End-of-life doulas work with a dying person, their loved ones, paid caregivers, and medical team at any point following a terminal diagnosis, and especially in the last months of life to support them emotionally, spiritually, and physically.

The end-of-life (EOL) doula will also provide information to help the dying person and others make choices about, or understand the nature of, the dying process.

Advanced Planning

Health Care Directives

Health Care Powers of Attorney

Financial Powers of Attorney & Other Legal Documents

Final Disposition

Funeral/Memorial Services

Life Review

One of the primary areas of focus for the EOL doula is exploring life meaning through life review that helps a dying person and those close to them look at what has been important to that person over the course of their life, what they have learned, the values they have come to hold, their impact on the people they have lived among, and what they consider to be their legacy.

Anticipatory Grief

It is not unusual for the dying person to experience their own grief over their life coming to a close. Very few are ever truly prepared for death, and the grieving process may include such varied factors as regrets over experiences not yet lived, unresolved issues from the past, missing milestones of loved ones left behind; i.e., a wedding they will never attend, a milestone birthday that never occurs, a grandchild never met, their own planned bucket list item left unticked, etc.)

Sometimes the grief turns into a resistance toward the concept of dying itself, a generalized fear of the dying process, or a specific terror of anticipated pain, or perhaps what awaits them on the other side of this life.

The EOL doula is available to assist the dying person in processing their regrets, work with them to participate after death in milestone events, and offer tools to help them cope with their anxiety and fear of the dying process.

Forgiveness Work

Ideally, we all deal with forgiveness, both of ourselves and of others, as issues arise throughout our lives. But forgiveness is a process, and sometimes that process needs attention in order to die unburdened.

The EOL doula can assist the dying person (and where appropriate, their loved ones) in first forgiving themselves for all of the things they did or didn’t do about which they are now experience regrets. We can offer concrete and practical ways to understand that it is not fair to judge oneself by the increased experience and abilities they now have, but that their life choices were made as the best they could do at the time with the tools they were given.

Understanding this for both ourselves and for those whom we have previously judged goes a long way toward healing old wounds, but sometimes true healing requires actually asking (and offering) forgiveness, and this active forgiveness process need not be constrained to only those who can be physically present, and we can work with the dying person to obtain this release and ease of mind whether they need to ask for forgiveness on their own behalf, or offer their forgiveness to others.

Legacy Project

The EOL doula will support a dying person and loved ones in extracting from the life review the material they might want to use in creating a remembrance project, often referred to as a legacy project. This project may reflect who the dying person has been and the impact they will leave behind on people and their community. The legacy project can be as simple as writing letters to loved ones to open on events to occur in the future, or a photo album of the dying person’s favorite memories. On the opposite end of the spectrum, the legacy project can be as complicated and expansive as a written memoir, establishing a scholarship at their alma mater, or setting up an endowment fund for a research project

A “Good” Death

One of the main areas of focus for the EOL doula is to assist the dying person in defining their best expectations for their own death death, their “perfect” death if you will; and once defined, the EOL doula uses their skills and training to ensure that the death conforms as closely as possible to that ideal. At any point in this process the dying person may change their previously stated desires for their death plan, and the EOL doula will immediately conform to those wises as best they are able under the circumstances, and within legal limitations.

The EOL doula will help the dying person and loved ones plan for their wishes during the last days of life. This involves reviewing and explaining the choices they have in where they want to die, how the space is set up around them; the kinds of interaction they want with loved ones, caregivers, and others; as well as the kind of sounds, reading, smells, light, and touch they would find comforting and helpful as they go through the dying process. If desired, the EOL doula can assist in developing rituals that meet the spiritual and emotional needs of the dying person and their loved ones through the entire dying process.

If there is conflict in the wishes of the dying person and their loved ones, the doula will advocate for the primacy of the dying person’s wishes and also explore ways to support the loved ones.

Transition & Vigil

The EOL doula will inform loved ones and caregivers about the signs and symptoms of the active dying process and imminent death, discuss how and when to address these symptoms, as well as what to expect as the process continues to unfold.

When the dying person is in their last days of life, as they transition toward death - the time we refer to as the “vigil” - the EOL doula will attend to them and those around them in ways that reflect their wishes and the need for doula presence.

The primary focus of the EOL doula in this stage is maintaining and advocating for the spirit of a plan they had worked out beforehand. If no such planning work occurred prior to the EOL doula involvement, the EOL doula will work on the choices and options with those involved as the vigil begins.

The EOL doula will do what they can to hold the space for the choices about the atmosphere and the wishes of all involved. The EOL doula will use sound, readings, touch, guided imagery, and ritual to deepen the sense of meaning and bring greater comfort to everyone involved.

The EOL doula might also assist in the physical care of the dying person by providing simple mouth care, assisting the caregivers in repositioning the dying person or changing the bedsheets, applying a cool or warm compress, or wiping sweat from the person’s face and neck.

Respite Care

The EOL doula is available to provide respite care, either during previously scheduled meetings with the dying person or as requested by the loved ones and caregivers, as allowed within the Agreement for Services. This respite care allows the caregivers space to attend to their own personal needs for a specified time, knowing that their dying loved one is being attended.

The EOL doula might also assist in the physical care of the dying person by providing simple mouth care, assisting caregivers in repositioning the dying person or changing closing or sheets, applying a cool or warm compress, wiping sweat from the person’s face and neck, etc.

The doula will not administer medication, change wound dressings, or do any other kind of physical care that requires clinical training.

When the doula is providing care in a facility, hospital, or hospice in-patient setting they will only assist with physical care if asked by a clinician to assist and the doula is comfortable in doing so. If assisting with physical care, the EOL doula must abide by the rules and regulations of that setting for the kinds of physical care assistance that is permitted for non-staff people.

If the loved ones or caregivers need further clinical understanding, or events and issues suggest the need for greater professional involvement, the EOL doula will reach out to the appropriate clinician to have them provide information or to intervene appropriately.

The EOL doula will not perform any medical assessment or intervention, regardless of their background or licensure, which lies outside of the EOL doula’s training and scope of practice as stated in this document and the Agreement for Services.