How End of Life Doulas, Health Professionals and Carers Can Work Together for Holistic Support
Imagine This
Imagine a world where death is not treated as a crisis but as a natural and meaningful part of life. A world where the end of life isn’t rushed, clinical or lonely but is approached with care, presence and humanity. Where medical teams, aged care workers, families, and End of Life Doulas (EOLDs) come together – not in competition but in collaboration – to create a circle of support around the dying person and those who support them.
This vision is not idealistic. It’s practical. It’s achievable. And it’s already starting to happen.
The Current Landscape
In many parts of Australia and around the world, end of life care still unfolds in a way that is reactive, fragmented and heavily medicalised. Despite the dedication of health professionals, people often die in hospitals, not because it is their choice, but because there is no one available to support them to die elsewhere. Families, while doing their best, frequently feel unprepared. Care staff are stretched thin. The system leans on emergency responses instead of coordinated planning and presence.
As Professor Allan Kellehear has long pointed out, only about five per cent of the dying process happens within formal medical services. The other ninety-five per cent takes place in the community – in people’s homes, in aged care facilities, in conversations around kitchen tables and quiet moments with family. Yet most of our systems, policies and funding remain focused on that five per cent, leaving a huge gap in support for the emotional, practical and spiritual realities of dying1.
The Missed Opportunity
That gap doesn’t exist because people don’t care. It exists because the system wasn’t designed to hold all the needs of dying, especially the human ones. Our doctors, nurses and allied health professionals are skilled and compassionate, but their time is limited. Their roles are clearly defined in terms of clinical care. They can’t always sit at the bedside for hours, facilitate legacy conversations or help a carer understand what to expect in the final days.
What often gets lost is the in-between. The quiet. The questions. The emotional labour of dying and grieving is just as important as the medical side of things.
This is where EOLDs come in. We are non-clinical professionals trained to walk alongside the dying person and their loved ones. We advocate, we guide, we listen. We don’t replace anyone – we complement what already exists, bridging the gap between clinical care and community support.
What Collaboration Can Look Like
In practice, this partnership means that while a nurse manages pain relief, a doula might be helping the family prepare the space for dying – lighting candles, calming nerves and making sure everyone understands what’s happening.
While the doctor explains treatment options, the doula sits with the person afterwards to help them process what it means.
And when the palliative care team leaves for the night, it’s often the doula who stays, holding vigil or simply sitting quietly in the next room in case someone needs to talk at 3 am.
The doula’s role is relational. Flexible. Deeply human. It allows other professionals to focus on their scope of practice while ensuring the dying person is held, not just medically, but emotionally and spiritually too.
Evidence from the UK: The Leeds NHS Pilot
This kind of integrated model isn’t theoretical. It’s already been trialled and with exceptional results.
In Leeds, End of Life Doula UK was commissioned by NHS West Yorkshire to deliver over 1,500 hours of EOLD support across the region during the COVID-19 pandemic. The service evaluation2 provides a compelling snapshot of what’s possible when doulas are integrated into the broader care team.
The outcomes were remarkable. Only 13.4 per cent of those supported by a doula experienced an unplanned hospital admission in the last three months of life, compared to more than 60 per cent in the broader population.
Over 85 per cent died in their preferred place, often at home or in an aged care setting, surrounded by familiar faces and comforts.
Nearly all clients who were well enough to participate completed high-quality advance care plans with the assistance of their doula.
Healthcare professionals reported that doulas relieved pressure on their services, helped prevent avoidable calls and admissions, and improved communication with families. One clinician described the doulas as “the calm during an otherwise extremely stressful time.”
Why It Matters
What this tells us is simple: when we support people holistically, not just through clinical care but also through connection, conversation, advocacy and presence, outcomes improve. The dying person is less anxious. Families are more prepared. Clinicians aren’t left holding the whole weight of care.
And most importantly, the experience of dying can become one of peace, meaning and human dignity rather than confusion, crisis or isolation.
What Needs to Happen Next
In Australia, we are ready for this kind of shift. But to make it a reality, a few things need to change.
We need to formally recognise EOLDs as valuable collaborators in end of life care. That includes creating clear referral pathways, supporting training, professional standards and ensuring their work is funded, not as a luxury add-on but as an essential part of holistic care.
We also need to preserve what makes doulas effective: their autonomy, their flexibility and their commitment to person-centred, relational care. Integration must mean partnership, not assimilation.
We also need the Federal Government to urgently review the new Support at Home aged care program to ensure end of life support is included on the service list. This is a significant gap in the current framework. In doing so, the program should also recognise EOLDs as qualified non-clinical professionals who can help older Australians, their carers and health teams navigate dying in a way that aligns with personal values and preferences.
By embedding EOLDs into national policy, we take a meaningful step toward ensuring that no one falls through the cracks – and that dying becomes something better supported across all settings.
A Final Reflection
The way we die says a lot about the way we live. It’s time to stop treating death as a failure of medicine or as ‘losing the fight’, and start seeing it as a shared human experience, one that deserves just as much care as any other part of life.
EOLDs are ready to walk that path with others, not in isolation, but alongside the people who already care so deeply. Together, we can offer something extraordinary.
EOLDs work in a wide variety of settings. Some operate in community-based roles, supporting families in private homes, aged care residences and through informal networks. Others are working toward greater collaboration within formal systems, including palliative care teams, aged care programs, hospitals and hospices. I deeply support efforts to embed doulas within these formal settings, where our presence can ease pressure on clinical teams and ensure truly holistic support. However, I also deeply respect my doula peers who choose to offer their service independently, in the community or in spaces where institutional access is limited. All of these contributions matter. All bring value.
A better end of life is possible. Let’s imagine it and then build it.
About the Author
Shannon Beresford is an End of Life Doula, Sound Therapy Practitioner and founder of Your Path Guide in Adelaide, South Australia. He provides calm, ongoing support to clients and families through all stages of end of life care. Shannon is also Vice Chair of HELD Australia Ltd, the peak body for holistic end of life and death care and volunteers in the Central Adelaide Palliative Care Service (CAPCS).
References
- Kellehear, A. (2005). Compassionate Cities: Public Health and End-of-Life Care. Routledge.
- Clare, E. (2025). End of Life Doula UK: Leeds and Surrounding Areas NHS Commission – Service Evaluation. End of Life Doula UK: https://eol-doula.uk/leeds-nhs-commissioned-project/
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