Part 1: What They Offer, Why They’re Needed
 
To live … is to breathe … is to die, the natural and inescapable rhythm of human life. Deep down, we understand this. But in our death-averse culture, many of us need help remembering how to live into death, on our own terms. That, in a nutshell, explains the arrival of the death doula. 
 
What is a Death Doula?
A death doula, or more formally, an end-of-life doula, is a person equipped to walk beside and provide emotional, non-medical support to those who are dying and their loved ones. Doulas are comfortable with death, often feel called to this work, have completed and may be certified through a training program, and typically have experience working with patients and families as a companion volunteer in a hospice or other end-of-life setting. Currently in Minnesota, end-of-life doulas can be hired as private practitioners or assigned as volunteers through a handful of early-adopter hospice programs. 

Like the birth doula who provides emotional support to a pregnant woman while her medical team tends to the physical needs of mother and child, an end-of-life doula companions a dying person during the long hours between visits from medical and hospice teams and during the final days and hours.

The goal is to help the dying person take back a little control, gain a little peace, and live with intention in their final days. Doulas, as skilled listeners, give those they serve the opportunity to speak freely and express their needs. That can mean venting, talking about their fears and worries, taking stock of their life, preparing final messages for loved ones, or expressing how they’d like to be tended in their final days. Because those who are dying often come to a place of acceptance before family members, it can be easier for the dying person to process what’s happening to them with an end-of-life doula – someone who is less emotionally involved and, by definition, accepting of death’s reality. 

Sometimes, it’s family members who seek the presence of a doula, especially if their loved one is too weak or unable to communicate because of dementia-related conditions or medications. For loved ones, a doula shows up in much the same way – inviting conversation, actively listening, and helping them, if they choose, to anticipate and plan for the active dying process, the death, and after-care of the body. In this way, a doula lessens the fear and normalizes the dying process, giving loved ones confidence that they can embrace and find peace and meaning in this experience.
 
Why Are Doulas Needed?
During the last century, Americans embraced medical innovation and benefitted in countless ways from pioneering treatments and surgeries supported by ever more powerful technologies. As life expectancy rates increased, however, death became less familiar and many of us lost touch with the traditions and rituals that once helped us manage death’s reality. When people did die, it was increasingly in a hospital, away from our everyday lives.
 
Fortunately, there were some who began working to address this loss. Hospice programs in the 1970s and 1980s, and palliative care programs more recently, have become a bridge, helping us transition from life-continuing medical care to life-affirming services designed to comfort us, manage our pain, and help us prepare for death. Still, as a culture, we have a long way to go. The end-of-life doula role was born and has come of age in the last 15 years to help us reclaim the dying process. And the current buzz it’s generating affirms that our culture is awakening to this issue. 

The International End of Life Doula Association (INELDA) is a prominent educational organization fostering the use of end-of-life doulas in hospices, hospitals, communities, and directly to dying people through the service of private practitioners. Between its first training in September 2015 and year-end 2018, the organization trained a total of 1,339 people. In just 2019, it trained 934 people, bringing its total to 2,273 people. And it expects to repeat or exceed last year’s number in 2020. To date, it has trained 169 Minnesota residents, and is offering two additional training classes in Minnesota this year. According to INELDA Vice President Jeri Glatter, “the state of Minnesota is establishing a prominent acceptance of the work of end-of-life doulas and we continue to be impressed by the forward momentum.”                       
 
Next issue: 
The Death Doula
Part 2: As Volunteer & Private Practitioner 
 
Kat Shea is a professional writer and volunteer end-of-life doula who collaborated with Grace Hospice to add volunteer doulas to its service offerings in January. She was trained by both Doulagivers and INELDA, certified through Doulagivers, and last year earned her proficiency badge from the National End-of-Life Doula Alliance. Well-networked within the growing death doula community, she welcomes conversation (katsheadoula@gmail.com) and invites learning through the recently launched Minnesota Death Collaborative (mndeathcollaborative.org). 

“This article was originally published in the spring 2020 issue of the MN Association of Guardianship and Conservatorship Journal.