ash marrow

Just as healthcare involves many providers and wraparound services, proponents of the term “deathcare” hope for a paradigm shift in the way we talk about end-of-life needs as integral to the spectrum of care throughout our lives.

Deathcare providers can include hospice and palliative staff, doctors, nurses, social workers, counsellors, massage therapists, music therapists, energy workers, chaplains, choirs, companion volunteers, and more. Deathcare providers can also support clients after death as morticians, funeral directors, cosmetologists, event planners, and religious authorities. 

In the last decade there have been growing numbers of people getting trained as death doulas, or end-of-life doulas, and joining the deathcare field. Historically, many of the tasks of the doula were covered by family, community members, and spiritual authorities, however the isolation of modernity, secularization, and the medicalization of death has severed many of us from knowing how to engage with death meaningfully. A trained doula is someone who can help bridge this gap.

The Death-Positive Movement is an advocacy movement hoping to destigmatize conversations and reflections on dying, death, and how we care for our dead. In our culture we are very avoidant of thinking about mortality which leads to many people not doing this reflective work or logistical planning until they have very little time left.  

To read more check out the history of the movement here.

Doulas can hold objective space for conversations that may be difficult for loved ones to hear as they work through their own grief. Having an “outside” person can create more unfiltered opportunities to tend to your process. 

Doulas are flexible and adaptive to client’s specific needs, and can cross over boundaries that many other professions cannot. We can wear many hats: companion, witness, assistant, celebrant, educator, coach, and advocate. Like birth doulas, our goal is to serve our clients through this chapter of their life in whatever way is needed.

While Doulas are not currently officially supervised by any provinicial department or regulatory body, many doulas (including myself) actively seek out coursework to prepare for the role, or else apprentice under other experienced doulas, which gives us more thorough understanding and practice for end of life issues.

Doulas are also a consistent support that can be with you through all stages of the process: from healthy folks looking for pre-emptive advanced planning or exploration of mortality in their lives, to those with a chronic or terminal diagnosis regardless of stage, prognosis, or hospice eligibility, all the way to bedside vigil, grief, and administrative support for loved ones afterward.

Many doulas (though not all) do this work as either a second job, or as volunteers to the community. Because of this they often have low caseloads with only a few clients at a time. This allows them to be extremely responsive and focused on each client they are currently working with rather than stretched across a full caseload as many hospice staff are. 

To learn more about the scope and role of death doulas, I recommend checking out these links:
INELDA Scope of Practice
INELDA Code of Ethics

• People who are dying soon
• People with a terminal or life-altering diagnosis
• Loved ones of people who are dying or have a challenging diagnosis (including pets)
• Loved ones of someone who has already died looking for support in creating ritual/ceremony
• People who would like support in exploring themes around body grief and mortality
• People who would like support in thinking about advance care planning, no matter how early
• People who feel drawn to explore their future deaths in an affirming way, no matter how early

There are doulas who work with people all across this spectrum and there are also many community spaces like Death Cafes to explore these topics in a group setting as well.

To work with me at this time, you must currently have a life expectancy prognosis of 2 years or less, and currently residing in the Comox Valley. I only work with 1 client at a time to ensure responsive and dedicated service while also working full time and volunteering in other capacities throughout the week. You are always welcome to jump on my waitlist and I can give you a rough estimate.
If you don’t have a prognosis, reside outside the valley, or can’t wait that long, please reach out – I can still help you find someone else to work with!

No. While this may resemble therapy in several ways such as nonjudgmental listening and provoking questions, this is not therapy.

There is no healthcare reimbursement for these services, doulas are not supervised by a regulatory board, and also not liable to PIPEDA requirements (though confidentiality is a value I protect as much as possible). Doulas do not create treatment plans or address severe mental health symptoms, and will refer out to a clinical mental health provider if we believe that support is needed.

Conversely, doulas have much more flexibility than a mental health provider – we can make house visits, help with errands, support the functioning of events, and can schedule sessions based on client needs not just insurance allowances.

It really depends on what’s important to you!

I am a culturally responsive and humble practitioner. If certain religious rites and observances are important to you we will work together to make sure those are prioritized. If it is important that this experience remain a secular one, we can incorporate ritual and ceremony in a way that is meaningful and self-determined. I am not a spiritual authority, just a companion beside you in this journey. That being said, I do believe that intentionally engaging in death work (rather than avoidance or passivity) is an inherently spiritual experience.

More importantly, though, is how you define spirituality, and I look forward to learning from you.

No. Licensed Funeral Directors are required to go to school for several years and maintain a high level of continued education to keep a license regulated by the province; doulas are not.

There are many things that both death doulas and licensed funeral directors both do, and many things that are separate in scope. For instance, while both doulas and funeral directors may talk to clients about body disposition options that are available and support them in conversations with difficult choices, doulas cannot sign death certificates, or take responsibility for transporting, preparing and embalming bodies. 

Likewise, doulas are able to support the client and their loved ones in much more responsive and intimate ways that funeral directors’ time and training provides, allowing us to spend time vigil and memorial planning, working on legacy projects, miscellaneous support around the home.

No. This is not legal advice, and unless a doula also has a specific background in law, doulas do not receive reliable legal education as a part of their training beyond basic vocabulary. I may refer to documents that may be useful for you but will not provide any physical papers for you to sign, nor will I serve in any legal role for you. 

I can commit to offering a minimum of 4 hours per month of scheduled support time to be used as you find helpful. You might prefer a 4 hour day once a month, or perhaps just a weekly visit for an hour. I can also help with some errands and tasks on my own outside that 4 hour window as I am available.

Times when I may be with you longer, or more frequently, could include respite care, vigil sitting, and event support. During Vigil-Time, I can be on-call within negotiated hours, but not 24/7 as I am also working full time. Vigil Collectives with other doulas may be available for coverage.

Doula services are dynamic and responsive to client needs. During session we might talk about your feelings, reflect on your life, work on a creative project together, or write up wishes for your care that you’d like loved ones to reference.  I might help you with taking the dog out, tidying, or helping you downsize possessions. As things progress, I might visit bedside and offer comfort and respite to you and loved ones, making sure your wishes are being prioritized, and maintaining concrete support for administrative tasks so your loved ones can focus on what’s important in your last days. 

I do not perform any medical caregiving tasks (i.e. bathing, dressing, feeding, medication administration, toileting, lifting, vehicle transport).

I do not provide legal documents and cannot serve as a witness, notary, power of attorney, health care proxy, executor, or beneficiary. I am only available to support you in reflecting on options and transcribing informal notes to be formalized at a later time with your loved ones

I do not facilitate ceremonies/rituals in a position of leadership like a celebrant. I am only available for creative conversations around developing plans, and providing environmental support as they are performed.

I do not take responsibility for the cleaning, preserving, or transportation of bodies, however I will support the loved ones’ execution of these tasks, as in a home funeral setting.

Nothing!  Many doulas such as myself offer this as an act of community care and side project rather than a business.

Generally, however, doulas offer services at rates they set themselves because our work is not currently covered by insurance. This might be hourly, a retainer, or package deal. Each doula is different.

Sure! If you feel called to give a gift to support this free offering to the community, you can e-transfer me at ashmarrow@proton.me