The thought of death is frightening to many. Our sense of our own existence is so strong that the idea of non-existence can have an unsettling effect, although we know in our rational minds that we have to die sometime and that we were non-existent before we were born so it would not be a new experience (or more appropriately non-experience) for us. When we go to sleep too we are to some extent non-existent in that we become oblivious to the world around us but that does not seem to bother us.

Many religions, with their threats of hell for those who have transgressed their rules in some way, do not help except perhaps for those people who are so sure that they will go to heaven. But one has to imagine that even the most devoutly religious person must have a sneaking fear that they might not pass the test. In fact, the more devoutly religious you are, the more likely you might have a nagging fear that you are not good enough for god. The fact that so few want to die and try to prolong their lives as much as possible despite the supposed much greater joys that await them in heaven suggests that they are not as confident of the afterlife as they let on.

The hospice movement is one way that people who are close to death are enabled to die while not being subjected to extraordinary, painful and futile measures in efforts to prolong life. But what about the need of people to come to terms with death and alleviate their fear? The hospice system can provide some assistance in this regard but most of its emphasis is on palliative care, to reduce the pain and suffering that can occur for people with terminal illnesses

This article about ‘death doula’ Rebecca Green suggests another option. We are familiar with doulas in the context of childbirth. These are nonmedical people who aid pregnant women through childbirth by providing physical and emotional support as needed. A death doula is one who performs a similar task, except at the other end of the life cycle by aiding people through the process of dying. Green explains what she does and how she came to do it. She displays a refreshing matter-of-fact attitude towards death.

“People want different things from me: it could be anything from being a companion at a bedside, to providing practical support for the family. Or aiding conversations with the person’s doctor, which will then help with making decisions about treatment. Or navigating their way through the structure of the NHS. I’ve even met up with a man who simply had a fear of death. We talked for a couple of hours, and that was it, I never saw him again.”

Although some death doulas have a spiritual approach, Green doesn’t. “Some people will hate me for this, but so be it. If a person has not found ‘spirituality’ to be useful to them before they became ill, why introduce it when a person is facing death? I feel it’s a way of avoiding the living person in front of you – and avoiding yourself. Providing a ‘solution’ to this ‘problem’ of death, with a story. It’s big business, this spirituality. It preys on the vulnerable and it’s a crutch that’s going to break when you lean on it. You have your life, your living moments, and yourself – right up to the very end. You are enough – you don’t need to be spiritual.”

Apparently the need for death doulas is rising in the UK. I had never heard of them before now so suspect that it has not caught on widely in the US though there are practitioners here too.

What makes a death doula different from a hospice nurse is that a death doula doesn’t administer medicine or perform medical procedures, and is not certified or licensed by the state, according to the Illinois Department of Financial and Professional Regulation. Also, the death doula will remain — if the family wants — after the client dies to help with the funeral, which often is carried out in a place other than a funeral home.

That place could be the person’s home, a nursing home, an elder-care facility or even a hospital. The death doula might also facilitate an array of social arrangements, such as contacting a minister or simply accepting food that people offer as gestures of condolence.

Does talking about death increase or decrease the fear of it? I think it decreases it, both for the dying person and those who love them. When my mother was faced with the recurrence of her cancer, we had long conversations about life and death. She reassured me that she had had a good life and did not fear death if it should come soon. These chats definitely helped me to deal with her death and I like to think that it helped her too.

Everyone confronted with a situation where someone is dying tend to avoid talking about the topic. The dying person may not want to upset their friends and loved ones while the latter in turn may not want to raise the topic because it seems like they have given up. So everyone maintains a phony cheeriness that may be more depressing than having an honest discussion. Former journalist Ellen Goodman has started The Conversation Project aimed at encouraging families to more openly discuss this taboo subject, with tips on how to start the conversation.

I can see death doulas as a valuable supplement to the hospice system by, in addition to the other services they provide, also providing a means for people to begin to have such conversations through a neutral intermediary.