Guest post by Deanna Cochran
All over the world, people are coming forward who want to accompany and guide others through the end of life. Some of these people are in traditional roles of nurse, physician, chaplain, etc. working through hospices and hospitals. However, there is a phenomenon happening now; people with the calling to serve others at the end of life who are creating innovative services that bridge present health and death care. We are known as an End-of-life Guide or death doula. We are developing private practices that bring forth our unique gifts. I am honored to work with these pioneers today and for the past several years.
These are some of the questions I am asked.
Question: You are an End of Life (EOL) Guide and Mentor. What does this mean?
Answer: I serve families as they accompany a loved one through dying. As an end-of-life guide, I provide a loving presence and companion the dying person through to death. Most often I am the primary caregiver as well. Because of my end-of-life experience and nursing background, I assist with a variety of medical and practical needs. I provide emotional and spiritual support, offer assistance with rituals or ceremonies that honor the transition and facilitate family meetings. I may make meals or refreshments. I serve in whatever capacity is needed.
As well, I mentor other end-of-life guides and doulas in their private practice development, ensuring they have all the components that will ensure they are fantastic guides and doulas.
Question: How do you define a death doula and their role?
Answer: In one of my workshops, we defined the role of a death doula as the person who provides a loving, compassionate presence at the end of life. This is difficult to fully describe as not all doulas do the same things. They offer support in the area where they have expertise. But we do have one thing in common: we are people who provide loving compassionate presence at the end of life, regardless if we do practical services, medical services, spiritual services, or anything else.
Question: Are there any regulations governing death doulas in the United States?
Answer: No, we are self-regulating. There is no Board or governing body offering credentialing or certification at this time for death doulas in the USA. Each end-of-life certificate program is an in-house certificate program of the issuing organization.
Question: What kind of insurance does a death doula require in the United States?
Answer: None, as far as I know. It is wise though to have a professional liability policy, be bonded, have a business structure that will protect your assets (like a LLC for example) and have a general good faith agreement in writing with your families.
Question: Can you tell us about people who have developed a private practice as a death doula and how their business works?
Answer: Most death doulas have a private practice and offer their services on a sliding scale basis and are private pay. Insurance does not cover death doula services at this time. Some are forming nonprofits so they can raise money to fund their services. Most charge an hourly or per session fee. Their services range from helping with advance directives, to patient advocacy, to vigil services.
Question: What do you anticipate will be the need for and the role of the death doula in the future?
Answer: The baby boomers have always wanted innovative services during their lifetime and it will be no different as they continue to age. Death doulas are able to provide the extra support some people will want and need: support that mainstream health and death care may not be able to provide due to time and financial constraints.
Question: Do most death doulas have a professional background (i.e. as a nurse)? And what do you recommend for those considering becoming death doulas?
Answer: No, most are not medical. You do not need a medical background to be an amazing death doula. You need to be grounded emotionally, not afraid of death and dying and be able to deeply listen and hold space for tremendous suffering. None of that is even taught to medical professionals. For someone who is called to serve the dying, I recommend you volunteer at your local hospice and really see how it feels to do this work. You need experience with how you react in situations and with death. That’s a great beginning. I have a free series called 30 Day Death Doula Training: Primer, designed to assist people figure out what exactly they may want to do with this passion. This is a free training by Quality of Life Care: https://accompanyingthedying.com/30-day-primer-sign-up
Deanna Cochran, RN, is an End-of-Life Guide to families and Mentor to other Guides and Doulas. She is founder of Quality of Life Care, devoted to bringing awareness that palliative care should be initiated from day 1 of diagnosis and supportive of nourishing and mentoring those called to serve the dying and their families. Her book Accompanying the Dying: Practical, Heart-Centered Wisdom for End of Life Guides, Doulas and Families will be published soon.
Spiritual Care Programme and Quality of Life Care join together to support those who want to serve at the end of life as guides, doulas, coaches, or the go-to person in their circle. This program provides a beautiful foundation for the support of our work. We must learn ways of nourishing our being and spiritually supporting those we care for in this work.
Central to the “being” of the end-of-life practitioner is presence. And what better principles to guide us in this than the ancient wisdom and practices described in the writings of “The Tibetan Book of Living and Dying” by Sogyal Rinpoche. The Spiritual Care program has taken this wisdom and prepared a program that people of all faith traditions can use and incorporate in to their practice.