Artful Dying: The Roll of an End-of-Life Dula

“It is in the dying that we awake …” —St. Francis

Dying to live is a yearning for what life has to offer. Living to die is just being alive for life to end. But what if we are faced with an end we are not ready for? This is where an end-of-life doula can help.

What is an End-of-Life Doula?

Sometimes referred to as a death midwife, or death doula, end-of-life doulas assist with the dying process, much like a midwife assists with the birthing process. An end-of-life-doula empowers a dying person to take control of their situation, get questions answered, and put a plan in place as they move forward with treatment or choose supportive care. Doulas can connect us (or our loved ones) with resources, and help us prioritize what is most important, enabling us to better communicate our wishes to our health care team, family, and friends.

Doulas are skilled listeners who provide a calming influence and help troubleshoot challenges that may arise. They provide emotional support and comfort measures related to non-medical aspects of care such as positioning, visualization, and breathing techniques. Some doulas help with household chores, meal prep, and transportation to medical appointments. Doulas take a non-judgmental, non-medical approach to death support, working to ensure we live our best life as we move toward saying “goodbye” to those we love, and “hello” to those who have gone before us.

Setting the stage for creative dying

Doulas use a “life review” to guide the dying in reflection on the meaning of life. Many times, our most powerful memories are those connected to unresolved conflict, regret, shame, and guilt. Being guided through a life review process can help a person let go of guilt and shame, and feel relief. A life review reminds the dying of life’s joys and allows us to celebrate life’s big moments.

Impending death is the time to finish unfinished business, which can cause pain and heartbreak if not confronted. Dr. Ira Byock, a pioneer in palliative care, recommends a forgiveness practice. He encourages his patients to take care of the unfinished business now, rather than at the end, when it may be too late. The practice, which originated in Hawaii, includes saying “I love you,” “I am sorry, please forgive me,” and “thank you.”

A life review acknowledges we leaves a legacy when we die and doulas encourage families to work with the dying on legacy projects such as audio recordings, videos, photographs, and memory books. Legacies are the final gift we pass on to our family and future generations.

Awakening the Spirit

Spiritual care is different for everyone. Whether you belong to an organized religious faith, or you are agnostic or an atheist, spirituality plays a role in how we cope with our impending death, have hope, gain strength, and find comfort and connection. Recognizing the importance of traditions and practice is critical to artful living and a creative death experience. Doulas can provide support in helping us find meaning in our situation and handle the stress we feel.

Creative Space for Living and Dying

Where do you want to take your last breath? It is not just about the care we receive as we face death, but where we want to die. Most people prefer to die at home. Yet sometimes, for many reasons, we may not get to make that choice.

If we or a loved one is dying in a hospital or nursing home, things can be done to make the space look and feel more like home, such as creating comfort and peace by bringing in objects that have special meaning.

If lucky enough to be at home, small considerations matter such as where the bed should be placed, such as in the living room or bedroom? Do you want natural light and fresh air from open windows? Would you like comforters, quilts, candles, flowers, plants, music, or special oils? Are there spiritual or religious objects you’d like displayed?

As the end draws near, entering the space of a person who is dying is a sacred event. Some people take off their shoes before entering the space just like is done in temples or mosques. One family requested a chair be placed outside the room so people can pause and gather their thoughts before entering this sacred space. There are many ways to create and hold space, such as having loved ones gather around the dying to share stories.

As William Ernest Henley states in Invictus, “I am the master of my fate, I am the captain of my soul.” An end-of-life doula educates and empowers individuals to face and embrace death and dying by beginning the conversation, and by bringing meaning, dignity, and quality to the final days as we stand at threshold of our life’s journey.

Bonnie Blachly is a co-founder of Gentle Passage Doula Collective, a certified end-of-life doula and coach. A professional nurse educator, she team-teaches doula classes and walks with clients with life-ending conditions from diagnosis through death, supporting their loved ones after death, and promoting a positive death experience.

Colleen Hewes DC, MSN, RN is a do-founder of Gentle Passage Doula Collective, a certified end-of-life doula and conscious dying educator. She has taught Gerontological Nursing courses at several colleges and universities and is involved in speaking engagements in Washington state, promoting a death positive culture. She is a co-host on “A Different Kind of Doula.”


Doulas come from all walks of life because this is a non-medical role. Having an idea of what you need the doula to do for you will help you choose the best person for your situation.

Most end-of-life doulas become qualified to do this work through training programs—from a weekend intensive hands-on training to a six-month self-paced program. Be sure to interview the doula to ensure they have the qualifications you are looking for in your situation.

Suggested interview questions to ask a doula:

  • Describe the doula training you received.
  • What other kinds of training have you done?
  • Why did you decide to become a doula?
  • How long have you been doing this work?
  • What kind of clients have you worked with?
  • Given our situation, what kind of support would you be able to provide?

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