People often ask me where an End-of-Life Doula fits.
Is it a community role? Something that happens in loungerooms and around kitchen tables? Or is it work in formal settings, tucked in beside the nurses and the palliative care team?
The honest answer is both. And everything in between.
End-of-Life Doula work runs along a wide spectrum. At one end sits the grassroots, the quiet local networks that cared for the dying long before anyone used the word doula. At the other end sit hospitals, hospices and residential aged care, where the work happens alongside formal clinical teams.
There is a place for us at every point on that line.
The community end
Much of what doulas do begins in the community.
It might look like:
- A death cafe in a suburban hall, where strangers can talk openly about dying over tea and cake
- A workshop on advance care planning where they help someone name what matters to them, while they still can
- Sitting with a neighbour through a long afternoon so their daughter can finally sleep
- Companioning a family through a home vigil after a death, in no hurry to move things along
None of this is medical and that is the point.
This is the work of presence. Of normalising a conversation most of us were taught to avoid. It builds what some call compassionate communities, where death is not handed over entirely to professionals and institutions, but held, in part, by the people around us.
Grassroots work is not a lesser version of the role. For many families it is the whole of it. A steady person. A cup of tea. Someone who is not frightened of the room.
Somewhere in the middle
Between the community and the clinic, a lot of doula work happens in the home.
This is where families often meet us first. A diagnosis has been given. The system feels vast and confusing. Appointments pile up, and nobody seems to have the time to explain what any of it means.
A doula steps in here as a constant, supporting clients and their families/community by:
- helping people understand their options
- sitting in on the hard conversations
- holding the practical threads, such as meals, respite, or who to call at 2 am. This allows the family to go back to being a family rather than a roster of carers.
We do not replace the medical team. We work around it, filling gaps a stretched health system was never designed to cover.
The formal end
At the other end of the spectrum, doulas are starting to work inside formal settings.
Hospitals. Hospices. Aged care homes. Community palliative care services.
Through my volunteering with the Central Adelaide Palliative Care Service, I have seen up close how much room there is for this kind of presence. A patient admitted to a busy ward can go hours without company.
Staff are skilled and kind, but they’re also run off their feet. Because of this, there is real value in someone who stays, who notices the small things and, in turn, advocates gently when a person cannot speak up for themselves.
That is exactly the space an End-of-Life Doula could fill.
It is not standard practice yet. In most places, doulas are not a formal part of ward teams or community palliative care services. But the opportunity is real, and it is starting to open up. Bringing doulas into clinical environments takes trust, clear boundaries and a shared language. This work is only just starting. It is worth doing.
Why every point matters
Here is the thread that runs through all of it.
The room does not define the doula role. It is defined by the relationship inside it.
That relationship is non-medical. It is led by the person who is dying, not the institution around them. And it lasts. Wherever someone is nearing the end (their own bed, a hospice, a nursing home two suburbs over), that kind of presence has worth.
A death cafe and a hospital ward look nothing alike. The need underneath them is the same – people want comfort. They want to be known, not managed, and nobody wants to face the end of life alone, or watch someone they love face it alone.
The spectrum is not a ladder to climb. A doula running a community workshop is not on their way to somewhere more important. A doula in a hospice has not left the grassroots behind. Most of us move back and forth across the whole range, often inside a single week.
That flexibility is the strength of the role. We go where the need is.
And the need is everywhere.
About the Author
Shannon Beresford is the Director of Your Path Guide Pty Ltd, an Adelaide-based End-of-Life Doula practice dedicated to helping people live and die with comfort, meaning and connection. The practice works alongside individuals and families to honour each person’s story and choices at one of life’s most significant transitions.
As Chair of HELD Australia Ltd, the national peak body for holistic end-of-life and death-care practitioners, Shannon advocates for stronger recognition of the End-of-Life Doula role across Australia’s health and aged care systems. He also holds a Certificate IV in End-of-Life Doula Services, the only nationally accredited qualification in this field.
Shannon also volunteers with the Central Adelaide Palliative Care Service (CAPCS), providing practical and emotional support to individuals and families in their final weeks of life.