An End of Life Doula, also known as a death doula, dying companion, or death midwife, is a trained, non-medical professional who provides emotional, physical, informational, and spiritual support to individuals who are nearing the end of their lives and their families. Doulas offer guidance, education, and assistance before, during, and after death. An End of Life Doula operates like a life coach for patients and families at the end of life. She is there to help you determine what matters most during your life's final chapter and helps bring your wishes to fruition. What loose ends do you need help tying up? What broken or estranged relationships would you like to resolve? She can help you share your untold stories or help you hold a "pre-memorial so you can reminisce together with your friends and family. While most people cannot comfortably discuss death and the end of life, an End of Life Doula is trained to speak easily about these subjects and to treat dying as a natural process. She will help you and your loved ones experience the best outcome possible - death with dignity and physical, emotional, and spiritual comfort. We answer questions, ease anxieties, serve as guides, and advocate for autonomy and dignity. End of Life Doulas are not only for the imminently dying. We can assist people in all stages of life with advanced care planning, education, resolving death anxiety, and supporting grief. Please see the section under SERVICES for more specific information on what support I can provide.

When we let death “happen” without planning, it becomes a medical event rather than a normal part of a life cycle. We must remind ourselves that death is a natural part of life. Approximately 30% of people create end of life plans and share them with their loved ones. But what about the other 70%? We will all experience death at some point, so why not plan for it? The more you plan for your death, the better the experience will be for all involved. The greatest determining factor in whether or not an end of life journey is considered positive is the level of support experienced throughout the process. End of Life Doulas are Event Planners for the dying and help fill the gaps between all of your different service providers. We can work with you, your family members, and caregivers to help you develop an “End of Life Care Plan” so you have a say in the different aspects of your dying journey. End of Life Doulas are a calming and reassuring presence with knowledge of the death process. We serve as a compassionate resource for families who may be in shock, overwhelmed, and grieving at the impending death of a loved one. There are various services the End of Life Doula can offer in the dying process, and they are primarily a comforting, reliable, and knowledgeable presence during a difficult and emotional time. Why wouldn’t you need an End of Life Doula? Maybe that’s a better question.

End of LifeDoulas can be called in at any point during the end-of-life process (or earlier; see the next question). The best time to hire a death doula is at the point when a person first gets a terminal diagnosis. End of Life Doulas do not have the same admission criteria that hospice does and can begin important discussions at any time during one's illness. The sooner the End of Life Doula enters the process, the more time she has to get to know you and your family, prioritize end of life needs, and, with your input, create a high-quality End of Life Care Plan.

Absolutely not. You do not have to meet any particular criteria to work with an End of Life Doula. If you (or someone you love) receive a life-limiting or terminal diagnosis, even if the prognosis is years, I welcome you to contact me whenever you feel ready to start the conversations and planning around death. People without known diagnoses also work with End of Life Doulas to facilitate challenging conversations, create advance directives and manage death anxiety.

Yes. End of Life Doulas provide supplementary and complementary support. Anyone who has had a loved one in hospice knows that the number of hours of weekly hospice care is usually quite limited due to staffing, budgeting, and Medicare restrictions. Doulas work well alongside hospice staff and can provide more service hours than hospice workers.

Yes. The National Hospice and Palliative Care Organization (NHPCO ) is the membership organization for all the hospices in the US. They have created The End of Life Doula Council to be able to share with hospices and families how the professional End of Life Doula can assist and complete the hospice team to fill in “the gaps in care” and allow for the best end of life experience for both the patient and their loved ones.

It is recommended that every individual and family facing a terminal illness call a local hospice as soon as possible. Usually, there is a medical referral to hospice, but that’s not necessary, as they can be contacted directly. End of Life Doula services do not replace the hospice's medical team of nursing, social work, and physician care; they complement the hospice team. Doulas offer more personalized attention, more continuity at the bedside, more advocacy for patient wishes, and more time availability than what hospice can provide. We are trained and practiced in being with intense and difficult emotions and listening fully. We can provide a consistent relationship with clients and families and full-time presence and companionship at the vigil and death. No other programs are currently providing that level of end of life support.

Some hospices in the U.S. offer complimentary end-of-life (EOL) doula services as part of their care. While these hospice doulas receive specialized training, their role is limited by hospice regulations. Unlike private EOL doulas, who can provide comprehensive support, hospice doulas may be unable to address certain immediate needs independently. This can lead to potential delays as patients must be referred to hospice social workers for assistance. Private EOL doulas offer more extensive support, including immediate attention to practical needs and ongoing emotional and spiritual care. While hospice doulas are provided at no cost, many clients find the value of a private doula's comprehensive services outweighs the financial investment. Our experience shows that patients and loved ones often prefer the personalized and efficient coordination provided by a private EOL doula, in conjunction with the medical care offered by hospice.

Several qualified training programs educate and certify End of Life Doulas. Many Doulas have medical, social work, psychology, counseling, ministerial, or similar backgrounds before training as an End of Life Doula. When you choose an End of Life Doula, be sure to choose one who has earned certification.

Not yet. The End of Life Doula profession is non-medical. Just like the establishment of birth doulas 40 years ago, a government license is not necessary to enter the profession.

Yes. The National End of Life Doula Alliance (NEDA) has set a national practicum with Core Competencies for the practice of professional End of Life Doulas. All End of Life Doulas that pass the assessment receive the NEDA National Credential and can become members of the national membership organization.

No. End of Life Doulas are usually private pay. All “companion” services, such as home health aides, are private pay. Some hospices in the US include End of Life Doula services, but Medicare limits these individuals in how much time they can devote to each patient. End of Life Doulas charge for their services in various ways. Some create service packages for a set fee, while others charge by the hour.

No. An End of Life Doula does not give any prescription or over-the-counter medication. Only specific medical personnel and trained caregivers (including family members) can administer medication.

Yes. An End of Life Doula can help with all the necessary preparations before and after a person’s death.

A good death might be defined as one that is well-planned ahead of time. The plans covers your medical care choices (what care you want, what care you don’t want), the location of death (home vs. facility), and the people and things you'd like in your immediate environmentwhen you're actively dying . Pain is controlled and death occurs peacefully. The dying person has a sense of closure, feels loved and supported, and trusts in their caregivers. They may have left a legacy for their family, have talked about regrets and unfinished business, forgiven and been forgiven, and said their good-byes. They recognize with some acceptance that it's their time and feel peaceful and prepared to leave the physical world.

Dr. Elisabeth Kubler-Ross recognized five stages a person who is diagnosed with a life-limiting illness and is dying or who has encountered a loss traverses. These are denial (shock), anger, bargaining (let's make a deal), depression, and acceptance. The stages are not meant to be linear, and one can feel acceptance one moment and anger or depression the next. According to the grief expert, David Kessler, who studied with Dr. Kubler-Ross, there is a sixth stage: finding meaning. His definition of this last stage is the hope that the person dying and the griever find a sense of purpose and integration as a final step.

According to grief expert, David Kessler, people who are grieving need six experiences in order to find their equilibrium again. To have their pain recognized To express their feelings To release the burden of grief To be free of old wounds To integrate the pain and the love To find meaning in life after loss. When I work with grieving clients, we work through these six steps if the client finds it helpful.