Death doulas

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.


  1. says

    the more devoutly religious you are, the more likely you might have a nagging fear that you are not good enough for god

    Where else could the PUAs have gotten the idea of “negging”?

  2. Crimson Clupeidae says

    Wow, Marcus, that is a disturbing parallel I hadn’t even noticed.

    It is refreshing to see this person’s attitude though. I find the older I get, the less the idea of my death seems to bother me, but it’s still, hopefully, a comfortably long way off.

  3. Mano Singham says


    Man, I am so out of it when it comes to current popular language. I had to actually look up ‘PUA’ and ‘negging’ to understand your comment.

  4. colnago80 says

    Speaking of obituaries, is Prof. Singham planning to comment on the following item? Just for the record, Prof. Guralnik was my co-PhD thesis adviser.

  5. Heidi Nemeth says

    The more demented and sick a person becomes, the more the primal survival instinct trumps the intellect. That makes it unlikely a still conscious but sick and demented older adult will agree to forego medical treatment, even if the treatment is futile, painful, and expensive. I wonder how much a death doula could help with this issue?

  6. Jonny Vincent says

    World Airways Evacuation From Da Nang To Saigon in 1975

    The final flight out of Da Nang with the North Vietnamese closing in. Life for those who caught the flight, death for those left behind. Of the 268 humans that managed to board the flight, 261 were men. There were five women and only two children. Wives, children, parents, entire families were left on the runway by young men. Men left behind fired shots at the flight (“If I can’t leave, no one can.”)

    The reaction of the men who made it onboard is chilling.

    I have a theory about survival; I believe the reaction humans have to dying is counter-intuitive.

    The more miserable, pain-filled and disconnected humans are from Humanity the more viciously they will fight to remain alive. The more happy, fulfilled and connected they are; the more willingly humans will die to save the lives of others. If my theory is correct, I suspect it’s due to the phenomenon of sunk costs. The more pain and suffering has been invested into a life, the harder the invested human will fight to survive.

    Have you ever been so happy you knew you could just die right then and it’d be fine?

  7. ll says

    Jonny: Death should indeed be embraced with the same jouissance with which we approach the largeness, the beauty and the exquisite particularity of life. I am not sure about your “sunk costs” hypothesis. I do think you are close, though; perhaps it is trauma that reduces us to the Infant, crying out for Mother, never safe, never heroic, , never fulfilled, and never to be autonomous again.

  8. says

    I too loved this article about Rebecca too. I have been a doula to the dying since 2005 and have been training others since 2010. I find that most people are seeking meaning in their life and in their dying as they leave this earth. Whatever their spirituality is as they go through this is what I will support. As a doula, it is my belief that it is not my place to bring mine into their experience but for me to hold the space for them to explore or to be a witness, whatever reason they have brought me in their world. Some people want me to create ritual with them, but most people have simply wanted emotional support and someone with them who knew what was happening and could help maintain a peacefulness practically speaking. To me, our main role as a doula is to provide a safe harbor during a frightening time for many, helping people in ways that are meaningful for them. peace, Deanna

  9. Jonny Vincent says

    …perhaps it is trauma that reduces us to the Infant, crying out for Mother, never safe, never heroic, , never fulfilled, and never to be autonomous again.

    Yes! I think this explains the self-defeating obsession so many people have with securing power and control over others, reducing those they need into things (Josef Fritzl need for Elisabeth or anyone unwilling to do themselves a favour and allow their Loved One/s free will to choose). Our courage was taken from us when our Self was eroded, leaving us powerless and infantilised.

    Humans are emotional basket cases, glass jars that shatter into tears or psychotic violence at mean words they imagine are hurting them in their imaginations. A world of abused Toddlers, terrified but putting on a brave face, acting tough and talking smack but when we front, we reveal our need to front. You can’t conceal the need to conceal. Courage and Self go hand-in-hand. With courage, no one has ever needed to be brave.

    If everyone rediscovered their Self, we could salvage this deity species choking on illusory need. But we won’t, because everyone already Knows Best and they’re prepared to kill to prove it.

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