Death doulas answer your burning questions about end-of-life planning.
Most people would say death is scary, but it doesn’t have to be — and there’s a growing community of professionals who compassionately demystify the process to make this inevitable experience as peaceful as possible.
Last month, we introduced you to a group of death doulas who’ve made it their mission to change the conversation around the way people die. They’re sensitive, fascinating, and deeply knowledgeable about the end of life, which means they’re perfectly equipped to help folks of all ages and all walks of life think differently about their final moments.
These doulas admit that so much of death is a mystery no one can solve, but also empathize with the craving everyone has to understand as much as possible before the end comes. So when we told them we had questions about death from our Wake-Up Call subscribers, they were more than happy to give us all the answers they could.
Our panel of death doulas includes:
- Alua Arthur of Going with Grace
- Zoie Kujawa of Reclaiming Death
- Nic Marrone of I Bid You a Doula
And now, without further ado, some crucial insight into the things you most want to know…
What’s it like to be with a dying person during their final moments?
Alua Arthur: When I get to be there with somebody who’s dying, it is the juiciest, most dense, awe-inspiring moment ever. Nobody knows why or how, or what’s coming next. And so as it’s happening, there’s a lot of sadness, obviously, but when life leaves the body and you can tell that person is no longer who they used to be — they won’t speak any more words or make any new memories — it’s awe-inspiring. There’s an incredible stillness that takes over. It’s deafening almost. The body becomes still, and that’s it. Just like that. Life hangs on a breath, and in the space of an inhale and an exhale, it’s over. There’s obviously a lot of grief and sadness that comes with recognizing the finality of it, but at the same time, it’s light at the doorway of existence. There’s no way not to be profoundly touched by the experience.
How does a dying person’s family usually react during those final moments?
Zoie Kujawa: It’s pretty quiet, depending on how many people are around. Typically, people are sharing memories about the person. They’re also getting this opportunity to talk about death, other deaths they’ve experienced, and how they want future deaths they experience to be different. There are tears and laughter and a lot of different emotions going on all at once, especially when you’re caring for somebody who has been in pain for a long time, and who has been dealing with an uncomfortable condition. You don’t want them to die, but you want them to be out of pain, so there’s that dichotomy where you’re sad the person is gone, but you’re also happy for them because they’re no longer suffering.
How much does a death doula cost?
Alua Arthur: It’s really case by case, depending on what the client needs. Having somebody there planning six months in advance and doing weekly visits is going to be a lot more expensive than doing one planning session and helping people figure out what to do with their body after death. If they want somebody sitting bedside with them at the end, that might be $20 or $25 an hour.
Zoie Kujawa: I start with a $35 consultation, then build a package from there based on needs. I use a sliding scale, and it’s negotiable. Trying to come up with a cost for my services was really difficult; if I could do this work for free, I would, and many death doulas do work as volunteers. That’s a topic we talk about a lot as doulas, making sure the service stays accessible.
Is it better not to touch someone when they are close to passing away? I’ve heard it sometimes makes it harder for them to let go of life here.
Alua Arthur: It depends. You can touch, but it’s also crucial to talk to people about how much touch they feel comfortable with. When I’m sick, I don’t like anybody touching me, but some people love to be cuddled and held. Something I practice often is asking for permission before touching. If a person is still conscious enough to communicate, then you know what to do. And if they’re not able to respond, let them know that you’re touching them before you do it, like, “I’m going to hold your hand.” Then pay attention to any clues about whether it’s OK. If you see a grimace, you should probably stop. If someone squeezes back slightly, keep holding on. There’s no clear “do” or “don’t.” Some schools of thought say touching grounds a person to this world, and others say touch is comforting and people want comfort when they’re dying.
If someone has a terminal illness and wants to end their life, could a death doula help?
Zoie Kujawa: That varies state by state because there are medical-aid-in-dying laws that aren’t legal everywhere. [In those states] it’s a choice that someone can make to end their life. It’s done in a certain way, and it’s not necessarily available to everyone because you have to be able to take the medication yourself, so a death doula could not administer that medication. Legally, the person has to be able to give themselves that medication. But your death doula and your family can be there.
As I age, it frightens me to think that after death I will be “gone”: not existing, with no consciousness, just a black void. How can I become more accepting of death and stop thinking about it so much?
Alua Arthur: The fear of death is built into our brains. That fear is the thing that makes you not walk all the way to the edge of a cliff. It’s very natural. It becomes problematic when the fear of death is stopping someone from engaging with life. I’d recommend spending some time unpacking where those images of nothingness came from. Nobody knows what happens, right? And often when we don’t know, we imagine the worst possible scenario. But it could be literally anything, so we can choose to believe whatever we want. Think about where that idea came from, and if it serves you, make a new narrative.
Nic Marrone: I would suggest thinking about the idea of leaving legacy. Regardless of whatever happens beyond death, what do you want to leave behind here that you feel good about? Maybe that’s making art or writing letters to your descendants. Think about what you want to do to make an impact on this world because a lot of people really fear being forgotten. I don’t know what happens on the other side, but I can tell you that you could leave some love on this side.
How does one navigate end-of-life choices when family members don’t want to have that conversation?
Zoie Kujawa: That can be really difficult. My advice is that if you’re going to elect someone as your power of attorney or your decision-maker, it doesn’t have to be someone in your family. It can be a friend, a coworker, someone you can have the conversation with. It’s important to choose someone you trust and who understands your point of view. You can just put that in your advanced directive, that this person is in charge of your decisions.
Alua Arthur: When Aretha Franklin died, I was supporting a woman who was doing her own end-of-life planning and really wanted to talk to her mom about it. And after Aretha Franklin died, she told me that her mom started making comments about the outfit changes Aretha had, and all the mourners, and all this stuff. I was like, “Well, there’s a way in.” You can say, “Oh, you don’t like how many people were at her funeral? How many people do you want at your funeral?” Take any little opening you can get, but be cautious about the setting. The dinner table may not be the appropriate time to bring that up, but maybe when you’re washing dishes afterward. Find a way in, pay attention to the way in which you talk about it, and also talk about your own passing. I can’t force my mom to talk about her death, but I can talk about mine, and maybe she’ll start thinking about hers as a result.
Do death doulas work with hospice, or are they an alternative?
Nic Marrone: Hospice offers a medical component, like a live-in nurse or an aide. So while they’re both focused on comfort and support toward the end of life, hospice may do a better job of taking care of those physical elements. A death doula is almost like your liaison between all of it: Your doula wants to make sure that you have everything in order, from your spiritual health to your medical health, so that everybody is in the loop on what you want for your relationship with death and dying.
What is a death meditation, and how do you lead clients in the practice?
Nic Marrone: In a peaceful and open environment, we go through the nine contemplations of death. They are hard truths we need to hear about death: death is inevitable; death has many causes; at the moment of death, your loved ones and your material things cannot save you. It can hit you hard, but we explore it in a gentle way. And then we walk through the shutting down of the body, which is actually very natural and painless. So we walk through that slowly, eyes closed, in a peaceful place, until you kind of remove the body from the picture of the meditation, and you get to that moment of human soul facing human soul. Then I bring people back into their full bodies and their hearts. Just let them be warm, give them a hot cup of tea, digest it all, and speak if they need to.
What is a “life review,” and how can that help us prepare for death?
Alua Arthur: It’s fun to do at any age, but a life review basically asks you to look at who you’ve become and what your life entails. Some of my favorite questions are: What’s one story people will tell about you after you die? If you could clone yourself, what traits would you keep and what would you get rid of? Who do you need to say ‘I’m sorry’ to? Who do you need to forgive? What is your signature meal? They’re things that make you look at your life as a whole. I find it really useful to do, particularly during an end-of-life planning process, because it helps people look at their lives through the rearview mirror with fondness, as opposed to terror about what’s coming.
What is a death doula’s training like, and where do you get it?
Alua Arthur: My training course is intended to be a big tool bag of potential areas anyone could pull from to do the practice. The course has information about funerals, hospitals, lawyers, possessions, end-of-life planning documents, grief — all the bits that I learned how to do. And people can choose what fits them most and use that out in the world. One cool thing about death work is there isn’t any part of society that it doesn’t touch, so if people have an interest in it, they can do something with it in their existing professions. If you work in the restaurant industry, there’s food delivery for people who are ailing in health. If you’re a hairdresser, you can cut hair for people in hospice. If you’re a lawyer, you can do estates and wills. There’s something for everybody, and the course is intended to present as many different practice areas as possible.
