For the Rev. Beth Stotts, death is a natural part of her ministry. A major aspect of her job is guiding her congregants through their most vulnerable moments from birth throughout life. The struggles she has seen in her community led her to seek more training to help people face death, and in 2022 she added another credential to her spiritual one: end-of-life doula.
“I wanted to be a part of the process of facilitating tough conversations and normalizing [everything],“ said Stotts, a pastor at the Central Square Congregational Church in Bridgewater, Mass., since 2012. “A lot of that turmoil and grief could be taken care of by pre-planning and by discussions.”
Stotts earned her professional certificate as end-of-life doula from the University of Vermont, joining a growing number of end-of-life doulas who provide advanced care planning and other non-medical services to support the dying and their loved ones.
While there are no official statistics on the number of end-of-life doulas in the United States as this emerging field is still largely unregulated, Fortune reports that the National End-of-Life Doula Alliance (NEDA) has significantly grown its membership, especially after the pandemic. In 2024, NEDA had over 1,500 registered members, compared to about 250 in 2019.
The term “end-of-life-doula” was first formally used in the early aughts. In 2001, the Jewish Board of Family and Children’s Services launched the “Doula to Accompany and Comfort Program,” a pilot program that trained volunteers to aid and support people who would otherwise die alone.
Sometimes known as “death doulas,” professionals like Stotts help people navigate what can be a confusing and overwhelming time. That includes helping clients put together advance directives, such as living wills and designating a health care proxy, and giving them space to visualize how they want their last moments to look and feel like. Do they want to have music? Maybe a candle? Do they want to be surrounded by loved ones, or would they prefer to be alone?
“I think it’s actually very empowering for individuals to be able to say, I don’t want this or I do want that,” Stotts said. “You feel less of a victim to the end of your life.”
Death doulas also discuss funeral arrangements with their clients, and act as a conduit for loved ones, keeping them informed according to their client’s wishes and being a steady presence for family and friends as they keep vigil.
Stotts has also helped people with what she calls “legacy projects,” allowing people to achieve certain goals or tie up loose ends. This could mean arranging a call for estranged family members to connect, or helping people plan what to do with their remaining time. She particularly remembers helping a man write the story of how he met his wife. Before he died, he gave the story to his wife as a gift, which Stotts read at his funeral.
“It was thrilling to hear something so intimate and beautiful,” she said. “The details he remembered were so vibrant and vivid. It was so neat to be invited into someone’s story like that.”
As a pastor and as a doula, Stotts has worked with dozens of people who are journeying to the end of life. She says that just as people need doulas to guide people into life, they need death doulas to guide them out. Because people have different needs, she walks in open-minded and simply ready to be a companion. Sometimes, all someone needs is just someone to be present.
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.