Canadians aren't dying well. The death doula can help

Published in-print and online in The Toronto Star

If you had two weeks left to live, what would you do? Healthy people frequently say that they’d use the limited time to reflect, travel or reach out to an old friend.

What we sometimes fail to consider when thinking about death are the unavoidable, perhaps awkward, particulars. Would you feel comfortable telling your family about the fears running through your mind? What about making financial or practical arrangements?

They are questions not just for those confronting mortality, but their loved ones, too. According to the Government of Canada, 8 million Canadians currently care for someone they know and this number is expected to increase given our aging population.

We all want to die well, facing our end or that of a loved one as best we can. A key part of this process is what’s known as emotional end of life care in which the dying and their loved ones receive support and guidance.

Though it may be less physically taxing than, say, helping a terminally-ill loved one to and from the washroom, it is not easy work for non-professionals. It is a task, however, which can be aptly undertaken by a lesser-known class of care worker: the death doula.

Death doulas provide non-medical, emotional, practical and spiritual support to dying persons and their families. By attentively listening and performing routine tasks such as picking up groceries, doulas provide a space for the dying and grieving to process the inevitable. It is a service that deserves to become a more accessible and standard part of Canadian health care.

The need for such care is pressing, especially for those averse to talking about death.

The Canadian Psychological Association says one in four people with incurable cancer will develop anxiety or depression disorders. Just as tackling this mental-health issue is a better job for a psychologist than a son or daughter, encouraging emotional wellness in death is a better job for a doula than the bereaved. A 2017 study from the University of British Columbia says a third of bereaved families of adult cancer patients regretted not having talked about death sufficiently.

Death doulas aren’t guaranteed to make clients feel at peace with dying. Still, they can help facilitate necessary, and often hard, conversations about cultural rituals and exchanging goodbyes. The opportunity to speak frankly is valuable during moments typically shrouded in delicacy, or even avoidance.

Such assistance could be particularly helpful for the many older Canadians living alone, without a built-in support system.

Certainly, there are lovely nurses, doctors and palliative care team members working tirelessly to make end-of-life care comfortable for the dying and their families. But expecting medical workers whose focus is prolonging life to help a patient feel emotionally at terms with death is somewhat unrealistic. Death is not the focus of their agenda.

To address dying people’s needs sufficiently and holistically, Canadians should be able to turn to someone who can deal with death unencumbered by the reasonable, predictable hesitation of many physicians.

Alas, death doulas are currently not accessible to most Canadians. They should be. The unregulated practice is not covered under the Ontario Health Insurance Plan (OHIP) or third-party insurance in Ontario. There are registered charities like the Home Hospice Association (HHA), which run death doula certification programs and work to make the service more readily available. But without regular, consistent funding, guaranteeing these services remains unrealistic.

An August 2024 Statistics Canada report says 61 per cent of Canadians are not aware of the support available in their community to help them care for someone with a life-limiting illness. Funding and partnering with organizations like the HHA is a crucial way to help Canadians die well. Talking about death won’t kill us; in fact, it may be the only source of solace during times of loss.