variety of options for dying and disposal, presumably as an invitation to think about what we want for ourselves when our time comes.

The film’s opening scenes land us in the heart of the funeral industry at the National Funeral Directors Alliance expo. We see a variety of products for the disposition and memorialization of the dead, from a casket fitted with camouflage lining to a holographic technology that allows you to appear (and speak!) at your own funeral. These scenes are interspersed with text alerting us to the industry’s annual revenue of $16 billion, and crediting “baby boomers” with reshaping the industry as they “take control” of end-of-life options. The scenes celebrate all the choices available to us, but do so within the accepted parameters of a funeral industry that stands to profit from these new options. The implication seems to be that choice is always available… if you have the money to pay for it.

Film poster. (©HBO/IMDB)

The expo scenes provide us with a sense of the industry’s scale, but the subject of the film is not the expo or the funeral directors who attended it. Rather, the film contains six short vignettes, featuring people who were either in the process of dying or who were responding to a recent death. Each is focused on an “alternate ending,” though the meaning of this term was only implied. The directors presume the viewer has a general image of a traditional funeral in mind: the embalmed body in a casket, a funeral home chapel filled with flowers, maudlin music, and mourners in black clothing. The vignettes show people who chose something different, strongly emphasizing the value of individual choice in these decisions.

Three of the vignettes feature stories in which a death has occurred, and those left behind who chose non-traditional disposition or commemoration options. Leila hired Memorial Reefs International to deposit her father’s cremains into a concrete “reef ball” and sink it into the Gulf of Mexico to help rebuild coral reefs. Sara hired an aerospace company to place her father’s ashes into the nose of a rocket (along with those of forty-four others) and shoot them into space. The Matthias family memorialized their young son Garrett by throwing an elaborate party — including bouncy houses, superheroes, and fireworks — that honored the boy’s wishes to not have a “sad” funeral.

Barbara Jean also selected an unconventional end, opting for a home funeral and a green burial in a nature preserve, without embalming. Unlike the previous stories, however, we meet Barbara Jean in the final stages of her disease. In this, she overlaps with the remaining two vignettes, which also feature terminally-ill people as they prepare for death. These cases allow us to see examples of dying, and are united by the individuals’ acceptance of death. We watch as Guadalupe says goodbye to his family and friends at a “living wake,” Barbara Jean selects her burial plot at the Eloise Woods Natural Burial Park, and Dick ingests a fatal drug cocktail to end his life under California’s Medical Aid in Dying option.

O’Neill and Peltz allow these stories to speak for themselves with no commentary, to show rather than analyze the shift away from the “norms” of American death care. They never explicitly critique this “norm,” or argue why people should move away from tradition. What’s more, the six stories are presented on equal footing with one another, but this elides the fact that each story represents a distinct kind of rejection of tradition, with only a few truly breaking away from the profit-driven funeral industry. Barbara Jean’s decision to have her family and friends wash, prepare, and bury her body was the most radical form of DIY death care in the whole film. In the cases of Guadalupe and Garrett, we do not know what their families did with their bodies, but it’s likely they worked with a funeral home. Similarly, Leila and Sara’s decision to place their fathers’ ashes in unconventional locations still required the bodies to be cremated. As such, the traditions that are being called into question are cultural traditions of how to die and how to memorialize, not necessarily how to move beyond the funeral marketplace. There is no consideration about how the funeral industry has shaped and controlled our expectations about death, nor how they seek to further capitalize on changing consumer preferences under the guise of “choice.”

“Pre-Need.” (LazyLibrarian/Flickr)

Historians have traced the criticisms lobbed at the American funeral industry since its emergence in the late nineteenth century.1 The industry’s takeover of what had once been a primarily domestic (and female) practice by scientifically-trained male “experts” shares a lot with the history of childbirth in America. Just as women were attracted by the technological promise of pain-free hospital deliveries, so too were Americans enticed by the aesthetic and hygienic promise of embalming, a preservation method that has been the industry’s hallmark service for decades. Then as now, families drawn to the funeral home by embalming were then marketed a range of additional goods and services that funeral directors framed as necessary components of a dignified funeral. While funeral directors have always performed important social and psychological work, the funeral business’s dual obligations to provide intimate services to the bereaved while also profiting off their grief has long been part of the public discourse, especially since Jessica Mitford’s famous 1963 expose The American Way of Death. As such, it is surprising to me that this documentary presents the idea of “alternate endings” so simply, without exploring the historical, socio-economic, or cultural contexts in which we ascribe meaning to funerary practices. Why do people make the choices they make? Are all choices equally valid? What do these choices say about death and dying in the twenty-first century? Is choice truly accessible to all Americans?

Instead, the film’s thesis feels extremely thin: do what you want. As Garrett’s mother stated, “It’s ok to talk about what you want after you pass away… Death doesn’t have to be scary. Hold true to what you want and make it happen.” I agree with such messages that can bring comfort to a viewing public that, by and large, does not discuss what we want done with our bodies until it is too late. In that way, the film taps into the Death Positive movement, though the film never addresses that movement’s work to destigmatize discussions about death. But, ultimately, the film does little to question how much individual choice is still framed by the funeral industry itself. By opening the film at the NFDA expo, we are told that you can do what you want with your body, and there are people who will accept your money to make it happen. I wonder, though, whether seeking alternatives within the industry represents true choice at all. The funeral industry’s history of successfully equating materialism with love makes it hard to break away from tradition.

And what of those Americans who simply cannot afford to spend lavishly for what they want? The film failed to acknowledge that economic disparity can deny some Americans the ability to make such choices. For example, a concrete reef ball from Memorial Reef International costs $5995, which does not include costs associated with the funeral, cremation, or travel to the Gulf of Mexico. A plot at Eloise Woods, where Barbara Jean was interred, costs $2800, plus an additional charge of $1200 for opening and closing the grave for burial. These examples demonstrate that, ultimately, choice is often the privilege of the few. The very poorest members of American society rarely have the chance to think about how they want to die, or what disposal options are best for themselves, their families, or the environment.

The film’s suggestion that these “alternate endings” are an option for everyone is troubling, because it ignores the limits of choice. The death care industry does not need alternate endings as much as it needs radical endings. There are different ways to do this. The starting point is to become better funeral consumers. We need to inform ourselves and ask better questions about the industry. We might become better advocates for those with less consumer choice, doing outreach, education, and fundraising to bring information and support to those who need it. Finally, we might leave the industry all together, reclaiming the body and rejecting its commercialization through the home funeral. None of these are perfect solutions, but can begin to move us beyond the more limited definition of choice we currently have.

Alternate Endings: Six New Ways to Die in America, HBO, 2018, directed by Matthew O’Neill and Perri Peltz.


  1. Gary Laderman, Rest in Peace: A Cultural History of Death and the Funeral Home in Twentieth-Century America (Oxford: Oxford University Press, 2003); Suzanne E. Smith, To Serve the Living: Funeral Directors and the African-American Way of Death (Cambridge, MA: Harvard University Press, 2010); and Jessica Mitford, The American Way of Death (New York: Simon and Schuster, 1963). Return to text.

Vicki Daniel is a historian of American medicine, death, and the body. She earned her PhD in the History of Science from the University of Wisconsin-Madison in 2017 and is currently a SAGES Teaching Fellow and Instructor of History at Case Western Reserve University in Cleveland, OH.