Lessons From Living And Dying: Death Doulas Share Their Insights

No one indeed escapes death, yet how you die can be an extraordinarily personal experience. And those personal thoughts and choices as to what can happen appear to be having a moment, as even celebrities are now not only discussing their thoughts about death but are in fact choosing to go through the process of becoming death doulas. You know the concept of a death doula is having its cultural moment when you read headlines such as “When Did Everyone Decide To Become A Death Doula?” Many people decide to go through death doula training because of a personal experience they’ve had with a loved one dying (as is apparently the case with Nicole Kidman). Our own agebuzz guest blogger, Kathleen Rehl, has written a series of essays detailing her decision to go through the training after experiencing the deaths of her husband, her mother, and her father. And as Americans become more comfortable discussing and facing the end of life (one recent study suggests 9 out of 10 Americans are comfortable discussing death), the number of Americans training to become a death doula has soared, from 260 death doulas in 2019 to over 1500 death doulas in 2024.

What that suggests is that for many more individuals, and their families, the opportunity to have a death doula be present at the end of life and provide comfort, support, and even practical help can be more of a reality. The website US Funerals Online has a page of links to help you find a death doula in your specific area, and INELDA (The International End-Of-Life Doula Association) also has a directory on its website. It is important to understand that because the services of a death doula are non-medical in nature, it’s unlikely that you will have any insurance coverage to pay for such services, though many doulas do provide a sliding-scale fee for families with limited budgets, and there are even pro bono doula services in some areas. The costs of a death doula can vary widely, depending upon the services provided, the amount of time spent, and the geographic region of the patient at the end of life. Fees can range anywhere from $25 per hour to $150 per hour, with the average being about $85 per hour. It’s also possible to contract for a set rate for set services. You can find out more about pricing here.

Sitting at the side of a person at the end of his or her life, or sitting with a family as it approaches the death of a loved one, is a position of tremendous responsibility and, as many see it, a privilege. Whether helping a dying person come to grips with unresolved affairs in their life or supporting a dying person as they create letters to loved ones, doulas work to make the last days and moments a peaceful, calm experience, filled with love and arrangements as close to what the person wished for as possible. And because of this work, doulas have much to share in terms of the wisdom they’ve acquired and the experiences they witnessed at the end of life. A recent article in The Washington Post reflected some of this experiential wisdom. For example, many doulas make clear that the end of life can be a peaceful transition and that it doesn’t have to be painful (doulas often work in a complementary fashion with hospice providers, who can manage end-of-life pain and suffering). Doulas also often work to create an environment that’s in keeping with the personality of the patient, perhaps playing a certain type of music or having certain people be at the bedside. They also work to remind those at the bedside that for dying persons, hearing may be the last sense to go, so continuing to express love and connection to the person who is dying, and letting them know they are not alone, can be very important. And while dying people often reach out and react as though previously deceased loved ones are in the room with them, they also often wait to actually pass until their living loved ones have left the room.

Grief is also something handled and addressed by death doulas, especially among family members after their loved one has passed. Many doulas talk about the wide array of expressions of grief that they see- it’s not all- or always- floods of tears. In fact, many of those grieving take on specific tasks to celebrate or keep alive the memory of the person they’ve lost. Just because grief is not immediately or intensely felt doesn’t mean the surviving loved one is not grieving. As one doula recently wrote, “But grief doesn’t follow a set script, and just because someone’s not openly mourning doesn’t mean they aren’t feeling the weight of loss. We often have ideas about how it’s supposed to look because of how we’ve seen others experience it. But, trust me, grief is there — it just shows up in ways we don’t always recognize right away.”

Many doulas have been motivated to write down their experiences, to share with others what they have learned, and to teach individuals and families how the end of life can be approached openly and tenderly, releasing fears, tensions, and regrets to create a peaceful ending. For some of the more recently available books, take a look at the following: Never Can Say Goodbye: The Life of a Death Doula and the Art of a Peaceful End by Darnell Lamont Walker; A Death Doula’s Guide to a Meaningful End by Jane K. Callahan; and Unfinished Business: Writing the 5 Essential Letters of Your Life by Frish Brandt, which will be published in October of this year. Ms. Brandt is also the founder of My Lasting Letters, a website and educational opportunity to help you craft those essential letters that give meaning to your life, including letters written as your life comes to a close.

Whether seeking practical help with logistics or possessions or spiritual support when formal religion is not appropriate, doulas can provide a calm and tender presence to bear witness and offer comfort to patients and their families at this most personal moment. As one doula recently recounted, “I can’t fix things or make it better, but I can sit with them in their grief and ensure they’re not alone.” For so many, the availability of that level of intimacy and support is a crucial step toward reconciling what happens at the end of life.