Beyond Legacy: Supporting Voice and Agency at the End of Life
by Mina Devadas
Her often-shaky hand did not tremble as she held the pen to paper. A laser beam of afternoon sunlight streamed across her face through the nearly closed bedroom curtains. The rare neuralgia on her left side—what she described as “buzzy like swarm of bees” under her skin—was a steady presence that day. Yet she focused fully on the task before her. With great intention, she signed her full birth name—each letter slow, deliberate, unmistakably hers. When she finished, she exhaled a deep, satisfied sigh, a sound that carried accomplishment, relief, and quiet pride.
My mother had just voted in the 2024 presidential election.
As we navigate the end-of-life space, as both death doulas and humans, we recognize and want to acknowledge that many of us are experiencing pain over recent headlines. We are devastated by the scale of violence and inequities that we are living with both in the United States and overseas. We firmly believe that everyone should have self-determination and choice at the end of life. The killing of others and inequitable policies eliminate the ability to have choice at end of life.
There are many things we can point to, from the deaths of Israelis and Palestinians to the United States breaking the record for mass shootings in 2023 to the millions of deaths that have occurred due to ongoing global conflicts, intentional homicides, and lack of access to basic services and health care. All of these things leave us untethered and pained by the human experience.
Only weeks after her 94th birthday and eight months into hospice care at home, she was radiant with a kind of autonomy that transcended her physical decline. Her eyes, though tired, exuded satisfaction. For her, voting was more than a right—it was a moral act, a final expression of agency, part of what she called “being a good citizen.”
The Librarian’s Lifelong Curiosity
My mother worked at the Library of Congress for 46 years and always valued being informed. Her work was highly technical, rooted in the intricate coding and data systems that supported the library’s vast collections, long before computers made it easier. Accuracy and precision mattered. So did curiosity.
Even in her final months, when fatigue made one of her favorite daily activities difficult—reading The Washington Post from front to back (except for the sports section)—she still wanted to stay informed. To broaden her access beyond standard television programming, we connected a computer to her bedroom TV. From her bed, with assistance, she could watch cooking vlogs from Azerbaijan, listen to hard-to-find Beverly Sills recordings, and seek out the information she wanted to inform her choices before marking her ballot.
She welcomed our help, yet remained quietly intentional about her choices. That day, she engaged with the world as she always had—with curiosity, care, and conviction. That gentle partnership captured something profound: the exchange of support that does not diminish agency but instead sustains it.
The Doula’s Reflection
As end-of-life doulas, we are trained to support the autonomy of those we serve—to honor their choices and affirm their humanity even as independence fades. We walk beside them as they navigate meaning, what they leave behind, and the emotional and spiritual landscape of letting go.
We often ask: What still feels unfinished? What brings you peace? Who or what remains important? Yet I find myself wondering—how often do we ask about one’s civic life? About the ways a dying person still wishes to engage with the world beyond their room?
For my mother, her final ballot was a bridge between her inner and outer life—a way to continue contributing to something larger than herself. For others, it might mean writing letters, sharing a message, or expressing concern for a community cause. These acts are more than expressions of opinion; they are affirmations of belonging—reminders that one’s voice still matters, even as the body grows weaker.
Supporting someone’s civic identity at the end of life may not appear routinely in traditional care plans, yet it is deeply aligned with a doula’s purpose. We acknowledge the whole person—their values, roles, and stories—and hold space for every dimension of who they are. The desire to stay connected doesn’t vanish as death approaches. For some, it sharpens.
Civic Life as Meaning-Making
Including civic engagement in end-of-life conversations can open another dimension of meaning. It invites reflection on what participation has meant to a person over a lifetime, and whether there’s a final act or message they wish to leave behind.
Sometimes it’s symbolic—the act of casting a final vote, making a donation, writing a letter, or speaking with family about the values that guided one’s life. Sometimes it’s simply being witnessed in continued care for the world.
For doulas, these moments can deepen our own understanding of purpose. They remind us that our work is not only about comfort or support—it’s about affirming dignity, presence, and agency right up to the end.
Returning to the Signature
After confirming that her ballot had been mailed, my mother rested more often. With acknowledgement that there was nothing unsaid or undone, she began to move between two realms. The envelope had gone out into the world, carrying her name, her intention, her final act of civic life. The rhythm of her days slowed.
In that small, ordinary moment, something larger was revealed: Autonomy doesn’t have to be loud or defiant. Sometimes it’s a soft assertion—a mind that still wants to engage, a blink, a kiss, a hand that still wants to write.
Weeks later, after she passed, I found myself looking at a copy of her signed ballot. It seemed like such an ordinary set of papers, yet it felt sacred. It represented her lifelong relationship to learning, to service, and to community.
For me, it became a reminder that autonomy is not limited to medical choices or physical independence. It is the ongoing ability to express who we are—to remain connected to what gives us meaning. Even when the body weakens, spirit and purpose can endure.
Closing Reflection
As end-of-life doulas, we are not only companions to the dying—we are witnesses to the continuing humanity that persists until the very last breath. My mother’s act of voting reminded me that our work includes helping people find ways to express that humanity in whatever form it takes.
Because sometimes, the smallest act—like signing your name—can still be a declaration of life.
Bio: Mina Devadas is a Maryland-based, INELDA-trained end-of-life doula and hospice volunteer. Contact her at [email protected]
Posted 11/13/2025