I first learned about end-of-life doulas, or “death doulas,” after reading The Collected Regrets of Clover last year. Written by Mikki Brammer, the book follows the fictitious life of Clover Brooks, a death doula living in New York City, who helps individuals and their family members through the dying process. Each experience Clover encountered was unique and life-changing. As a death doula, she was provided a voice for the dying, representing their desires and wishes as they transitioned from life to death.
While Clover was a fictitious character, there are many end-of-life doulas working throughout the United States. According to The National End-of-Life Doula Alliance (NEDA), as of April 2024, there were over 1550 end-of-life doulas working in the US, the District of Columbia, Puerto Rico, and 13 additional countries. End-of-life doulas value providing “non-medical, holistic support and comfort to the dying person and their family, which may include education and guidance as well as emotional, spiritual or practical care.”
Though they do not provide medical assistance, end-of-life doulas often complement hospice services by providing emotional, physical, and spiritual support. Such support can include educating individuals and family members about the dying process, assisting with obituaries and funeral planning, providing grief counseling or companionship after someone has died, and sitting vigil as an individual is dying.
End-of-life doulas can also work with individuals and families who may need assistance in talking about death. For example, healthy and “non-terminal” individuals can work with end-of-life doulas to assist with their fears about death. Additionally, end-of-life doulas can offer support to individuals and families navigating the grief and loss of a pet. Such support can include sharing stories about the pet, deciding on a resting place for the pet, and creating a memorial or way to honor the pet.
Unfortunately, end-of-life doula services are not covered by Medicare or other insurance. Instead, such services are typically paid for by individuals and families as an out-of-pocket, private expense. However, some hospice services support end-of-life doula services through private donations, grants, or scholarships. For example, Goodwin Hospice in Virginia has a service agreement to provide end-of-life doula services to patients and families when the need arises through philanthropic donations made to the agency. Volunteers can also be utilized by hospice agencies to provide no-cost end-of-life doula services to individuals and families.
There is currently no government certification required to become an end-of-life doula. However, there are several organizations, including the NEDA, Lifespan Doulas, The Dying Year, and The University of Vermont, that provide training and certification for individuals interested in becoming an end-of-life doula. The NEDA established Standards of Practice and Code of Conduct Guidelines for ethical and professional end-of-life doula practice, along with a “micro-credential” proficiency assessment process. The University of Vermont also offers an end-of-life doula professional certificate program.
Having conversations about death and the process of dying can be complicated and challenging. To assist individuals and families during this difficult time, end-of-life doulas can be utilized to provide emotional, physical, and spiritual support. Though usually privately funded, such services may be covered by hospice organizations through volunteers, private donations, grants, or scholarships. Individuals and families should consider end-of-life doula services if they have questions about the dying process, need assistance in preparing for death, or would like to complement existing hospice services.
