Death with Dignity: How a Doula Best Serves The Dying Person & Family

If a dying person chooses to end their life through a lethal dose of medication, or for that matter by refusing all food and fluids, an end-of-life doula can still play an active role in their dying process. In fact, the doula’s importance may even be elevated, because the dying person is cognitively intact until the moments of death and we can predict the timing so much more precisely.

The first phase of the doula approach is to work with a dying person and family on summing up their life and creating a meaningful legacy project—if they want to do that work. This gives people a sense of purpose and helps them to face unfinished business they still want to address. This work can be very profound. We have seen peoples’ lives transformed in this process, leading to a death free of fear and blessed by a spiritual awareness everyone can feel. Not to mention the treasure a legacy project becomes for the family after a death.

Sometimes legacy work is put off thinking there is more time. Unfortunately, that can result in waiting too long and the opportunity is missed. But when a person has decided to use medical aid in dying, they will make that decision when their mind is still clear and they have more energy. This allows for a more concerted and focused effort on creating a legacy.

The other activity in the first phase of the doula work revolves around planning for the last days. Much of that planning work centers on how the space is set up: what it looks like, the objects around the dying person, what they can see from the bed, and so on. It also involves considering the sounds in the space, the scent in the air, the feel in the room. In a general sense these elements don’t change because a person is choosing the time and manner of their death. But, how we approach some of those elements may be very different.

Normally when a person is in the final days of life they are likely to be unresponsive, so their connection to the plan they worked on earlier with a doula is more subliminal for them at that point and much more oriented to the family. But in a medical aided death the dying person gets to experience all those elements consciously right up to the moment they take a lethal prescription of medication. This tends to shift thinking around plan elements in a way that wouldn’t be possible otherwise.

For example, a person would have a better chance of dying outside if they wanted to, which can introduce a great many possibilities for the environment that are just not possible otherwise. Family could build a canopy to cover the bed or the ground with special fabric and foliage to create a sacred sense of separateness from the rest of the outdoors, while still allowing the breezes to circulate around the dying person. A death outside connects us to the greater cycle of nature in a deep way.

Naturally, in a medically aided death the vigil time is extremely compressed. When a person takes a lethal prescription it generally takes only minutes for them to fall asleep. Death will follow within an hour or possibly a few hours. So a vigil will begin while the dying person is awake, with close family and friends around them. This presents wonderful opportunities for conscious closure and particularly meaningful rituals. An example, the dying person and family might offer each other blessings. This could involve words spoken, touch, anointing, and kisses.

Because the final process of dying is guaranteed to be short, the doulas don’t have to worry about determining imminent death and calling people to the bedside.  On the other hand the brevity in this manner of death makes it feel sudden and somewhat surreal. So doulas should allow more time for the ritual, support, and sharing that may occur right after the death. Processing takes on heightened importance.

As doulas work with more people who choose their own dying process, other considerations will undoubtedly reveal themselves. The movement toward death with dignity seems to have gathered steam, so we will continue to monitor developments and offer other suggestions we discover or that people share with us.

We hope this two-part discussion of the medical aid in dying has proven enlightening and helpful.