The Pros and Cons of Hiring a Death Doula

If you're reading this, then you've never died before, so nobody will blame you for not knowing what to expect. Even if you've been present for a loved one's death, that doesn't mean you know what to expect of your own or anyone else's. As a death doula, I can tell you that everyone's death is unique to them.

For those faced with a terminal diagnosis — and their families — bringing a death doula into the fold is an increasingly popular option for navigating our final days. Also known as end-of-life doulas or death midwives, death doulas help the dying and their families pave the way to a better death through logistical, emotional and spiritual preparation. We are non-medical, non-legal professionals that act as a complement to hospice, filling the gaps to provide more holistic death care.

While studies have shown that families have an overwhelmingly positive experience when they hire a death doula, it may not be the best fit for everyone. As with most any significant choice, the key is to weigh your pros and cons. Here are what I consider to be the top benefits and possible drawbacks in signing on a death doula — and how you can address them.

Doulas offer knowledge and experience you likely don't have. Unless you've cared for many people at the end of their lives and sat vigil through the dying process until death, you won't have the know-how that an experienced death doula does. Death doulas can share their education around all things death and dying, from signs that death is getting closer to a strong understanding of essential end-of-life paperwork. This takes much of the guesswork out of an already stressful and emotionally draining time, and helps clients anticipate needs and ask questions they wouldn't have thought to ask.

Death doulas with years of experience have encountered many different scenarios, whether it's family conflict over treatment decisions or having to formulate a plan B when things don't go as you hoped. By working with an end-of-life doula, the dying can make more informed decisions, personalize their care and increase their agency in a situation that involves a loss of control. Think of it as having your own personal project manager whose job is to help you have the most peaceful, sacred death possible.

They can quickly connect you with resources. When someone is dying, the last thing they want to do is spend hours researching things like home care options. Determining which service provider is the best is hard to do from a Google search alone. A prepared death doula will have a large database of local resources around end-of-life needs, and can offer recommendations based on their own experiences and connections. Resources include:

• Funeral homes and cemeteries
• In-home health care agencies
• Reputable holistic care providers such as Reiki practitioners, thanatologists or masseuses
• Meal services
• Veteran assistance organizations
• Creators and businesses that can help carry out legacy projects
• Grief support groups

Being part of the deathcare community means that if a doula can't help you with a particular need, they likely know someone who can.

Doulas don't have an agenda. A foundational trait of being a death doula is coming into a situation with no bias, no judgment and no preferences. We are facilitators, not directors. We are supporters, not influencers, and we come without all the baggage of having had a personal relationship with you beforehand. This is helpful to dying clients who want to talk openly about regrets, hopes, needs and fears without feeling like a burden to others or being influenced in their end-of-life choices.

Additionally, we aren't beholden to the constraints of hospice — we can spend as much time with our clients as we need to, without worrying about profit margins or getting to the next five patients that day. Our goal is to help clients find meaning at the end of their lives, wrap up loose ends, design a death that reflects who they are, offer support and be of service — and only in the way that our clients, not a bureaucracy, dictate.

It's hard to determine if a death doula is "good" at what they do. Each year, more organizations that train death doulas pop up — and they are not all created equal. Without knowing the difference in the quality of a doula training program, it's hard to know the caliber of service you will get. Furthermore, even if a doula is trained by a respected institution such as the International End of Life Doula Association (INELDA), the International Doula Life Movement (IDLF), or the Center For Conscious Living and Dying (CCLD), they may not have sufficient on-the-ground experience or adhere to the framework. You have to do your own detective work.

To assess a doula's qualifications, ask:

• Which organizations have you trained and/or become certified with, and can you direct me to their website so I can learn more about them?
• How many clients or families have you served? How long have you been practicing? Can you provide any references?
• Are you associated with any local hospices, faith communities, senior centers, universities, doula collective or other relevant bodies?
• Do you specialize in, or have experience with, serving clients who suffer from a particular disease such as Alzheimer’s or cancer?
• How many clients do you serve at a time, and what is your availability?
• How would you describe your approach to this work?

Not everyone may be on board. A doula's primary client, and sometimes only client, is the dying person — but that doesn't mean they won't need to interact with family members and others in your support systems. While the terminally ill person may be open to working with a death doula, some family members may be skeptical or feel uncomfortable incorporating a stranger during one of the more intimate and vulnerable moments in life.

This can stoke some fires, and while an experienced doula knows how to work with these challenges within the confines of their role, it can add a layer of tension at times. If this is the case, it's worth asking yourself if you want to use a doula on the family level, versus solely engaging with them one-on-one for different parts of the dying process. Ask prospective doulas what creative solutions they propose to address any conflict. A doula will help you find the best way to advocate your needs to your support system, and can facilitate a constructive conversation among family members to debunk any myths, clear up misunderstandings, and help everyone feel heard.

It may be expensive. Medicare does not cover end-of-life doula services (yet), and as a result, most hospices do not offer doula services as a part of their care model (though this is changing as more hospices see the impact of doula work.) This has made equitable care that is accessible to everyone a challenge, as doulas need to make a living like everybody else, and have spent significant time and money learning their craft.

But families don't need to cross off the idea of working with a doula if funds are tight; many doulas do pro bono services or will work on a sliding scale. Some will charge for services as a one-time packaged deal no matter how many hours they invest in a client, whereas others charge by the hour, which can lead to less predictable costs.

Another option is to tap into your hospice's volunteer network. Many hospices have volunteers on staff who are trained as doulas, but can't officially practice as doulas on behalf of the hospice. This does not prevent them from offering some of the hospice-approved services that a paid doula can offer, such as working on legacy projects, conducting life review, being a calm presence at the bedside of the dying, or providing much needed respite to caregivers.

Deciding whether to make an end-of-life doula part of your dying experience is a high-stakes decision — after all, we only die once, with no do-overs. That's why it's important to think about how, exactly, you want to work with one. Once you've pinpointed where you see the value, knowing the advantages and prospective challenges makes your decision much easier.