The Importance of End-of-Life Planning in Historically Marginalized Communities
by Valoria Walker
Facing the reality of death can be difficult for anyone, but for many in historically marginalized communities, the conversation about end-of-life planning is often avoided altogether. Historical health inequities, discrimination, and personal experiences with the health care system have created a deep mistrust that makes discussing end-of-life care challenging. As an end-of-life doula and African American woman, I have witnessed firsthand how these barriers prevent meaningful dialogue and preparation. This article explores why end-of-life planning matters, especially in marginalized communities, and how the end-of-life doula model can help bridge the gap.
Why End-of-Life Planning Is Often Avoided
Many people delay or avoid conversations about the end of life because it feels uncomfortable or frightening. In historically marginalized communities, this avoidance is compounded by a history of unequal treatment in health care settings. For example, studies show that Black Americans are less likely to have advance care planning or advance directives compared with white Americans. This gap is often due to:
- Distrust of medical professionals based on past discrimination.
- Lack of culturally sensitive information about end-of-life options.
- Fear that their wishes will not be respected.
- Limited access to resources that explain caregiving and legal planning.
These factors create a cycle in which individuals and families are unprepared when critical decisions arise, leading to stress and conflict during already difficult times and disempowering them from making informed decisions.
How Advance Care Planning Can Empower Historically Marginalized Communities
Advance care planning is a key tool that allows people to maintain control over their medical care and caregiving preferences. When done thoughtfully, it can:
- Reduce unnecessary and unwanted medical interventions.
- Ensure that cultural and spiritual beliefs are honored.
- Decrease stress for families making decisions under pressure.
- Improve communication between patients, families, and health care providers.
For historically marginalized communities, increasing awareness and education about advance care planning is essential. Community-based programs, faith leaders, and trusted doulas can play a vital role in spreading this knowledge in culturally relevant ways.
Practical Steps to Start the Conversation
Starting the end-of-life conversation can feel overwhelming, but small steps make a difference. Here are some ways to begin:
- Ask questions about what matters most to you in your care and life closure.
- Talk with family members about your wishes and listen to theirs.
- Seek out a doula or counselor who understands your cultural background.
- Learn about advance directives and how to complete them in your state.
- Create a personal plan that includes caregiving preferences and spiritual needs.
These actions help normalize the discussion and reduce fear around end-of-life planning.
Addressing Skepticism and Building Trust
Distrust in the health care system is real and justified for many individuals who have been historically maligned. To overcome this, health care providers and doulas must:
- Provide clear, honest information without pressure.
- Respect cultural values and personal stories.
- Build relationships over time, not just in crisis moments.
- Advocate for equitable access to end-of-life resources.
As trust grows, so does the willingness to engage in advance care planning.
Addressing Skepticism and Building Trust
Death is a natural part of life, yet many avoid thinking about it until it is too late. Facing death openly allows people to live more fully and with gratitude. End-of-life planning is not about giving up hope but about honoring life and ensuring dignity in the final hours.
For historically marginalized communities, embracing this process can heal wounds caused by past injustices and create a legacy of empowerment for future generations.
Taking the time to understand and engage in end-of-life planning can transform how marginalized communities experience caregiving and death. By incorporating the end-of-life doula model and promoting advance care planning, we can build stronger support systems that respect culture, reduce fear, and improve quality of life at the end of life.
Bio: As a doula, Valoria Walker incorporates a holistic approach to end-of-life care that honors her clients’ wishes. She loves to speak on end-of-life options in communities to empower people to make informed decisions that impact the quality of care received at the end of life. Valoria established her private practice after completing INELDA’s business development course in 2016. She loves to dance and spend time in Myrtle Beach, South Carolina. Valoria holds a master’s degree in management of aging services. She is director of activities in a senior nursing home and assisted living facility and serves as a hospice volunteer. From 2020 to 2022, she was on the advisory council for the National Hospice and Palliative Care Organization. Valoria is a certified INELDA end-of-life doula as well as a facilitator of INELDA’s BIPOC peer mentoring group.
Posted 2/22/2026