Jane Euler is an end-of-life companion who founded a Virginia-based group practice four years ago to help the dying and their families. Euler and her fellow “death doulas” support people so their last hours are “not tragic, but beautiful,” she said. Photo courtesy of Present for You

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When Alexandria, Virginia, resident Donna Marie’s father was suddenly hospitalized, she visited him, prayed with him, hugged him and said she’d talk to him in the morning. But he died hours later, alone in a sterile hospital room.

“During a long period of grief, I experienced a lot of guilt because I left my dad alone in the hospital,” Marie said. “He kept asking me to stay, and I left anyway.”

Marie’s grief led her to a new career. Today she works as a “death doula,” a non-medical companion who supports families before, during and after the death of a loved one. Thousands of end-of-life doulas exist in the United States.

“We are there as a nonmedical support to provide comfort in any way that’s needed,” explained Marie, who works at Present for You, based in Fairfax, Virginia.

Marie’s supervisor, Jane Euler, lead doula and founder of that group practice, had similar regrets after she lost her mother 12 years ago. Euler was alone with her mother in a nursing home and didn’t take advantage of what little time she had left with her.

“A few years later, I read an article on death doulas and had an a-ha moment: I should have had someone like that with me. I would have done things differently.”

So seven years ago, after Euler retired from a 32-year career in IT, she signed up for a certification course and in 2021 founded Present for You, which has six doulas on staff, including Marie.

“I’ve seen such resilience, such beauty, such strength, such love, that it makes you appreciate each average day,” Euler said. “It sounds very cliché, but are we present in the moment? Oftentimes we’re not.”

What’s a death doula?

Doula is the Ancient Greek word for female birth attendant.

“There have been birth attendants and death attendants since the dawn of human need,” said Sam Stebbins, a retired physician who is a death doula in Euler’s practice.

Just as some mothers-to-be make a “birth plan,” you can make a “vigil plan” for your final days. Doulas can help create and facilitate that plan, choosing the right music, poems to read aloud, or religious rituals.

End-of-life doulas fill the gap between medical care and hospice care. “We’re an extension of hospice,” Euler explained.

Think of it this way: Doctors, nurses and even social workers don’t have unlimited time for every patient.

“As much as they would like to sit and talk, they have another patient to see in an hour. So what we give is time and presence with no agenda,” Euler said. “We mirror the person we’re working with.”

The cost varies, but the hourly rate ranges from $30 to $100 per hour. (Medicare covers hospice care but not doulas.) Sometimes a hospice organization partners with a doula group and pays them out of their philanthropy budget.

Some death doulas are volunteers, though. It’s by no means a lucrative occupation. “About 99% of us do it out of love and caring,” Stebbins said.

Training programs

Although death attendants are nothing new, the field officially emerged in this country about 25 years ago. In 2000, NYU Medical Center and the Jewish Board of Family and Children’s Services started a program that sent five volunteer doulas to visit terminally ill patients once a week.

Later several certification programs were established, including one at the University of Vermont, which has trained 4,000 people so far, and the nonprofit International End of Life Doula Association (INELDA), which has trained more than 2,000 doulas since 2012, including Euler and Stebbins. Other training programs are available both online and in person.

As more people become death doulas, more people are enlisting their help to plan their final months.

“Why wouldn’t you want someone to attend to all your needs?” asked Patricia Dubroof, director of community relations of Assisting Hands of Potomac, a home healthcare service.

“There’s a big death-positive movement that’s exponentially accelerating in our area. We’ve gone from having a handful of death doulas to thousands in this country.”

Not necessarily somber

Euler, Marie and Stebbins see people at their most vulnerable times, but they see strength and joy, too.

“I sat with one family, and the two daughters are drinking wine while their mother is dying. We’re talking family, we’re talking about memories, and it was actually a beautiful moment,” Euler said.

In fact, many people who have witnessed the dying process call it an honor rather than a trauma.

“I like to have people be able to tell the story of their loved one’s death, that it wasn’t tragic; it was beautiful,” Euler said. “It was full of love. It was full of transformation. ‘He was peaceful; she was peaceful’ — a story that’s beautiful as opposed to painful.”

Doulas aren’t just there to help the dying person; they support the whole family and prepare them in advance. They can suggest hospice or homecare companies, explain what to expect at the end or just listen.

“My mission is to normalize those grief conversations so people aren’t caught off guard,” Marie said. “I want to help people value their life more because they consider their mortality.”

A doula can help smooth the process. Marie recalls one woman who was screaming in pain because her back hurt. So Marie put both hands underneath her body to support her lower back.

“It gave her comfort, and she fell asleep peacefully,” she said. “Every time I went back, whatever she was going through, I found a way to provide support for her,” singing hymns, playing her favorite gospel songs, and snapping photos of her with her niece.

“I was just there by her side. That gentle presence made a big difference in her life.”

Letting go

Often what people need at the end is release — of secrets, trauma, mistakes, regrets.

“People who have life-threatening illnesses often find a great benefit talking to a relative stranger,” Stebbins said. “They just start to tell us stuff you wouldn’t think you’d share with someone other than your best friend.”

For instance, Euler recalls a visit with a man with advanced prostate cancer. When she arrived, he asked his family to leave the room. Before he died, he wanted to tell someone about the abuse he suffered as a child.

“I’m a listener. I go in with an open heart and a listening ear, and that can be very cathartic,” she said. “We cried. We laughed. He talked for about an hour and a half, and he looked up at me and said, ‘Jane, I think I can put that to rest now,’” Euler said.

“All I did was sit there and be compassionate and listen.”

For more information on finding a death doula or training to be one, visit nedalliance.org, deathdoulas.com, inelda.org or learn.uvm.edu/program/end-of-life-doula-certificate. To contact Present for You, visit presentforyou.co or call (703) 401-2778.