Why End of Life Doulas are Necessary

There are many ways Death Doulas can assist clients and families as people move toward the end of life. The patient’s symptoms will often multiply, and become more pronounced, and as this happens, caregiver exhaustion will increase. The family members and loved ones will often feel alone, unprepared, and afraid, and because of this, any opportunity to explore the deeper meanings that surround this time will be lost. The spiritual and sacred aspect of dying tends to get overlooked and ignored, and often times love and forgiveness goes unexpressed. Working with those who are transitioning and their families takes intense and continuous support and guidance. Many of the facilities we have, hospices, hospitals, communities, and other settings in which people typically die, do not have the organizational structure or resources to provide the necessary guidance and support. The HELD Program will fill in the gaps in these services. HELD offers the opportunity of dying consciously, can help find deeper meaning in the process, and provide great comfort to the family. The End of Life Doula will introduce best practices that will comfort the transitioning individual as they hold space and preside over the flow of life.

There are many ways in which an End of Life Doula can help. HELD refers to this as presiding over the flow of life. As End of Life Doulas work with families, they often work on all areas at the same time, and separate out aspects during and/or afterwards.  Multi-tasking is a skill that Death Doulas must master.  Although the different aspects with regard to presiding over the flow of life, can be messy, I have unpacked and teased apart various aspects for clarity (or for billing purposes if you are thinking of creating a business as a Death Doula, or hiring one.) This approach can be explored sequentially or separately, depending on individual wants and needs. Some patients and families desire help with all aspects, and some just a few—the power of this program is that it is tailored specifically to client and family needs.

During vigil, doulas stay continuously with the family, use the client’s specific guided visualizations, atmosphere, and music to help them stay calm and let go more easily. Doulas emotionally support the family, help ease anxiety, create and hold safe space, and guide people through each transition process.

Presiding Over the Flow of Life


Introducing the Concept to Clients: Communicating, Initiating Tough Discussions & Planning

  • Introduction to End of Life Work, and how death doula’s help
  • Concepts of Communication & Holy Listening
  • Address client’s worries, and identify opportunities for increased quality of life
  • Extend presence of support by being available as often as possible
    • Dying flows in its own way—inform about the natural process of dying
    • Open the door to deeper emotional support
      • Don’t avoid words like death and dying—talk from the heart and say what needs to be said
  • Explore the transitioning individual’s life meaning
  • Honor the client, who they are, what they have accomplished
  • Life History Summation
    • Qualitative techniques
    • Producing a completed document
  • Initiate legacy projects—What is legacy? What can they leave for family
    • Explore options with family and/or client
  • Explore unfinished business
    • We are participants to the family and the client in their transition
    • Process feelings with client and family
    • Explore and understand grief
    • Work with them in the early stages of grief (then direct them for further help)
  • Create personalized meditative, guided sessions and begin to reframe stories and events
  • Aroma touch sessions and other natural ways to relieve stress
    • Demonstrate ways to touch and hold the client as they transition (reassuring to the dying)
  • Create personalized visualizations
    • Address issues of culture and spirituality—ask family what is preferred
  • Determine how the space will look and feel at the time of transition
  • Vigil Planning: designing rituals and develop a vigil plan
    • Prepare a formal plan for their vision of a “good death”
    • What will the space look like? What is sacred to the client? Smells, sounds, and overall atmosphere.
    • How should individuals interact at the bedside?
    • Does the client want touch


Moving into Deep Communication, Open-ended Questions, & Developing Vigil Plans

  • Communication, Holy Listening, & Open-ended Questions
  • Active Dying & Conducting Vigil
    • Vigil Planning
  • Vigil begins when the person is actively dying (the last 2–4 days)
    • Around the clock care shifts (3–6 hours)
  • Assure the last days happen as planned
    • Hold space for the initial designed plan to unfold
  • Use touch, and holding to bring comfort
  • Provide family with respite
    • Normalize and instruct on the dying process
  • Make sure the individual does not transition alone
  • Inform about signs and symptoms
  • Lead guided visualizations and rituals
  • Maintain a sense of the sacred
  • Be involved and communicate with the professional care team
  • Monitor visitors time with the client—the death doula might be the one to control the time spent with the client
  • Provide emotional support
  • Make any phone calls to funeral home and friends
  • Care and Ritualized washing of the body after transition


After Transition: Funerals, Client Follow-up, & Grief Support

  • The how’s and why’s of funerals
  • Transcribe and/or Re-tell the dying story in detail—offer a formal written summation to the family
  • Uncover traumatic moments to reframe them
  • Uncover repeated images, sounds, smells, and/or thoughts
  • Discuss what was said and unsaid
  • Share the love and care you as a death doula experienced—this will help bring feelings of peace to the family
  • Give back beautiful moments to the family
  • Explore and explain the journey through grief
  • Provide emotional and spiritual support
  • Provide opportunities for grief processing
  • Assess what worked well and what did not
  • Bring completion to the doula involvement