The Increased Need For a Death Doula
In ancient Greek mythology, the figure of Charon the Ferryman awaited the souls of the dead to take them across the River Styx and into the Underworld, the House of Hades. Often combined and conflated with the image of the Grim Reaper, depictions of Charon usually show at best a disinterested and at least a cruel harbinger of death. However, original stories of the mythical realm showcase Charon as a caring navigator, ensuring the dead do not embark on their final journey alone.
A relatively new role in end-of-life care that mirrors Charon’s eternal task is rising in popularity, one that offers companionship, support, and wisdom to people who await death’s threshold. Death doulas, professional caregivers with a focus on the dying process, perform a variety of services ranging from logistical planning, emotional support, and advocating for the wishes of the dead and dying. Like Charon the Ferryman, death doulas offer compassion and understanding while ushering passing souls through unknown waters with dignity.
Advocate for the Dying
“Death doulas help to empower individuals and families to actively participate in the end-of-life process, advocating for their preferences and ensuring their wishes are respected and honored.”
- Karen Hendrickson
Awareness and demand for end-of-life care with a holistic and natural focus is growing, which has brought the presence of death doulas to prominence. As families and individuals begin to explore the options and outcomes of perhaps the most profound transitions in one’s life, death doulas strive to provide personalized guidance and tried-and-true support.
Emergence and Evolution of Death Doulas
Attitudes toward death and dying have evolved and changed throughout history and geography, usually as a reflection of the societal, cultural, and religious beliefs of the time and people. Historically, care for the dying involved a more palliative focus, managing symptoms and pain with the contemporary understanding of medicine, while mostly ignoring emotional and spiritual facets of the death process. Recent years have seen more of a demand for a holistic approach, shifting the paradigm to recognize how important it is to address the psychological needs of someone facing death.
The movement for a more natural philosophy surrounding end-of-life processes seeks to emphasize compassionate and patient-centered care for people entering hospice or palliative care. Advances of research and technology in many different disciplines across the board, as well as the increased availability of information for the layperson, empower individuals to seek out options for end-of-life and bodily disposition that align with what they’d prefer, their values, and beliefs. Meeting this new call, death doulas accept the role of personalized, holistic, end-of-life care.
The term ‘doula’ itself comes from an ancient Greek word used to refer to domestic servants, originally used in a modern context by the traditional role of a birth doula. As birth doulas provide continuous care for anyone giving birth, death doulas take inspiration from their practices by offering companionship, advocacy, and guidance to individuals and families who are either actively at the threshold of the dying process or for those who want to make sure they have a plan in place well before they’re forced to by circumstance. Some other terms for death doula are ‘death midwife,’ ‘end-of-life midwife,’ ‘end-of-life guide,’ or even ‘celebrant’ as a catch-all. No matter how they’re referred to, the people who seek to offer compassion and guidance to those navigating their own river to the afterlife can play a critical role in finding peace, whatever the stage.
Rethinking Death
“The pandemic really opened the door and caused this rising trend of Death Doulas. Before the pandemic, most people were focused on living well; when the pandemic happened it shifted the perspective, and brought more focus to dying well, and having a good death.”
- Patrice Horton
Why Are Death Doulas Becoming More Popular?
Many factors affect the rising popularity of death doulas, with probably the most important one being a growing awareness of limitations present in our current healthcare systems in addressing the emotional and spiritual needs of anyone facing death. Sometimes, traditional medical care can feel cold or impersonal while an individual may want more of a warm and personable approach to their end of life. This sense of disillusionment can lead people to seek out decision-making and planning that aims to navigate the complexities of modern death.
Karen Hendrickson of Death Doula Network International (DDNI) posits an aging population is finding a preference for home-based care, and a new appreciation for the importance of holistic care.
“People want to be empowered to advocate for themselves or their loved ones when it comes to medical and other care,” Hendrickson says. “Our healthcare systems are fractured and leave many gaps in care, therefore not meeting the needs of the patient and families. There is a slow cultural shift occurring as the public becomes more comfortable engaging in end-of-life conversations, and our shared mortality, with a willingness to focus on what matters most to them in their illness, dying, and death — and therefore in their living.”
One can’t ignore the effect of the COVID-19 pandemic on public awareness and perception of death, either.
High Priestess Lady P. 3rd EyE is a death doula operating out of the Chicago area, with a focus on meditation, hypnotism, and art as modal therapies for those experiencing either their own death or that of a loved one.
“I think that the pandemic really opened the door and caused this rising trend of Death Doulas,” Lady P. 3rd Eye says. “That was a time when the whole world was surrounded by death. Which caused people to think more about death. Before the pandemic, most people were focused on living well; when the pandemic happened it shifted the perspective, and brought more focus to dying well, and having a good death.”
Lady P. 3rd EyE’s perspective speaks to a growing perception shift around death and burial.
“Once the pandemic came, people’s lives became a lot simpler, and people began to have more appreciation and gratitude for the ‘little things.’ The realization came that we didn't need all the things we thought we did [like embalming], causing people to want to go back to the natural way of doing things.”
Having at least a passing understanding or preparedness and planning for end-of-life has become of paramount importance as people have reevaluated their priorities and preferences. Conversations surrounding death and dying have become more normalized and destigmatized, and more people seek out the type of care death doulas have to offer.
Filling Healthcare Gaps
“More than ever, with the rising increase of our senior populations, there are more and more gaps in services for individuals and families facing death and dying. Death doulas fill these gaps by providing personalized, compassionate care that addresses the unique needs and preferences of each individual and family.”
- Karen Hendrickson
What Services Does a Death Doula Offer?
The guidance, comfort, and companionship offered by a death doula are available at any time in someone’s life. Whether a life is impacted by a terminal illness diagnosis, an imminent death, or after a death has occurred, death doulas are there for support. Death doulas help lead important conversations with loved ones and medical professionals, allowing an individual facing death greater autonomy with clear definitions for their end-of-life processes.
Hendrickson says the main role of a death doula is to fill a need unsatisfied by the type of care present in our “fractured healthcare systems.”
“More than ever, with the rising increase of our senior populations, there are more and more gaps in services for individuals and families facing death and dying. Death doulas fill these gaps by providing personalized, compassionate care that addresses the unique needs and preferences of each individual and family.”
For Lady P. 3rd Eye, it’s to “help people die well and have the end of life they deserve.”
Death doulas provide opportunities for open and frank discussions about all things death and dying and can help create an advance care directive at any point in the journey of life. Discussion and support for end-of-life care are important to have before the transition of death is immediately imminent. Part of their services is to develop a plan for how the space where their client will die could look, feel, and sound, incorporate family traditions, or help create rituals for marking special moments throughout the dying process. Their intuitive and focused presence at the bedside helps provide calm and peace for those dying, and their surrounding family and friends. Doulas explain symptoms and signs the family might see while someone dies, and help process emotional experiences throughout and after someone dies, guiding people through early stages of grief.
Along with grief and emotional support, death doulas can be an extra set of hands to take care of concerns and burdens. They assist with physical and practical aspects of death care, especially during times when exhausted caregivers might feel overwhelmed. Sometimes, when appropriate, doulas encourage those who have gathered to touch the dying person. This important aspect of experiencing a death is not normally part of how hospice workers prioritize activities, so doulas can make sure this happens so the dying person can feel connected all the way to the end, and the surviving family and friends can actively process their loss.
Dying on Your Own Terms
“As a Death Doula, our main role is to help people die well and have the end of life they deserve. We advocate for their end of life wishes.”
- Patrice Horton
Dying in My Own Home
Before the advent and growth of the funeral home as a standard of the death care industry, for most folks, it was once a common event to host a home funeral. In those times, washing, laying out, viewing, the wake, and the funeral would all take place in the home, with the family members and other members of the community helping with each task. Much of the time, the body would then be laid to rest in the family plot.
With the growing interest in holistic and natural funerary and burial practices, the idea of dying at home has become more popular, too. Death doulas can help arrange everything that needs to take place for this to happen, as it’s legal in most states, as long as there is a death certificate and proper permission for the transportation of human remains.
“Death doulas help to empower individuals and families to actively participate in the end-of-life process,” Hendrickson says. “Advocating for their preferences and ensuring their wishes are respected and honored. This empowerment fosters a sense of personal agency and enables personal advocacy, creating dignity for those facing death, and contributing to a more meaningful and empowered end-of-life experience”
Dying in the comfort of one’s own home falls right in line with green and natural death care ideals, and is a wonderful way for those who wish to end their earthly journey in a place that is entirely familiar and brings with it a sense of peace and safety. The intimacy of family and friends in a home, gathering to usher the soul along with love and connection is an attractive idea that seeks to reframe how we practice care for our dying and dead. While there are certain situations where it would be better for someone to be monitored by medical professionals in a hospital, the general consensus is that it’s not a necessary practice. Death doulas are practiced in guiding families, natural and chosen, through the steps of at-home death care, incorporating practices and rituals like touching the body without fear of disease, enshrouding the corpse by hand, and decorating the (biodegradable, preferentially) coffin as a memorial to the deceased.
More Than Care for the Dying
“People are becoming more aware of our current funeral practices and they are consciously looking for earth friendly and cost effective funeral options... people are more educated than they were in the 1800's, when embalming and traditional funerals began after the civil war, and are more aware of body decomposition and its affects on the earth. Many doulas can help coordinate a home funeral and green burial”
- Patrice Horton
The Impact of Doulas on Death Care
There is a significant and growing shift in ideas and context surrounding Western society’s approach to death care, bringing about a need for care workers dedicated to guiding people at all stages of life through the end of life with an emphasis on compassion, dignity, and empowerment. Already what was once a fringe role in American funerals at large has grown in importance and use. Their focus on holistic practices throughout someone’s transition through the threshold of death aligns perfectly with a movement seeking to do death differently, seeing it as an event equal in significance to any milestone in one’s life, from birth and beyond. With death doulas on the job, no one has to face the end of their life alone.
For death doulas, ‘Doing Death Different’ brings everything back to an individual, human level unseparated from the physical, the mental, the emotional, and the spiritual facets of every being. The whole summary of a person’s life can and should be recognized and honored in their dying and death, and discussions about what we want for our end-of-life care could be as ubiquitous as friends sharing home renovation ideas over coffee. If the growing practice of death doulas can help make memento mori — a remembrance of the inevitability of death — a casual and everyday thing, perhaps dying doesn’t have to feel so lonely or scary. Maybe it can feel like a peaceful boat ride across quietly lapping waters. When we engage with their end-of-life compassion and care, death doulas do make a difference.
Written by: Brendan Reilly
