Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
Dylan Thomas famously advised raging against the dying of the light in his poem Do not go gentle into that good night. A common interpretation of his words is that people should rage against the approaching end of life. But for at least a portion of people who come face-to-face with inevitable dying, rage is not their choice. Some simply find themselves ready to go. Some wish to be released from unbearable pain. Some consider it wasteful to use expensive, extraordinary measures when death is otherwise certain and imminent. Some feel that if life can be prolonged only by being connected to machines and tubes, that is all too artificial, and even undignified.
For these non-ragers choosing to go gentle into night, there are other options. Such as hospice. Palliative care in lieu of aggressive treatments. Voluntary Refusal of Food and Fluid (VRFF). Medical aid in dying. People’s end-of-life choices are varied and highly individualized.
How a Death Doula Can Help Provide End of Life Guidance
One such choice may include voluntary acceptance of death along with the support of a person known as a death doula. Also going by titles such as “end-of-life doula,” “end-of-life guide,” and “death midwife,” death doulas provide holistic, nonmedical support of a dying person and their family. One organization that offers certified doula training, www.doulagivers.com, defines death doulas as “people who support people in the end-of-life process, much like a midwife with the birthing process. It is a new non-medical profession that recognizes death as a natural, accepted, and honored part of life.”
Doulagivers points out that 9 out of 10 people want to be kept at home if they become terminally ill, if this is at all possible, but over half are dying in a hospital or long-term care facility. Another relevant statistic is that about 20 percent of baby boomers do not have children of their own who could be sources of support. A death doula could potentially fill that gap.
How Do Death Doulas Work with Your End of Life Team
Compassion & Choices (C&C), a national nonprofit and AgeWise Colorado Provider that advocates for personal autonomy in end-of-life issues, says the work of doulas is rooted in empowerment. Doulas are “a complement to medicine and spiritual or faith leaders,” C&C says, “[and] serve as part of a comprehensive and knowledgeable support team.”
C&C says the work doulas perform for clients may include sitting bedside in the final hours of life, providing spiritual and emotional support to loved ones, and providing family members with logistical or paperwork assistance. Crucial to their work are open dialogue and careful planning.
Some doulas work strictly as volunteers. Others make a career of it. In 2021 the granddaughter of Elvis Presley, Riley Keough, let it be known she had become a death doula. It was a decision she made after the unexpected loss of her brother. For many people, this was the first time they had heard about the concept of death doulas.
End of Life Conversations Help Process Emotions
C&C points to Going with Grace as an end-of-life education organization created by death doula and attorney Alua Arthur (www.goingwithgrace.com). The Program Director there, Tracey Walker, says that end-of-life planning conversations with loved ones give everyone space to process their emotions early and often. It also ensures that no one has to make a last-minute decision in an emergency. A death doula can help with this processing.
“There can be so much guilt associated with the death of a loved one,” Walker says, “when decisions need to be made and we are not sure of what would have been wanted. It is heartbreaking to see time taken up with fighting, anger, guilt or ignorance, knowing it could have been avoided.”
Rhyena Halpern is a board-certified health coach and end-of-life doula known to C&C. Her philosophy of care, C&C notes, was shaped in part by the experience she had supporting her mother through the end of life. “The real gift was after she died,” Halpern told C&C, “because when I lost other loved ones, I was in real grief and sorrow. I had this experience of incredible love after my mom died. And that was when I realized if you are really ready for death, you give your people an amazing gift by lifting their pain and letting them feel tremendous love.”
C&C notes that just a few generations ago, American communities were better prepared to support themselves when death approached. Family members sat vigil with their loved ones while others close to them tended to practical matters such as funeral preparations. But circumstances evolved over time, families became more geographically separated, and the “group grief” practice of old was not as readily possible. Doulas represent at least a partial way of reconnecting to those past traditions.
Finding a Death Doula in Colorado
How does one go about finding a doula? The Colorado End-of-Life Collaborative (www.coeolcollaborative.org) offers a listing of doulas searchable by geographic location. Another, Ever Loved (https://everloved.com/death-doulas/CO/), also provides a searchable registry, as does Going with Grace mentioned above. Yet another option is exploring the website of the National End of Life Doula Alliance (www.nedalliance.org).
Frances Arnoldy, a program director for End-of-Life Doula Certification interviewed by C&C, recommends that once you find a prospective doula, make sure they offer free consultations. This allows you to ask about their training, philosophy of support, communication styles and availability before you make any commitment. It helps to facilitate a good fit.
Walker at Going with Grace told C&C she hopes to see supportive care by death doulas—when circumstances are appropriate for it—become such an accepted concept that it would be similar to the family and community care surrounding death that used to be so common. Arnoldy sees a positive future where people more instinctively accept what it means to be mortal, impermanent, and interdependent. She calls it a “re-embracing” of these realities. Walker believes such developments will help make discussions about death and dying something people can handle more easily, and more readily on their own. She goes so far as to say, “At Going with Grace, we would love to be out of a job someday.”
Please visit End of Life Planning for more information on providers in Colorado.