News Briefs – SEPTEMBER 2025
by INELDA
Doula Practice Protected by U.S. Appeals Court
Telling people about their options at end of life constitutes free speech, according to the 7th U.S. Circuit Court of Appeals—and is thus protected by law. That’s the latest development in the case filed by EOL doula Lauren Richwine, who was ordered by the state of Indiana to obtain a funeral director’s license or shutter her doula business, Death Done Differently. The August ruling means that Richwine can continue practicing as a doula without becoming licensed as a funeral director.
“This ruling is not only a personal victory,” Richwine said via Institute for Justice, which represented her in court. “It upholds the freedom required for individuals and families to explore the full scope of their options when faced with death.”
The state had issued a cease and desist order in 2023 mandating that Richwine not discuss funerals and other EOL planning with clients. Richwine’s services fall squarely within the scope of what many doulas offer, including general death and grief support, legacy and ritual development, and care planning. Her website states that she provides “non-medical forms of logistic, emotional, and spiritual support,” not funeral care or embalming.
The state’s case rested on protecting public health and consumers. As Judge Ilana Rovner wrote in her decision, “This approach [forcing Richwine to become a funeral director to provide doula services] furthers the state’s interests the way an atom bomb would further the eradication of a residential ant infestation. It goes much too far.”
For more on the legal approach to protecting doulas’ rights, members can watch INELDA’s virtual town hall with Richwine’s legal team.
Factors Influencing Advance Directives
“Low, static over time, and possibly unequal”: These are the findings of a recent systematic review on the usage of advance directives. The meta-analysis, published in Inquiry: The Journal of Health Care Organization, Provision, and Financing, found a number of factors that indicate the likelihood of having an advance directive. Chronically ill patients, people with a cancer diagnosis, White people, educated people, and women were more likely to complete an advance directive.
Drawing on more than 2,300 studies, the meta-analysis aimed for global inclusion, but nearly all the original studies came from high-income nations in North America and Europe. Within the studies, though, the authors point toward possible inequities among people with less education, men, and non-White people. Regarding the slant toward White people, they note, “This could be explained by a different approach in the discussion of treatment decisions with healthcare providers due to inaccessibility of care and mistrust of the healthcare system, greater preferences for life-sustaining treatments, religious and spiritual beliefs, language barriers and discomfort of EOL preferences within family members.”
Patients with acute illnesses were less likely than the general population to have an advance directive. People with chronic illnesses were more likely than both groups to have one, with a cancer diagnosis bringing a higher prevalence of a completed advance directive.
Self-Compassion Linked to Positive Attitudes on EOL Care
Self-compassion isn’t only a useful tool for preventing burnout. It’s also related to attitudes toward end-of-life care, shows new research published in Omega—Journal of Death and Dying. In a study of 219 nurses working in intensive care units in Iran, researchers found that positive attitudes toward caring for dying patients rose in tandem with self-compassion.
“The existence of a positive vision and attitude in nurses can be effective in caring for patients,” the authors write. They also found that age and work experience within the ICU were also related to more positive attitudes. Self-compassion was found to be correlated to education level and training experience, though the authors note that other studies have found contradictory results.
For more on giving oneself grace as a part of the doula framework, read our article on self-compassion.
Posted 9/11/2025