Above ground, or six feet under, “Lonely Planet’s Best in Travel 2009″ guide lists the world’s top 10 cemeteries, which are prime spots for both the living and the dead. Reuters has not endorsed this list.

1. Taj Mahal, India The Taj Mahal in Agra is surely the world’s most [...]]]>

World’s 10 Best Cemeteries - Famous RIP Cemeteries

Above ground, or six feet under, “Lonely Planet’s Best in Travel 2009″ guide lists the world’s top 10 cemeteries, which are prime spots for both the living and the dead. Reuters has not endorsed this list.

1. Taj Mahal, India The Taj Mahal in Agra is surely the world’s most beautiful place in which to push up daisies. The 17th century Mughal emperor Shah Jahan built the mausoleum in memory of his favourite wife, Mumtaz Mahal, using white marble from Rajasthan, crystal from China, turquoise from Tibet and sapphire from Sri Lanka.

2. Pyramids of Giza, Egypt These pyramids on the outskirts of Cairo may date back to around 3,200 B.C. but they’re as space age as tombs get. They pierce the sky, unperturbed by crowds of hustlers, camels and camcorder-toting tourists. An estimated 20,000-30,000 workers built the pyramids, the largest of which is constructed from over two million blocks.

3. Dogon Tombs, Mali A craggy mass rears up from the sun-bleached plan, one of West Africa’s most stunning sights. This is where the remote Dogon tribe lives. Most extraordinary in this extraordinary place are the tombs. These are tiny buildings set into cliffs, often halfway up, with no discernible method of approach.

4. The Non-Catholic Cemetery, Italy This overgrown garden is a surprise in a busy corner of Rome. Romantic poets Keats, who died at the unripe age of 26, and Shelley are buried here. The garden is dominated by a sharp-tipped pyramid: the fanciful tomb of a Roman general with a penchant for Egyptology.

5. Hollywood Forever Cemetery, United States. These immaculate lawns and stately memorials are the final picture for much of Hollywood royalty. The glamorous graves at the back of Paramount studios are a veritable Milky Way of departed glitterati, including Rudolph Valentino, Douglas Fairbanks and Mel Blancs, the voice of Bugs Bunny whose tombstone reads: “That’s all folks”.

6. The Catacombs of Rome, Italy Ancient Roman law forbade burial within Rome city limits. Most Romans were cremated, but early Christians were buried in a series of endless, echoing underground tunnels, out near the old Roman road, the Via Appia. This underground death complex is Rome’s most haunting sight – now empty of bodies but retaining early Christian frescoes, altars and icons.

7. Pere Lachaise Cemetery, France The world’s most visited cemetery has a star-studded afterlife gathering, with residents as diverse as Edith Piaf, Marcel Proust, Oscar Wilde, Honore de Balzac and Isadora Duncan. It was founded in 1804, but languished until the management had the bright marketing plan of moving here the remains of famous people, such as Moliere, to attract business.

8. Tomb of Pacal, Mexico In the foothills of the Chiapas mountains, lie the remains of the ancient Mayan city of Palenque, set in a tangle of jungle. It is a place of cinematic splendour, complete with rolling mist and thick undergrowth. The city’s most famous monument is the Tomb of Pacal (Pacal was the city’s 7th century founder-king), which is located within the glorious Temple of Inscriptions, a steep, stepped pyramid.

9. Hartsdale Pet Cemetery, United States In 1896, Dr. Samuel Johnson, a vet, offered his apple orchard to a bereaved friend as the burial place for his dog. Today, Hartsdale, in New York, has 70,000 graves, including those of some famous war dogs, and a memorial to the Red Cross dogs that served during World War Two. Famous owners who have interred their pooches include Mariah Carey and Diana Ross.

10. The City of the Dead, Egypt This is the most curious cemetery in the world: not only a city of the dead, but of the living. Chronic housing shortages in Cairo have driven families to live in tombs in the large cemeteries on the city’s outskirts. Traditionally, Egyptians buried their dead surrounded by rooms, so that relatives could live in them during the long mourning period. These are now occupied by squatters who use the gravestones as tables.
(This is an edited extract from Lonely Planet’s Best in Travel 2009)

In America, the way we die is largely determined by where we live. Geography dictates what kind of care is provided to the dying and whether death following a long illness occurs at home, in a hospital or in a nursing home. But don’t move just [...]]]>

Top 10 Places To Die. Can You Afford To Die?

In America, the way we die is largely determined by where we live. Geography dictates what kind of care is provided to the dying and whether death following a long illness occurs at home, in a hospital or in a nursing home. But don’t move just yet. Patients can gain control over how they die by talking about end-of-life care with their families and physicians. If patients speak up, sheer numbers will force the health care system to take better care of the dying. Over the next 30 years, the number of people older than 85 will more than double to 9 million.

Top 10 Places To Die

1 Washington
 
2 Oregon
 
3 Delaware
 
4 Colorado
 
5 Hawaii
 
6 New Hampshire
 
7 Iowa
 
8 North Dakota
 
9 Vermont
 
10 Montana

Can We Afford To Die?

NEW YORK – Doctors tend to view every patient’s death as a failure, but one of medicine’s greatest shortcomings is its refusal to fully care for the dying.

“In our attempt to focus so much on cure,” says Kathleen Foley, a neurologist at Memorial Sloan-Kettering Cancer Center in New York, “we forget to care for people the way we should be.”
 
A good number of cancer patients probably die in severe pain, even at the best hospitals. Worse, patients don’t seem to be the ones making decisions about how and where they die. Instead, their care is mostly determined by the habits of their local health care system or hospital. Geography is the biggest factor in whether patients die in an intensive care unit, elsewhere in a hospital, in a nursing home or in their own homes, where most people say they want to die. And the need for better care of the dying is only getting greater as the baby-boom generation gets older–and, eventually, sicker.

Already, end-of-life care is straining the health care system. Half of lifetime health expenditures occur in the senior years. Treating symptoms of pain is far cheaper–and possibly more humane–than extending life by a few months with the newest, most expensive drugs, and treating patients at home is far cheaper than treating them in the hospital. In cases where such measures are better for the patient, why aren’t they always put in place?

“Patients are not looking for better end-of-life care,” says Susan LeGrand, a palliative-care physician at The Cleveland Clinic. “They’re looking for not having to die.” Doctors, patients and families all avoid talking about death–and the need for patients to make their own decisions about how it happens–until the end is very near. “Because they won’t talk about it,” says Sloan-Kettering’s Foley, “patients get themselves into circumstances where they don’t want to be.”

If people don’t decide how they want to die before death is imminent, and discuss that decision with their families and doctors, their location may make the decision for them. For instance, a full 30% of Medicare patients in Newark, N.J., die in an intensive care unit, the least preferable option, compared with just 6% in Bend, Ore., according a Dartmouth University study.

In another study, Joanne Lynn, director of the Washington Home Center for Palliative Care Studies, found that patients’ preferences, their disease and their family situation only had a minor impact in where they died. People were likely to die in a hospital, she found, when there were a lot of hospitals nearby. The problem, Lynn emphasizes, may not be with having lots of hospitals, but with a health system that simply does with the next dying patient what it had done with the one before. For instance, she says, areas where people frequently die at home, not in the hospital, are more likely to have at-home care available. Still, it’s possible that the number of people who want to die at home has to do with the awful job that many hospitals have done in caring for the dying. What patients may mean, Lynn says, is “I don’t want to be stuck in a hospital tormented by machinery and surrounded by a bunch of people in white coats.”

Certainly it is possible for a hospital to do a good job caring for the dying. One shining example is Calvary Hospital, a 200-bed facility in the Bronx that is the nation’s only hospital devoted solely to the care of dying cancer patients. Michael Brescia, who has directed Calvary for 40 years, agrees that hospitals often do too much. “Patients suffer greatly because of it,” he says. But he also thinks that home care, also called hospice care, often does too little for many patients.

“My mother died of cancer,” Brescia says. “She was at home. With me and my expertise, and four sisters taking a leave of absence, it was very difficult on a daily basis to care for her at home the way we wanted to. We ran out of sheets. A lot of people run out of money.”

Hospitals can do a better job. Brescia points out that more than 95% of patients at Calvary have their pain under control within a day of arriving there. He also believes that doctors simply need to spend more time with their dying patients. Moreover, sometimes the basics–like keeping patients clean despite oozing wounds–are as important as new treatments. “Stressful is being at a hospital where there are no sheets and no towels and nobody cares,” says Nancy D’Angelo, a nurse who runs Calvary’s hospice program. Sometimes, making patients comfortable can be as simple as making them what they want for dinner.

All this isn’t that expensive–Calvary spends only $700 per patient per day, a third of what a regular hospital spends. Meanwhile, treating diseases aggressively until the bitter end adds dramatically to health care costs. According to a study in the journal Health Services Research, patients who reach the age of 85 still have a third of their lifetime medical costs ahead of them. Trying to slow cancer deaths by a few months with the latest cancer drugs from ImClone (nasdaq: IMCL – news – people ) and Genentech (nyse: DNA – news – people ) can easily cost several hundred thousand dollars per patient or more.

“If we handed the patient a check for part of that amount,” asks Joanne Lynn, hypothetically, “how many people would take the check and how many would take the treatment?” Says The Cleveland Clinic’s LeGrand, “If we cure breast cancer, if we cure heart disease, people are still going to die. So how much money do we spend to prevent something that’s going to happen anyway? Those are philosophical questions to which I don’t have answers.”

But delivering end-of-life care to cancer patients may be the easiest part. Increasingly, patients die of chronic ailments, such as a weakened heart or Alzheimer’s disease, that can linger on for years. Cancer patients under Medicare are entitled to months of hospice care, but they rarely get it. We don’t know how to care for dying patients over the long haul, or how to pay for that care. But as the baby boomers age, we’re going to have to learn to treat people better as they die. And we’re going to have to ask hard questions about what kind of care we can actually pay for.

“I think it will be wrenching,” says Lynn, “because we’ve been under the illusion that we can afford it all.”