End-of-life doulas — death doulas, as they’re sometimes called — provide a wide range of services. Isabel Knight, a board member of the Funeral Consumers Alliance of Pennsylvania and herself an end-of-life doula, explains.

“The scope of work of what people often do as death doulas involves a lot of pre-death helping someone who is in their actively dying phase or people who are pre-planning,” Knight says. “It then often also covers all the way into helping a family of community do some reprocessing of grief after death has occurred.”

Knight coordinates with funeral homes and crematories once death occurs, but she provides other services as well, such as vigil planning and setting up legacy projects, right on up to compiling important documents related to the death and creating a password manager to give access to those documents to loved ones

But she is also clear — a doula is not a medical professional and not a substitute for hospice care.

She also notes that although death doulas are often certified by a training organization such as INELDA (International End of Life Doula Association), there is no certification in a legally binding sense.

“It’s been a topic of debate basically within the doula space for a number of years now,” she says. “Right now the death doula space is unregulated. There were two prominent cases in which the mortuary boards of California and then the mortuary board of Indiana sued two death doulas, both for the same thing, for quote unquote practicing funeral directing without a license.”

Those two doulas were represented by the Institute for Justice, a national nonprofit, Knight says, “and they used First Amendment grounds to say none of those people were doing any essentially licensable activities. They were just educating families and individuals and communities on what to do and that was all essentially education that was covered under the First Amendment.”

The rise of death doulas apparently does not bother every funeral director.

Take, for example, Camelia Clarke, funeral director at Paradise Memorial Funeral and Cremation Services in Milwaukee and a spokesperson for the National Funeral Directors Association.

“The first circumstance that I experienced with a death doula was actually a child that passed away,” Clarke says. “We were servicing the mom, and she actually had multiple children pass away. She had the assistance of a death doula. That was my first time working in collaboration with a doula and it was a very positive experience. … She was there as the second set of ears to hear the things that we needed the mom to get back to us.”

Every family has its own particular needs, Clarke says, and “I can absolutely see where this could be beneficial for individuals prior to a death happening or maybe someone who’s going into hospice for a long illness that may not have come to terms where a death is imminent. So absolutely there are situations where [death doulas] can be beneficial just like hospice can be beneficial.”