With hospitals and health systems looking for better ways to support patients with serious illness, a new resource is showing up as an addition to inpatient care teams: death doulas. Also known as end-of-life doulas, these practitioners provide nonmedical support focused on the emotional, practical, and existential dimensions of dying.

While not much research exists around this burgeoning field, a study published in November 2023 that surveyed 10 bereaved family members indicated a positive impact of their services. The conclusion says that “For families in this study, DDs (death doulas) enabled the family member to be prepared for death, which led to a sense of empowerment. This, in turn, made them feel emotionally supported and enabled the family member to provide personalized deaths and funerals for their loved ones.”

“End-of-life doulas provide nonmedical, holistic services that support person-centered care and complement a clinical care team,” said Cryst’l Scheer, an end-of-life doula, educator, and owner of Lanexa, Virginia-based Summit Care Partners. “Death doulas are not clergy and are not able to provide pastoral, spiritual, or religious guidance through a professional lens. But death doulas are trained to support personal rituals, legacy work, and values-based conversations.”

Hospice, palliative care, and even social workers have different roles from a death or end-of life doula, Scheer said.

“Hospice and palliative clinicians diagnose, manage symptoms, and facilitate complex medical planning,” she said. “A death doula can support the lived experience of that plan by helping families process the information provided, prepare for next steps, and stay grounded throughout the process.”

Social workers, she said, are experts in psychosocial assessments, resources, and systems navigation, while a death doula can reinforce that work by staying close to the bedside, facilitating family communication, and accompanying patients and loved ones as they navigate next steps and create new routines.

While death doulas have traditionally worked in community or home-based settings, some hospitals are now exploring how (and whether) to integrate them into inpatient palliative care programs, volunteer services, or hospice-adjacent teams. The model is evolving quickly, but evidence remains limited, and questions about role definition, workflow, accountability, and reimbursement persist.

Reframing Death Inside the Hospital

Much of the renewed attention to death doulas reflects a broader discomfort with how dying unfolds in modern medical settings.

End-of-life nurse educator, hospice pioneer, and author Barbara Karnes has long framed death doulas as a parallel to birth doulas not because death and birth are identical but because both represent profound transitions that are physically intense, emotionally charged, and unfamiliar to most families.

“There are so many similarities between birth and death — I mean I can go on and on, from food to sleep to labor,” Karnes said. “It takes some of the fear out of dying if we understand that this is a normal part of life. We are born, we experience, and then we die, and both ends are very similar.”

That framing resonates with clinicians who regularly care for dying patients in hospitals.

‘Death Is Not a Medical Event’: Why the Role Resonates in Hospitals

For Adjoa Boateng Evans, MD, MPH, an anesthesiologist and critical care physician at Duke Health and an assistant professor of anesthesiology at Duke University School of Medicine, Durham, North Carolina, who spends a significant amount of time at patients’ bedsides during life’s final hours, the idea of adding nonclinical end-of-life support feels like a recognition of what hospital medicine often can’t provide consistently: time, presence, and emotional steadiness.

“Even as a physician, I wholeheartedly agree that death is not a medical event,” Evans said. “It’s actually a spiritual one. We have medicalized it in this country in particular, but it really isn’t.”

She said clinicians who have been present for many deaths recognize that the transition itself is qualitatively different from most other hospital events.

“Even the physical process of someone making that transition — it’s very different from most of the other medical events that happen in a hospital,” she said.

For Evans, the analogy often used by end-of-life doulas — that this work parallels that of birth doulas — is more than metaphor. It’s a practical description of the kind of support patients and families often need.

“When we think about the introduction of midwives or doulas at birth, it was all about support,” she said. “It’s an extraordinary life experience that’s physically challenging, emotionally charged, and a myriad of emotions. The same is true with death.”

One reason, Evans noted, is that most people have very limited firsthand experience with dying.

“Most people might witness one, two, maybe three deaths in a way where they’re physically present,” she said. “So to have someone who is comfortable in that space and can say, ‘I’ve walked this path many times, I sort of know what you’re about to experience’ — that expectation setting, I can’t emphasize how important that is.”

Where the End-of-Life Doula Can Benefit the Hospital

Shoshana Ungerleider, an internal medicine physician and founder of the End Well Project, said doulas are most often brought in when a patient transitions to comfort-focused care or when death is anticipated within days to weeks.

“Their support tends to be most beneficial for families with limited emotional or social support, those struggling to process the dying process, or those seeking to bring intentional rituals and meaning to the experience,” she said.

Scheer noted that doulas may be especially helpful during prolonged or complex dying trajectories.

“Within hospitals, death doulas can assist with high family distress, vigil or respite care, decision fatigue, death and grief education, and nonmedical comfort techniques like guided imagery, meditation, and breathing exercises,” she said.

She said that because doulas are not embedded in hospital staffing models, they can often provide continuity and flexibility that clinical teams cannot.

Evans said that ultimately, end-of-life doulas could provide a real resource to clinicians as well, in helping address families’ urgent, concrete fears without turning the interaction into a medical discussion.

“When someone is transitioning to comfort care or they’re on the precipice of dying, so much of my job in family meetings is expectation setting,” Evans said. “It’s not a medical conversation.”

Evans said the kinds of questions families often carry into the room have medical components but actually come from a place of seeking reassurance or comfort: Is my loved one suffering? Are they choking? Are they suffocating?

“When we go into the room, it’s expectation setting: ‘Here’s what your loved one might look like. Their breathing is going to be irregular. It might sound gaspy,” she said. “That is part of the dying process. It’s scary, but it’s actually normal.’”

At the same time, Evans said that families also need to hear that comfort is being actively managed.

“We let them know, ‘We’re giving medication for anxiety. We’re giving medication for pain. We’re giving medication for secretions,’ so they feel like everything is being addressed in that moment,” she said.

She said that’s where doulas can be especially complementary.

“Sometimes we (as clinicians) can get hyper-focused on the medical aspects,” she said. “End-of-life doulas are well-equipped in a language that speaks to that spiritual aspect, and a lot of physicians aren’t versed in that. Most physicians are trained to do science and medicine.”

Many hospitals already have resources available to dying patients and their families, including palliative care teams and chaplains. Death doulas can be complements to these resources, and don’t overlap their work.

“What I see as the difference is individualized care, you know, like having one doula for one individual patient, vs as the physician and the palliative care team, we’ve got to spread ourselves thin between multiple patients and just can’t give the amount of time and attention that we would like to,” Evans said.

“Today, hospice is absorbed into the medical model, there’s all kinds of things that have taken away from the time that is needed in working with people at the end of life,” Karnes said. “I think the biggest gift end-of-life doulas give is time.”

Scheer said that in most hospital settings, death doulas are not formally integrated into care teams. Instead, patients and families typically engage them independently, often alongside hospice or palliative care services.

Evans, Karnes, Scheer, and Ungerleider reported having no disclosures.