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Emily Hoffman was walking home from lunch in the Pittsburgh neighborhood of Squirrel Hill in February 2023, when a driver turning left struck her on the crosswalk.

Hoffman was 34. By the time paramedics arrived on the scene, she had gone into a traumatic cardiac arrest. They strapped her onto a machine that delivered automated chest compressions and rushed her to UPMC Presbyterian, a major trauma hospital in Pittsburgh.

Over the next several days, doctors performed multiple surgeries, kept Hoffman on a ventilator, and waited until she was stable enough for an MRI. The scans showed multiple strokes and severe traumatic brain injury. She was alive, but her family understood that she was not going to make a meaningful recovery to a life she would have wanted.

The next Thursday, a week after the crash, Emily’s parents and her sister Beth Hoffman met with the care team and decided to remove ventilator support to allow her to die naturally. Organ donation came up only afterward. Emily was already a registered donor, and Beth knew it was what her sister wanted.

For most of the short history of organ transplantation, Emily would not have been the usual kind of organ donor.

Almost all transplanted organs once came from patients who died in one specific and rare way called brain death, in which the brain has irreversibly stopped functioning, even as machines keep the heart beating and the organs supplied with oxygen. Brain death is extraordinarily rare,  but it happens often enough to create a workable — though far from sufficient — supply of life-saving organs.

But Emily was not one of the brain-death donors. Even after the strokes and brain injury, she still had some reflexes. She was dying, but not brain dead.

Her donation followed a different path, one that has transformed American transplantation in the last decade. It is called donation after circulatory death, or DCD. Instead of death being declared because the brain has stopped functioning, in DCD, death is declared after circulation ceases and the heart stops beating. Many more people die this way than by brain death.

Death by circulatory criteria has been legally recognized since the 1980s, but for decades, doctors rarely recovered organs this way, because, once blood stops moving through the body, organs begin to deteriorate within minutes. In recent years, however, new machines and surgical techniques have helped change that, giving doctors the ability to preserve organs outside the body, making DCD far more viable.

↗ Explore the interactive version of this chart.

Hoffman’s donation is hardly an outlier anymore. In the last decade, DCD has gone from a rare practice to something that now accounts for nearly half of all organ donors who have died in the United States. In 2000, DCD donors supplied just 219 organs (kidneys, livers, lungs, hearts, and pancreas combined) to the transplantation system in the US. In 2025, DCD brought in close to 17,000 organs. (Most transplanted organs, about 85 percent, come from dead donors, though some organs, most often kidneys, can also come from living donors.)

That growth has saved lives, but it has also pushed transplant medicine into an unusually sensitive moment: the time after a family has decided to let their loved one die but before death has actually occurred.

In brain-death donation, a patient has already been declared dead before the possibility of donation is raised with the family. Because most brain-dead donors are on ventilators, with machines supplying oxygenated blood to their organs, transplant teams can take their time with the donation process.

DCD doesn’t offer that same cushion. Because organs deteriorate so quickly after circulation ceases, the work of donation — the testing, matching, surgical teams flying in — has to be set in motion once the family has decided to withdraw life support but before the patient has died.

This is where the tension in DCD begins. The process pushes transplantation into the narrow interval between that decision to let someone die and the moment death occurs. It creates a situation with almost no parallel in medicine: one set of hands caring for the dying, even as another prepares to recover and transplant their organs.

The medical system tries to manage that complexity with a strict procedural sequence. First, hospital doctors and family conclude that no treatment will bring the patient back to a life they would have wanted. Only then, and only from a separate team, does the word donation come up. The firewall is in place so that the need for organs never shapes the decision to let someone die. 

“Ethically, you want to make sure that those two are uncoupled,” said Wade Smith, director of the Neurovascular Service at the University of California San Francisco.

But as DCD has scaled up, more weight is put on that narrow interval. What was once a rare event is now routine in hospitals across the country, carried out by teams with different levels of experience and overseen through rules that can vary from one place to another. At the same time, the organizations that handle organ donations are under new federal pressure to acquire and distribute more organs from eligible donors.

DCD has saved thousands of lives by making donations possible from patients who once wouldn’t have been donors. Hoffman’s donation improved several lives at once: Her kidneys went to two men, her liver to a third recipient, and her corneas helped give sight to a nine-month-old baby. 

But its growth has also made the fragile period before death more consequential: how families are told, which steps can be taken while the patient is still alive, how consistently hospitals and organ donation teams follow safeguards, and who has the authority to stop the process if something feels wrong.

When DCD was still rare, these questions stayed at the edges of transplantation. Now, they are moving towards its center, as a lifesaving practice becomes a routine part of how Americans die and donate.

The breakthrough

Modern transplantation is a relatively young field, only about 70 years old. And from the beginning, transplantation has depended on the novel medical achievement of keeping organs functional after a person had been declared dead.

The mechanical ventilator, developed in the 1950s, made that possible. It could keep a body breathing, and its heart beating, even after the brain had stopped for good. That created, for the first time, a situation where patients were deceased by every older measure, even as their organs were still functional.

Surgeons were initially wary of recovering organs, largely because the legal lines between life and death had never been clearly drawn. Then, in 1968, a Harvard committee proposed a definition of brain death. By 1981, a model law gave states the language to recognize two ways of legal death. Your heart and lungs could stop for good (circulatory death) or your entire brain could (brain death). Today, every state recognizes some version of that framework.

With those lines in place, transplant teams could work with more confidence, and brain death turned out to be close to ideal for them. Because a ventilator kept the heart beating and blood moving through the organs, even after death, there was no ticking clock to race against. The hospital staff had time to evaluate the organs, sometimes convince families to donate them, find the right recipients, and bring in surgical teams before recovery began.

The problem was always with the math. Brain death is rare — only about three in 1,000 deaths happen in a way that leaves organs usable for transplant. That puts a hard biological ceiling on how many ideal donors there could ever be.

But demand for the organs had no such ceiling. Nearly a million Americans are diagnosed with heart failure each year, while surgeons performed just 4,636 heart transplants in 2024, after DCD became a widely used part of transplantation, up 81.5 percent from 2013. There are “just not enough organs to go around,” said Ashish Shah, chief of cardiac surgery at Vanderbilt University. The kidney numbers are even bleaker. Over 500,000 people are on dialysis in the US, but only a fraction will ever reach the waiting list, and even among those who do, many will die before receiving a transplant offer, said Dorry Segev, a transplant surgeon and researcher at NYU Langone.

The modern DCD boom grew out of this desperation, presenting the possibility of donation in far more common cases of death that transplantation surgeons had rarely been able to draw on before: catastrophic strokes, car crashes, cardiac arrests, and other injuries that left patients with no meaningful chance of recovery but short of brain death. But with DCD, the clock suddenly became a factor. Once circulation stopped, the organs deteriorated fast, and, in many cases, they were ruined before surgeons could recover them. 

Because of those challenges, DCD stayed marginal for decades, at well under a tenth of all donations. Those numbers ultimately spiked because of several things that happened almost simultaneously.

The first was technological. New machines, like TransMedics’ Organ Care Systems — which were first used in 2015 in the UK — could keep a recovered organ alive outside the body, pumping it with warm, oxygenated blood instead of packing it in ice, allowing a heart to beat and function as normal inside a box. This meant that even if there was delay in recovering an organ, that damage could be limited, even reversed, once the organ was put in the machine. 

Other teams found ways to use machines originally developed to support failing hearts and lungs to restart circulation inside the bodies of donors after death had been declared. Transplant teams in Spain and the UK began adapting that technology before American programs picked it up for DCD hearts around 2019. Both approaches helped extend the time to successfully perform DCD.

“As soon as the results were good, the big American centers took it on,” said John Dimarakis, a cardiac transplant surgeon at the University of Washington.

Policy changes also helped push DCD further. In Hoffman’s case, the donation process was coordinated by CORE, the nonprofit responsible for organ donation in the Pittsburgh region. Organ procurement organizations, or OPOs, cover a particular region in the US, and they work with hospitals in that region to evaluate potential donors, speak with families, arrange testing, and offer organs to transplant centers. There are 54 such OPOs in the US, which are certified and regulated by the Centers for Medicare and Medicaid Services (CMS). 

For years, critics argued that OPOs were judged according to weakly defined standards based on numbers they reported themselves, and poor performers were rarely penalized. But in 2020, new federal rules began ranking them against one another, with a mechanism to strip the worst performers of their territory. Facing the threat of losing their monopolies, many OPOs began pursuing harder cases they would’ve earlier passed over, according to Greg Segal, who founded patient advocacy group Organize. A larger share of those more complicated donors were DCD.

Still, no single force explains the speed of DCD’s rise. “Technology plays a big role in it,” said Nader Moazami, a cardiac surgeon at NYU Langone who helped pioneer one of the new techniques. “But it doesn’t explain how suddenly 50 percent of our donors are DCD.” In 2000, there were only 118 DCD donors in the United States. By 2025, there were 8,137. Brain death donation grew over that same period but far more slowly — from 5,867 donors a year to 8,416.

↗ Explore the interactive version of this chart.

Whatever the mix, it’s clear that DCD has led to more organs, shorter waits, and saved thousands of lives that otherwise would have ended on a list. “People who have been waiting now wait less,” Dimarakis said.

On a chart, it looks like an unambiguous triumph — until you step into a hospital room.

The passage

Beth Hoffman remembers her sister Emily’s last morning. She read aloud an email from Bradley Whitford, Emily’s favorite actor from the TV drama The West Wing, who had written after hearing what had happened. Then, a playlist of Emily’s favorite songs played as the breathing tube came out. Within about 10 minutes, while “For Good” from Wicked filled the room, her sister was gone.

What Beth mostly didn’t see was the second sequence unfolding around her: the referrals, tests, calls, and scheduling that would turn Emily from a dying patient into an organ donor. 

Federal rules require every hospital to alert their organ procurement organization whenever a person may be nearing death. The OPO screens those referrals, and most go nowhere. Alexandra Glazier, who runs the OPO that covers most of New England, says hers get about 50,000 such referrals a year. Only 2 or 3 percent turn out to have any medical possibility of donation at all. 

Emily was one such possible case for her Pittsburgh hospital’s OPO. The organization had to reach out to her family; explain what DCD would involve; and, then, start the work that had to happen while she was still alive: reviewing her medical history, testing whether her organs could be used, matching them to recipients, and arranging the surgical teams who might fly in to recover them.

Most families never see much of that work, but some do. Smith, the UCSF neurologist, watched a family agree to withdraw life support and donate, set a time, and gather relatives for a final goodbye, only to learn that the withdrawal had to wait because the OPO still needed more tests. Some families, after being told their dying relative must stay on machines longer for donation’s sake, walk away.

For the Hoffmans, things proceeded more quietly. When the time came, Emily was wheeled into the operating room, and the breathing tube was removed there. The surgeons who would recover her organs were kept away from the withdrawal and death declaration. They often fly in from their own hospitals — sometimes several at once for different organs — but they’re walled off from everything that comes before. “We are not involved in that process,” said Dimarakis, the cardiac transplant surgeon at the University of Washington, “because it’s not ethical for us to be involved.”

That separation is the line DCD depends on. One team cares for the dying patient, withdraws support, and declares death. The other waits outside that decision and recovers the organs only after. The OPO stands between them, coordinating the donation without letting the firewall be breached.

Then comes the waiting. Once the ventilator is out, the clock starts ticking. If the heart doesn’t stop within a window — often about two hours — the organ recovery may be called off, and the patient is returned to end-of-life care. But when circulation does stop, as it did for Emily, the team counts exactly five more minutes to make sure it won’t restart on its own. Only then can a hospital physician declare death, and only then can the transplant surgeons begin.

DCD rests on a simple promise: The need for organs never causes the death. The death is already coming, and donation only changes what can come from it. 

But a new frontier in DCD complicates that promise.

The reversal

Normally, after death is declared, most DCD organs are removed and preserved outside the body, either on ice or on machines that circulate oxygenated fluid or blood. The goal is to slow the damage that begins the moment circulation stops.

Then, around the mid-2010s, transplant teams in Spain and the UK began using a newer technique that restores circulation inside the dead donor’s body, before the organs are removed. It’s called normothermic regional perfusion, or NRP.

In one version of NRP, called abdominal NRP, blood is meant to be restored only below the diaphragm to preserve organs such as the kidneys and liver. In a more controversial version called thoracoabdominal NRP, it runs through the chest, as well, and the heart starts beating again.

For the transplant team, especially heart surgeons, the appeal is clear. Kidneys and livers can survive a stretch without circulation, but a heart is harder to preserve. Once it has stopped, there’s no easy way to know whether it will beat reliably again. NRP helps answer that question by restarting it inside the donor’s body after death has been declared, where surgeons can watch it work before deciding whether to recover it.

Shah, the Vanderbilt cardiac surgeon, says the technique lets doctors take hearts from donors who otherwise would not be able to yield a workable one.

But this kind of NRP is unsettling for the very reason that it is useful. If a death is declared because the heart has stopped, what does it mean to start it again inside a donor’s body, often only minutes later? Is that still death? Or something else?

The controversy isn’t simply that the heart beats again. A beating heart is not, by itself, the same as a living person. The heart of a brain-dead patient can beat, too, can be kept going by machines, and that doesn’t mean the person is alive. The deeper concern is whether restored circulation in the body could reach the brain, which could potentially restore consciousness.

To prevent blood from reaching the brain, surgeons clamp or cut the vessels that carry blood to the head before circulation is restored. That distinction is central to the defense of NRP, and it lets surgeons say they are restoring circulation and restarting the heart, not the person. 

But those safeguards haven’t always worked. In a safety notice last November, the Organ Procurement & Transplantation Network (OPTN), the federal system that oversees transplant policy and data, said it had received “verified reports” that blood had unintentionally reached the brain and brainstem during NRP. Such events are extremely rare, the notice said, but can occur when a clamp fails or blood reaches the head through an unrecognized route. The notice asked transplant programs using either form of NRP to strengthen their safeguards and report any failures. But those recommendations were not national requirements and as of May 2026, the OPTN was still developing formal standards for NRP. For Claire Morgan, a transplant surgeon from North Carolina who has criticized NRP’s rollout, that is a central weakness. “It’s a bulletin. It’s not a policy,” she said. “There’s no punishment for not reporting.”

But even if blood never reaches the brain, NRP can still introduce deeper ambiguity into our understanding of circulatory death. In the first few minutes after a heart stops, it can often be brought back, an event that happens every day in a busy emergency department. In conventional DCD, however, doctors don’t try to restart the heart, because a patient or family has already decided against being revived. It is that decision, not just the stopped heart itself, that turns the moment into a death. The same goes for anyone who dies under a do-not-resuscitate order.

NRP puts pressure on that logic. The circulation declared permanently gone is deliberately brought back. “There’s a misalignment between NRP practices and the legal standard for how death is defined,” said Glazier. You cannot, critics argue, pronounce someone dead because the circulation will never return — and then return it.

Robert Truog, professor of Medical Ethics, Anaesthesia, & Pediatrics at Harvard Medical School, supports NRP but thinks the possibility of blood returning to the brain is the issue that matters most. “The only questions are, is there a risk of pain or suffering in the procurement of the organs?” he said. And there’s a possibility of that if the circulation is restarted in the brain.

None of this is settled, which is why some hospitals refuse to perform NRP at all. Moazami pioneered the NRP heart technique in the US and practices it at NYU Langone. “But you cannot do it at Columbia,” he said, “just five miles away.” Glazier’s OPO, one of the country’s largest, said her organization has done roughly 650 NRP cases since adopting the practice — but only the abdominal kind, holding off on the heart version until the national protocols are better standardized.

Claire Morgan, a transplant surgeon from North Carolina who has criticized the rollout of NRP, is more worried about what happens if something goes wrong. The donor cannot complain, families may never know if there was a concern, and clinicians who speak up may have limited protection if they challenge what happened in the operating room. 

All of that matters, because NRP is already far from marginal. The Organ Procurement & Transplantation Network (OPTN), the federal system that oversees transplant policy and data, only began collecting data on whether NRP was used in a DCD recovery in October 2025. In the first five months of that reporting, from October 1, 2025, through February 28, 2026, 3,463 DCD donors were recovered nationally, according to data shared by the OPTN with Vox. More than half of those involved NRP; though, OPTN doesn’t collect data on which kind.

Vox’s analysis also found that NRP cases were concentrated among some organ procurement organizations. The top 10 OPOs accounted for 47 percent of all DCD recoveries that used NRP.

The patchwork

The core safeguard in DCD — that the decision to withdraw life support must come before questions about donation — is widely accepted. But many of the details around that sequence that shape a family’s experience, or a patient’s protection, are still handled differently from hospital to hospital, OPO to OPO.

“The entire process of DCD or donor withdrawal is not very standardized across the United States or even within states, even within different hospitals in the same city,” Moazami said.

That can mean differences in what families are told about the donation process, what medications are considered appropriate before death, whether NRP is allowed and how it is performed, and who has the clear authority to pause or stop the process if someone believes something is wrong.

That unevenness matters more now, because the transplant system has been trying, with good reason, to recover more organs. For years, many in the field, and those who depended on it, argued that the organ procurement organizations were leaving transplantable organs on the table. Greg Segal, whose advocacy group Organize helped push for stronger OPO accountability, compared the old system to a canvassing campaign where you only knock on the easiest doors. “The problem with OPOs is they were only doing the much easier ones,” he said.

A 2020 rule from the Centers for Medicare & Medicaid Services, the federal agency that oversees OPOs, was meant to change that. It ranked OPOs against one another and created a path to penalize low performers by stripping them of their territories. That policy appears to have had some impact, but it is hard to separate from other forces driving DCD’s rise including new preservation technology, like NRP and broader clinical adoption. Jeffrey Trageser and Charles Strom from the Association of Organ Procurement Organizations, the trade group that represents OPOs, argued that the metrics are too broad, evaluating OPOs partly on whether transplant centers ultimately accept organs and not fully accounting for regional differences such as age of potential donors, local rates of cancer, or how far organs must travel to reach transplant centers.

This pressure to recover more organs has also made some OPOs seem more aggressive to the clinicians working besides them. “Some people view them as vultures, which is horrible,” said Smith, the UCSF neurologist who has experienced the tension from the hospital side. “They’re trying to do their job.” Still, he added, “when you impose that [pressure], then it changes how aggressive they are.”

Both things can be true. The old system needed pressure to perform better. And pressure can create risks, or perceived risks, in a process that depends on careful judgement around a dying patient.

And the safety question isn’t a theoretical concern either. A March 2025 investigation from the Health Resources and Services Administration (HRSA), the federal agency that oversees the national transplant system, documented what can happen when those safeguards fail. In a review of attempted DCD cases at Kentucky Organ Donor Affiliates, an OPO that covered Kentucky and parts of Ohio and West Virginia, HRSA found recurring problems about staff missing vital signs in patients that raised concerns, failed to work collaboratively with hospital medical teams, failed to respect family decision-making, and documented medical data poorly. HRSA said the pattern suggested “organizational dysfunction” and a weak safety culture.

One OPO’s failure does not prove that DCD is broadly unsafe or that OPOs across the country behave the same way. But the Kentucky review showed how badly things can go when the line between patient care and organ recovery is not honored.

Since then, federal officials have been trying to close some of the gaps. HRSA has pushed for clearer family education around DCD and more standardized reporting on ventilated patients referred to OPOs, as well as opened up a reporting channel that sends misconduct concerns directly to HRSA. In a separate case, the Department of Health and Human Services also moved to shut down an OPO in South Florida after finding unsafe practices, underperformance, and paperwork errors.

Organ donation is a touchy subject, because it relies so much on the goodwill and the trust of the people who agree to give their organs so they can live on in others. But the procedural issues also matter, because there are lives at stake on both sides of the process. 

Around 13 people die each day in the US waiting for organs. In that desperate landscape, the rise in DCD has led to many lives saved and helped several more live better, fuller lives. The dearth of organs even compelled my former Future Perfect colleague Dylan Matthews to sign up as a living donor and donate his kidney to a complete stranger. (You can read his story here).

And the value of the donation is not just measured in recipients saved. For the Hoffmans, the knowledge that Emily’s organs helped others offered a solace they had not expected. Emily “gave the gift of life in her death,” Beth told me.

That is the highest ideal organ donation — and DCD – can achieve: a death already coming that still changes the lives of others in need. The case for DCD is clear, but its future depends on its proponents’ ability to protect both patients and public trust.

Clarification, July 1, 6 pm ET: A previous version of this post described how the NRP process intends to stop blood from reaching the brain, but did not acknowledge cases where that does not go according to plan. The post has been updated to include a safety notice from the Organ Procurement & Transplantation Network, which said it had received “verified reports” that blood had unintentionally reached the brain and brainstem during NRP. The post has also been updated to clarify that Dorry Segev and Nader Moazami are doctors at NYU Langone. 

Hi readers! I’m Shayla Love, a science journalist and longtime fan of Your Mileage May Vary. I’m honored to be subbing for Sigal while she’s out on parental leave. I’ll be diving into your questions as a way to help understand human nature and our choices through multiple lenses: philosophical, psychological, and beyond. Please send me any emotional, body/brain, sociological, perceptual, or other kind of life quandaries you might have. 

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My mother is religious, and I can tell that it brings her peace of mind to think I share some of her religious views. For this reason, I currently attend church with her on Sundays. However, I hesitate to tell her directly that I do not necessarily share her beliefs, as this would likely upset her and would not substantially improve my own quality of life. 

At the same time, attending church while knowing I do not fully believe feels somewhat disingenuous. I am unsure whether continuing this practice is the more ethical choice or whether honesty, despite its potential emotional cost, would be the better path. On the other hand, would it not be selfish to prioritize my own sense of integrity over my mother’s peace of mind, especially when the “cost” to me is relatively small: attending church once a week in order to preserve this tacit understanding? 

Dear Pew-Warmer,

Your question raises two interesting issues: whether to tell your mom that you don’t share her religious beliefs and whether to still attend church with her, even if you don’t share the faith. They might seem to be part of the same quandary, but teasing them apart a little more, we’ll see that your church attendance doesn’t necessarily require as much dishonesty as you may think. 

First, no matter what you decide, it could be helpful for you to know that you’re far from alone in managing different beliefs within a family. The amount of mixed-faith families has been steadily increasing, often because — like you — children grow up to have different beliefs from their parents. And this includes people who decide to no longer follow any prescribed religion at all. A Pew Research Center survey done in 2007, for example, found that 44 percent of Americans had changed or left the religion they were raised in. Relationships between people of different religious leanings are common now, too. A different Pew survey from 2015 found that 39 percent of couples married after 2010 identified as mixed-faith (again, including people who identify as non-religious). 

How do all of these people deal with being married or related and believing such different big things? It’s not easy. In a more recent Pew survey from 2023, more than a third of parents said it was extremely or very important that their children have the same religious views as them, which is in line with your sense that your mom would like to share her faith with you. And this is where much of your tension seems to lie. But, perhaps, I can bring you some solace by sharing that the overall data on all of this is more nuanced. I reviewed some qualitative studies — which include interviews — on religion in families to hear from people on both sides of precisely what you’re grappling with. 

In general, parents do seem to wish for their kids to have the same faith as them. As a highly religious Christian father said in one study: “How to pass our belief to our next generation is a burden to me. … We want them and their next generations to have God’s blessings.” And that makes sense, especially for a parent who belongs to a faith tradition that comes with everlasting consequences for people depending on their beliefs and behaviors. 

But, of course, religion is more than a narrow set of rules and consequences. Each contains an elaborate offering of traditions, beliefs, and values. Many very religious parents responding to the same survey said they understood it was up to their children to choose whether to continue in the tradition or not and that what truly important to them was knowing that their children shared the same values. Religion served as a proxy for that. That same 2023 Pew survey referred to earlier found that the majority of religious parents thought it was more of a priority to pass on ethics and values, as well as traits like ambition and being hardworking, than religious belief alone. 

There can even be upsides for relationships when some core beliefs differ, as one 2022 study suggested. Interfaith families — by having to accommodate multiple beliefs — have the opportunity to actually become stronger. The authors concluded that such “families are not more turbulent or problematic than other family relationships” but actually had many additional strengths, like improved communication skills. 

I won’t try to predict your mom’s response based on others’ replies in a study. Nevertheless, I think these findings suggest, at the very least, that it’s not automatic that parents cannot handle it when their children don’t follow their own faith. From the experience of these families, I suggest, if you decide to be more honest with your mom about this, you should emphasize the moral qualities you have in common — and that you plan to maintain. It could be helpful to stress that your decision is a genuine one; taking any other position wouldn’t be true to what you really feel. 

No matter the outcome of this conversation, though, your quandary about whether you should go to church at all won’t be solved. You say that it might feel disingenuous or pose a problem for your integrity to attend church services if you don’t believe. That assumes that your presence at the church is endorsing a belief in God, or in the theology of that religion, or that the latter are required for the former. 

I wasn’t raised with religion, and, instead, grew up around several atheists who worked as scientists. A few had a pretty disparaging view of the belief in God, which they saw as empirically unsound. Yet, as I got older, I began to notice some streaks of religiosity in their positions, like a dedication to the idea that science is the only tool with which to understand the world, a view that’s sometimes called “scientism.” Science is an excellent way to figure out how the world works, but there are other aspects of life — like art, music, spirituality — where it can fall short. I bring this up to say that religious thinking can rear its head even in the non-religious. And within a religious framework, you may discover non-religious elements too. A sociologist from the late 19th and early 20th century, Emile Durkheim, would push back on the idea that going to church means you believe in God, which helps me understand what I saw in my family.  

Durkheim wanted to understand how religion functioned in society. He dismissed the idea that religion, at its core, was about supernatural events and God (or gods). In his 1912 book The Elementary Forms of Religious Life, he examined Australian Indigenous religions to come up with theories about what all religions had in common. He argued that religion emerges when a group of people get together and agree upon what is sacred and what is profane, and then they act in ways that support those categories.

I’ll add that Durkheim’s views on religion have been questioned over the years. For starters, he vastly oversimplified the Indigenous religions he focused on. Yet, I think one of his central ideas — that religion is primarily an expression of agreement within social groups — is useful in making the act of your going to church less about your individual endorsement and more about participating in a group with shared values. 

Durkheim didn’t think that the concepts of “sacred” and “profane” applied only to those within organized religions; it was a more general principle in how societies were organized. Secular groups like sports fans and political parties also gathered together to perform rituals about their shared definitions of what is sacred. Following Durkheim, you could see your choice as less a theological one and more a social one. There could be plenty of values at your mom’s church that mean something to you, like community, taking care of others, and acting morally. 

Durkheim’s theory does require you to be a participant, however, in upholding these values. If that doesn’t apply to you, there is still a way to engage with those with differing beliefs with curiosity, like the psychologist William James. 

His book, The Varieties of Religious Experience, was based on a series of lectures he did at the University of Edinburgh. He was assigned to do 20 talks, and he thought he would dedicate the first 10 to describing “man’s religious appetites” and the rest on various philosophical interpretations. Instead, he became so engrossed with recounting people’s religious experiences that the subject took up all of his lectures. 

James was not a very religious man himself, and so, his thirst for learning about religion is remarkable. In the introduction to The Selected Letters of William James, the novelist and literary critic Elizabeth Hardwick wrote how James’s tolerance for “nuts and cranks, his mediums and table-tappers, his faith healers and receivers of communications from the dead” sometimes confused his peers. How could a man of science be so interested in visions and conversions? 

Like Durkheim, James wasn’t focused on whether religion was true. He had very little interest in theology itself; he fixated on the psychological — the feelings that came with being religious. 

James thought that these feelings — which we all share — were the deeper source of religion. All organized religions came later; they were emotions transformed and organized. He recognized that there were true emotions at the heart of religious conventions, and that people turned to religion to solve human concerns: melancholy, uncertainty about the future, morality, the need for community, expressions of joy. Yet, he was an outsider. He didn’t require himself to be a convert in order to be curious.

James and Durkheim have different approaches, but they both offer clues as to how to turn toward shared social values and how to be curious about others’ emotional lives while not having to commit (or pretend to commit) yourself to beliefs that you don’t have. 

You say that the cost of going to church once a week would be relatively small for you, and, so, I’ll assume that your concerns don’t include participating in a religion that is openly hostile to you or your identity. It would be difficult to participate in shared sacred-making with a group of people that places you in the “profane” category. And being curious about others is a highly generous act that, if not reciprocated, feels dismissive. I hope that by opening yourself up to your mom’s emotional life that underpins her faith, she can do the same in return, even if your own interior landscape isn’t transmuting into religious belief. And it may well be that a genuine connection is what she wants — not a false one. 

A final thought related to Durkheim: He came up with a lovely concept called “collective effervescence”: when many people have the same big feelings together, and the emotions crash together into one big collective firework of expression. To see an easy example of this, watch videos of what happens at events like World Cup matches as teams and fans celebrate big wins. This experience comes about by shared feelings of any kind. If it still feels discomfiting to go to church with your mother, perhaps you can find another way to share ecstatic emotions together and come up with a new definition of the sacred.  

Bonus: What I’m reading

• Speaking of family, Jonathan Weiner writes in this ethereal piece in the American Scholar about how his robust memory skills compare with his brother’s patchier recollections as they both remember their father. 
• In Harper’s Magazine, Katie Thornton tries to learn the utopian, universal language of Esperanto. 
• And my favorite thing I read last week: an older piece of prose from the poet Elizabeth Bishop that I came across in a used bookshop in London, called “The U.S.A. School of Writing.” (It was originally published in The New Yorker.) Bishop takes a scammy job as a writing tutor over the mail and finds surprising connections with oddball students and co-workers.

This story was originally published in The Highlight, Vox’s member-exclusive magazine. To get early access to member-exclusive stories every month, join the Vox Membership program today.

This story was originally published on June 29 in The Highlight. To get access to member-exclusive stories like this every month, become a Vox Member today.

America in the summer of 1976 was not in a good place. 

The president who presided over the country’s bicentennial, President Gerald Ford, only had the job because the previous president and vice president had resigned in disgrace, making him the sole US president who was never actually elected. The Vietnam War had ended in defeat and disgrace when Saigon fell the year before, after the deaths of nearly 60,000 American servicemembers. Inflation hit double digits in 1974 and stayed ugly, unemployment sat near 8 percent, and economists had to invent a word — stagflation — for an economy that seemed to encompass the worst of both worlds.

Given all that, you might assume the national mood leading up to the 200th anniversary was grim. And, yet, on July 4, 1976, something strange happened: Americans threw themselves a hell of a party. 

In New York Harbor, more than 200 tall ships sailed up the Hudson for Operation Sail, drawing an estimated six million spectators — the largest crowd in the city’s history. Ford reviewed the fleet from the deck of the aircraft carrier USS Forrestal. It was the same scene up and down the country that day: parades in small towns, fireworks over the National Mall, church bells ringing in unison at 2 o’clock. It was one cathartic day of celebration after a decade that had offered little reason for it.

And when pollsters asked people how they felt about the country’s future that year, the mood was, improbably, sunny. A Roper survey found more Americans were optimistic than pessimistic about the future by a nearly three to one ratio. More than three-quarters told Gallup the nation had already achieved at least a fair amount of its founding ideals. Somehow, a nation that was in the middle of a genuinely miserable decade looked in the mirror and liked what it saw.

Jump forward 50 years, to this year’s 250th anniversary, and you’ll find the vibes flipped. Roughly 60 percent of Americans tell pollsters the nation is on the wrong track. A majority say its best years are behind it. About three-quarters think today’s children will end up worse off than their parents. Asked a version of that same founding-ideals question from 1976, 77 percent now say the founders would be disappointed in what we’ve become.

But just as they were in 1976, the vibes don’t match reality. Set the mood aside and look only at the numbers, and the country that felt so good in 1976 was, by the most important measures, a worse place to be alive than the country that now feels so terrible on its 250th birthday.

Start with whether you’re alive

Let’s start with the most basic test of how a society is doing: how long its people live.

Life expectancy at birth in the US was 72.6 years in 1976. In 2024, it reached a record high of 79 years — an extra six and a half years of life. At the start of life, a baby born now is far more likely to survive its first year than one born during the Bicentennial, while cancer, once nearly a synonym for a death sentence, now kills a much smaller share of the people it strikes. 

The US made those gains by stopping some of its worst habits, things that were commonplace in 1976 . You might have seen the Bicentennial celebrations through a cloud of smoke, as cigarettes were woven into ordinary life — on airplanes, in offices, in hospital wards — and roughly 37 percent of adults smoked. Today, it is closer to one in 10, and it keeps falling. 

The heart disease and lung cancer that were connected to all that tobacco have receded with it. Add seatbelts and airbags, better trauma care, and cheap drugs that lower cholesterol and blood pressure, and the result is a country where the things that were most likely to kill an American in 1976 are less deadly now.

The America of 1976 sat at the leading edge of a brutal crime wave; the murder rate would peak in 1980 and stay high for more than a decade. By the early 2020s, however, violent crime had fallen back to roughly a 50-year low, and homicide rates this year may end up at a record low. And the single most dangerous thing most Americans do — get behind the wheel of a car — is far less likely to kill them, with the death rate per mile driven now a fraction of what it was at the Bicentennial.

The country got cleaner, and richer, and fairer

In 1976, the air in American cities carried lead, an honest-to-God neurotoxin that was pumped out of every tailpipe of the more than 90 percent of American vehicles that used leaded gasoline. 

Rivers literally caught fire: The Cuyahoga in Cleveland had burned so many times it became a national joke, and Lake Erie was widely written off as dead. And things were bad outside Ohio, too. In Los Angeles, the smog got thick enough to keep kids inside at recess and erase the nearby mountains from view.

Since 1970, however, the combined emissions of the six main air pollutants the EPA tracks have fallen 78 percent — even as the economy nearly quadrupled in real terms, the population grew by tens of millions, and Americans drove far more miles. That split, with growth going one way and pollution the other, is one of the least celebrated but most consequential triumphs of the past half-century, the product of legislative efforts and technological response. And lead? It’s essentially disappeared from the air. 

And it’s not just economic or environmental statistics that have improved; society advanced, as well. Women now earn the majority of college degrees. The Black poverty rate sits near a record low. Support for same-sex marriage is now the norm — maybe the single biggest social change from 1976, when homosexuality was criminalized in most states. Pick a metric more or less at random, and the line usually runs the right way.

This is not a matter of cherry-picking a few flattering numbers. It is the overwhelming direction of the evidence, across health, wealth, safety, rights, even the basic cleanliness of the physical world an American walks through every day. Measured against its own recent past, the US is in some of the best shape it has ever been.

So what’s with the bad vibes?

A more perfect union doesn’t mean perfect

Well, some things genuinely got worse, and they are not insignificant. 

Americans’ faith in their government has collapsed; fewer than one in five now trust Washington to do the right thing, down from solid majorities in the 1960s — and the country is more polarized than it was in 1976. Democratic decline and even collapse is a live threat. Those economic gains I highlighted above have flowed disproportionately upward. The top 1 percent’s share of income, near a historic low in 1976, has since roughly doubled.

Climate change barely registered in 1976. The carbon dioxide in the atmosphere has since climbed from around 330 parts per million to about 427, and warming will only get worse in the future. And buying a home increasingly feels out of reach for many. By 2024, a record share of households spent more than a third of their income on housing. (Notably, though, the percentage of Americans who own a home is slightly higher than it was in 1976, and those homes are much larger on average.) 

These are real problems, but they remain exceptions to a broader half-century trend of improvement. And a country that scrubbed the lead from its air and put out smoking can overcome new challenges, as well. 

Which brings us back to a tale of two birthdays. In 1976, Americans had less of nearly everything you can count, and, yet, they reported feeling good about the future anyway. In 2026, we have more, and we don’t. 

Just as it can be for a person, a country’s mood is a poor instrument; it measures the story we are telling ourselves more than the lives we are actually living. For all our pessimism about the state of the nation, more than three-quarters of Americans say they are satisfied with their own lives.

The Americans crowding New York Harbor in 1976 were cheering a country that was sicker, dirtier, more dangerous, and less free than the one we live in now. But they were right to cheer; the line was already bending the right way, and it kept bending. It turns out a nation can travel a long way, even while it is convinced it is going nowhere.

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