What is a Death Doula?
A Non-Medical Resource for the Dying and Those Who Love and Care for Them
Death doulas help you and your loved ones navigate the end-of-life journey with dignity, comfort, and peace of mind. Tending to emotional, spiritual, and practical needs at a very difficult time.
Providing Compassionate End-of-Life Care
The History of Death Doulas
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The term doula has traditionally meant a person trained to provide comfort and support to women during labor and childbirth. Today, it’s also used to describe those who are trained to provide support at the end of life.
Not all doulas deal with birth.
Caring for the sick and dying is an ancient role. In the past, people were more likely to die at home than in an institution. Most people had seen someone die. They knew the signs and how to give comfort and support.
As long as we’ve been living, we’ve been dying.
As medicine and health care advanced, more people died in hospitals than at home. Hospitals are designed to treat acute illness, not provide a safe and peaceful environment. They’re busy places by nature.
This gap in end-of-life care in an institutionalized setting is part of what has given rise to death doula programs. Death doulas fill that void. We’re trained to know the stages of death and dying, grief and grieving, and to advocate for patients’ needs. We’re also trained in comfort and compassion, in active listening, and in communication strategies to facilitate difficult conversations.
Why People Are Choosing to Die at Home
The Growing Need for Death Doulas
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Today, more people are choosing to die at home, but because so many of us have never experienced death firsthand, we don’t know what to do, what to expect, or even what to think.
End-of-Life Medical Care in the U.S., (KFF, April 27, 2017)
It’s not surprising that more people are choosing to die at home. Part of it is about having a greater say in what treatment options to pursue. Doctors are trained to keep a person alive with treatments, regardless of the outcome. But many patients with serious illnesses would prefer to stop treatments or focus on palliative care to improve their quality of life and relieve symptoms.
Dying at home means loved ones can visit whenever you like, not only during a hospital’s visiting hours. And studies have shown that patients choosing to die at home experienced a more peaceful death than those who died at a hospital. They’ve even found that the relatives of loved ones who die at home experience less intense grief.
Even as our society has become more comfortable with the idea of dying at home, we aren’t necessarily comfortable talking about death. And this is another way that death doulas are filling the gaps.
End-of-Life Medical Care in the U.S., (KFF, April 27, 2017)
According to a 2017 Kaiser Family Foundation report, nearly 70% of Americans avoid talking about death. We’re not very good at it. We hide children from it. And more people fear death than ever before.
As conversations around end-of-life care have changed, our views of death and dying are also changing. In fact, there is an entire movement focused on reducing death anxiety called the Death Positivity Movement. The name may make you think it’s about making death happy and cheerful, but it’s not. It’s about acknowledging that death is a natural part of life.
When we talk more openly about death, it becomes less scary and more manageable. We can feel like we have more control over our options. And it can deepen our experience of being alive.
With nearly 56 million Americans age 65 or older, it’s not surprising that interest in the movement has been growing.
And death doulas play an important role in this effort to reduce the stigma surrounding death. We’ve been trained to facilitate difficult conversations, to ask people about their wants, to make sure others know about their wishes, and to listen, most importantly, to listen.
Respite for Caregivers and Peace of Mind for Patients
How Death Doulas Complement Hospice Care
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Every year, more than 1.7 million Americans receive hospice care, which is covered by Medicare, Medicaid, and most private insurance plans. They’re medically trained nurses who provide emotional support, comfort, and symptom management to terminally ill patients. They also help caregivers navigate the uncertainties of taking care of someone who is dying.
Doulas complement hospice with additional emotional and spiritual support. We provide companionship, practical and physical assistance, and respite for primary caregivers.
The main distinctions between hospice and doulas are:
- Hospice nurses are medically trained, while doulas are not.
- Hospice workers visit once a day, while doulas can visit as often as you schedule us.
- Hospice is only available to those no longer undergoing curative treatments, while doulas can support anyone.
- Hospice is only available to patients with a life expectancy of six months or less, while doulas can help everyone.
For terminally ill patients who have decided to no longer seek life-prolonging or curative treatment, complementing hospice care with the support of a doula can bring peace of mind to the patient and their inner circle.
Here For Everyone
Who Should Hire a Death Doula?
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It’s not only the terminally ill and their loved ones that can benefit from what death doulas have to offer. We help clients of all ages whether they are experiencing a health issue or not. These are some of the people who hire us:
- People who know they are advancing in age and want to make sure their documents are in order and in a safe place and that their support team knows of their decisions.
- People who live alone and don’t know who will take care of them if they need help.
- Caregivers who work and need someone they trust to be there when they’re gone.
- Caregivers who don’t have other people helping them and could use a break or a person to talk to about what they’re going through.
- The adult children of a person who needs assistance but isn’t at the stage of entering hospice care.
- The adult children who live far away and can’t be there to provide the kind of care their parent needs.
- People who’ve lost a loved one and are mourning or in bereavement.
There are plenty of reasons people hire death doulas. Mostly, they hire us to solve problems related to death and planning for death, to provide comfort and compassion, to listen and be there in times of need.
What Exactly Does a Death Doula Do?
Problems a Death Doula Can Help People Solve
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Not all death doulas offer the same services and certainly not all clients have the same needs. The easiest way to explain what a death doula does is to highlight some of the problems we help solve:
- Making sure documents are in order in the event of an unexpected health crisis or death (for example, advance directives, wills, a safe place for storing essential files, plans for what to do with social media profiles).
- Discussing funeral options including help writing obituaries, deciding the music and who will give the eulogy, choosing where to be buried or even help finding green burial options.
- Helping with legacy preparation which might look like writing letters to loved ones, creating a slideshow to show at the funeral, or more involved legacy projects to share after death.
- Easing fear and anxiety about dying, what happens after death, what the dying process actually looks like.
- Clearing up uncertainties about end-of-life decisions and offering non-medical guidance on options including where a person wants to die, what people they would like to be present, death with dignity options, and how they would like to spend their final days.
- Advocating for your wishes with your health providers and your support team.
- Accompanying the ill in times of loneliness which could include reading, watching tv, talking and visiting, sharing stories, or just listening.
- Giving caregivers a break whether on a regular basis or not which allows them to look after themselves and have an ear to talk to about the challenges of caregiving.
- Helping out with practical and physical tasks when our client can no longer do for themselves or just needs some help with things like walking the dog, giving a ride to an appointment, tidying up their nightstand or preparing a simple meal.
- Where appropriate, planning and carrying out spiritual rituals.
- Planning a last hurrah for those who know when they are dying with more certainty because they’ve chosen medical aid in dying or voluntary stopping eating and drinking.
- Talking to our clients’ inner circles when they’re confused or worried about their loved one.
- Sitting vigil during the dying process and providing a calming and compassionate presence for everyone there.
- Facilitating difficult conversations and making sure everyone that should be included is involved and understands.
- Grief counseling which is just as important after a planned death as it is after an unexpected death.
You’ll want to determine your specific needs and ask the doula you’re considering what their services include.
Making Sure You’re a Good Fit
Questions to Ask Before Hiring a Death Doula
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The end-of-life is a difficult time for everyone. For our clients. For their loved ones. Even for the hospice team and medical support. It’s so important to make sure the doula you are hiring is going to be a good fit.
- What services do you offer and how do you customize them to meet the individual needs of your clients?
I have three services pages: Doula Services, Assisted Death, and Talking About Death.
- What is your training and experience as a death doula?
Read about my training on my About page.
- How do you feel about my spiritual beliefs and how can you help me find peace? Can you ensure that your services are culturally sensitive and respectful of my beliefs and traditions?
- How do you work with medical professionals, such as hospice, to ensure the best care possible?
- What is your availability and how do you communicate with your clients and their families?
- What kind of emotional and spiritual support do you provide to clients and their families during the dying process?
- How do you approach end-of-life planning and decision-making with your clients?
- How can I be sure you will keep our conversations confidential?
- What is your fee structure and what’s included in your services?
- Can you provide references or testimonials from previous clients?
Asking these questions can give you a better sense of a death doula’s approach, experience, and suitability for your needs.
The Most Frequently Asked Questions We Get
FAQs About Death Doulas
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This is a somewhat new field even if it’s not a new concept. Here are a few additional questions not answered above about death doulas.
What type of training or qualification does a death doula need?
At the moment, there isn’t a standardized certification process for becoming a death doula. However, many of us, myself included, have completed training programs and courses that provide the knowledge and skills necessary to support families and individuals in grief, during the dying process, and while planning their end-of-life. You can find my training listed on my About page.
What are the benefits of hiring a death doula?
One of the most important benefits is the calm and reassuring presence doulas provide and the knowledge of the dying process they can explain with love and compassion. A number of other benefits are mentioned above in the section covering the problems a death doula can solve.
How much does it cost to hire a death doula?
The cost for doula services will vary depending on what the client needs, the length of time they are needed, and their experience and qualifications. That’s why it’s important to discuss fees up front.
Do death doulas provide medical care?
No, death doulas provide non-medical support. But we can help caregivers keep track of medications and we are able to make sure our clients are getting the symptom relief they need from their medical team.
What qualities do you need to be a death doula?
Empathy, love, and compassion, above all. Doulas also need to be organized and detail-oriented.
Are death doulas only for people who want to die at home?
No, death doulas can provide support to anyone whether at home, in a hospital or other institution, and even via Zoom.
What does sitting vigil mean?
The last days of life are referred to as a time of vigil. During the final days of one’s life, a doula can sit with you, by your side, providing comfort, support and rest for you and your family.
How do I find a death doula?
You can ask your doctor or hospice provider. Some funeral homes even recommend death doulas. Here are a few directories that list death doulas for hire: Deathwives, Going with Grace, Compassion & Choices, and the American Clinicians Academy on Medical Aid in Dying.