Death doulas offer ‘radical love’ at the end of life

By Rebecca Tucker

If you’re familiar with the word “doula,” you likely know it in the context of birth. A doula, to most, is an individual who works alongside expectant parents to provide support before and after the childbirth process. While midwives, doctors and nurses administer necessary health care, doulas bring compassion, empathy and emotional support to the difficult work of ushering in a new life.

But just as there are doulas whose work centres on the beginning of life, there are also doulas whose work focuses on the end.

Death doulas – also known as end-of-life doulas – are practitioners who provide care for dying individuals and their friends and family members. Like birth doulas, the work of a death doula is wide-ranging, and can encompass everything from non-medical palliative care for a patient – like bedside counselling, sharing meals and assisting in planning any final gatherings or ceremonies the patient may want to participate in – to working with the friends and family members to complete necessary paperwork and help parse funeral needs and expenses of someone who has died or is dying. Through all of this, says Jennifer Mallmes, an end-of-life educator at Douglas College in Vancouver, and co-director of the End Of Life Association of Canada, a death doula’s aim is to make death as comfortable – spiritually, emotionally and, yes, administratively – as possible.

“Broadly, an end-of-life doula is a person who empowers and educates and encourages people to be more directly involved in their end-of-life decision-making,” says Mallmes. “This support is very specific to that person’s needs, beliefs and their preferences.”

In Canada, death doulas are an unregulated profession, meaning there is no standardized certification or regulatory body. Various colleges and organizations – like Douglas – and other accredited organizations offer coursework and certification to help prospective death doulas prepare for a career in end-of-life care. And the profession is increasing in popularity: The End of Life Doula Association has seen a 6-per-cent increase in membership since spring, 2020.

While more and more doulas join the ranks of those currently working in Canada, efforts are under way to make the profession as inclusive and intersectional as possible. Douglas, for instance, recently partnered with the B.C. First Nations Health Authority to offer formal end-of-life training to Indigenous community members, many of whom have been providing end-of-life care within their communities for years. And today, a new wave of individual death doulas in Canada is working to diversify – and modernize – the profession, aiming to address the needs of communities that they say have been underserved.

Toronto-based death doula Carmen Galvan co-founded the BIPOC Death & Grief Talk, a group that holds sessions to help those struggling with loss, in 2021, after realizing that the end-of-life needs of marginalized members of her community were not being met. “For many racialized folks, mortality is not far away,” Galvan says. “A lot of death-doula work is palliative, which makes sense. But the way we work, we recognize that you could die at any moment, which is true for everyone, but I believe is much more relevant to our communities.”

Galvan’s work is more advocacy-centric, she says, than that of traditional death doulas: She may help recent immigrants overcome language barriers when preparing their will, for instance, or explain the cost of returning the body of a deceased family member to their country of birth.

Through all of this, she works to help her clients understand that preparing for your own death isn’t morbid: “It’s just a radical form of love,” Galvan says, “because what we’re doing is preventing our families from having to deal with it while they’re grieving.”

In Winnipeg, death doula Rayne Foy-Vachon’s work centres on end-of-life care for members of the LGBTQ community. And like Galvan, she acts as an advocate for her patients, even when her work is palliative: “Say I’m at the bedside of someone dying, and the health care team is not aware or comfortable, or has even been around non-traditional families,” she says. “I can help make the person who’s dying a lot more comfortable by educating these health care providers.”

Foy-Vachon, who previously worked in traditional health care, notes that LGBTQ individuals may often have specific needs in death – such as the assurance that the correct pronouns will be used in funeral proceedings or ensuring that the legal paperwork is filled out properly to name chosen family members as next of kin, when biological family members are estranged or may not respect their funerary wishes.

“I’m working with a lot of older queer people right now who have seen it all,” Foy-Vachon says. “They still have family members who don’t want anything to do with them. And for them, knowing that there’s somebody that’s going to be able to be there for them after they’re gone is just a big relief.”

For both Galvan and Foy-Vachon, death-doula work manifests as advocacy but ultimately is rooted in destigmatization and compassion. At the end of the day – or the end of a life – the goal is to make death more practical, for all those involved. “We’re answering those questions of – what’s gonna happen when I die? What will happen to me, to my family, to my friends? We empower folks within that conversation,” Galvan says. “I think a big part of death work is giving people a bit of power.”

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