Manifestations of the Positive Death Movement in America:
Medical Aid In Dying, Voluntarily Stopping Eating & Drinking, and End-Of-Life Doulas

Aubrey DeVeny Incorvaia
School of Public Policy – Georgia Institute of Technology
Dissertation Abstract
Western society is in an era of death awareness, its most recent salience: A Positive Death
Movement. This dissertation examines manifestations of the movement, framing them as direct,
indirect, and induced effects of public policy. Policies have intended consequences, off-target
effects, as well as more distant, rippling impacts on society at-large. The empirical research
herein investigates these dimensions of policy’s influence, leveraging an assortment of
theoretical lenses, which originate from policy design, social psychology, and sociology.
Methods incorporate both qualitative and quantitative approaches, tools, and techniques.
Chapter one presents the history of American death culture and overviews the movement for
death positivity and its scholarship. Chapter two shows that implementation of Medical Aid in
Dying (MAID) policy reduces self-harm and undetermined intent death rates for those with
cancer. Specifically, use of regression analysis to generate a difference-in-differences estimation
indicates that implementation of MAID results in a statistically significant 20 percent reduction
in self-harm and undetermined intent cancer death rates, even when controlling for individual
and macro-level risk factors. Chapter three examines a church’s response to Voluntarily
Stopping Eating and Drinking, revealing that a church community may be a source of legitimacy
and support for this end-of-life choice to hasten death in the face of terminal illness. A case study
of one southern Anabaptist congregation employs a focus group and one-on-one interviews
during which study participants reported their affirmation of VSED, but professed uncertain and
conditional involvement in respite care provision post VSED initiation. Responses varied widely
to faith-based justifications for the practice. Chapter four uses analytic autoethnography to
elucidate a new role arising within the system of deathcare, End-of-Life Doulas (EOLDs). Two
EOLD training programs framed their education in hallmark terms of the movement and are
seeking to professionalize the role through the use of functionalist / trait – oriented documents,
an approach aligned with a ‘sociology of professions’ framework. Chapter five concludes the
dissertation by summarizing results and considering opportunities for future research, while also
acknowledging the necessity of addressing ongoing impacts of the coronavirus pandemic and the
racial reckoning currently underway in the United States.