Taboo, safe spaces, and death sociability: A comparative ethnography of two compassionate communities

Compassionate communities are a key public health palliative care strategy for addressing the social determinants of death. However, their evaluations often prioritize health indicators, overlooking the intended social and cultural transformations that are central to this social model. This study addresses this research gap by analyzing the transformative outcomes emerging from two distinct community initiatives.

Building on our prior analysis of community engagement processes, this comparative ethnographic analysis examines the transformative outcomes of two distinct compassionate communities in Montréal, Canada (2021-2023). Data from 84 h of participant observation and 26 semi-structured interviews with 22 participants were analyzed to identify the social and cultural changes resulting from the community-led and institutionally-led models.

Findings demonstrate that local contexts act as active forces shaping which social determinants of death are prioritized, specifically overdose stigma in Centre-Sud and fraud-induced social death in the West Island, thereby dictating unique engagement trajectories toward transformation. A universal outcome was the creation of safe spaces to break the death taboo, which addressed the mismatch between private loss and the lack of collective social scripts. This facilitated the emergence of "death sociability": a reciprocal mechanism for experiential learning grounded in shared recognition of human finitude, which actively builds cultural capital in its embodied (new skills and language), objectified (rituals and shared narratives), and institutionalized (formal recognition of community practices) forms.

Death sociability is a core mechanism through which compassionate communities achieve transformative change, addressing both biological and social mortalities. As an empirically grounded concept, it offers a novel theoretical lens for future research to track social and cultural impacts beyond health metrics. Therefore, supporting the creation of safe spaces where death sociability can thrive is crucial for building the cultural capital needed to advance equity in social determinants of death.