Ben Gibson bounces down the stairs at Life Rites Funeral Home in a floral shirt, black slacks and trendy trainers. He’s smiling and apologetic. 

“Sorry for keeping you. We just had a minor emergency. Two funerals this morning and two white coffins going out. All sorted now,” he says.

One of 39-year-old Gibson’s many hats, on top of End-of-Life Doula, Holistic Funeral Director and Celebrant, is operations: making sure the right coffin goes out the door.   

This plethora of job titles is not unusual for End-of-Life (EOL) Doulas in this emerging profession that supports and guides people and their families through death and dying.  

“All those roles fill up my week,” says Gibson. “There just seem to be more doulas available in Australia now than there are people taking up our service.” 

That may not be true for long. With Nicole Kidman’s recent announcement that she is training to be a Death Doula, there has been a surge of interest in the role.  

Helen Callanan, Founder and Director of Preparing the Way, sees the positive. “Whatever people think about (Kidman’s) capacity, she did doulas a bloody good turn by getting them known,” she says.  

Accreditation proves divisive

Callanan formed Preparing the Way 13 years ago and developed the world’s first nationally accredited End-of-Life Doula qualification. After Kidman’s announcement they had an influx of inquiries, and registrations rose by 30 per cent. 

Launched in 2022, Preparing the Way’s 10966NAT Certificate IV in End-of-Life Doula Services remains the world’s only nationally accredited qualification and today boasts 21 graduates. 

“There has been some resistance (to doulas) because it’s only recently become an accredited course,” says Gibson, who completed Preparing the Way’s Foundation and Intensive courses in 2022. “Prior to that, it didn’t have the foundation of a training background that was held to a set of standards.” 

These efforts at regulations are not welcomed by all. Some doulas believe they should be free to practise their own way in their community. “When deathcare is kept small and intimate within a community there is no need for regulation,” one training organisation responded in a 2022 Flinders University international survey of training organisations. “I’m American. Believe in freedom,” answered another. “If you want to disempower the profession then do it,” said a third.  

Callanan does not agree. “There is a difference between making all doulas practise in the same way and having a shared foundation around ethics, boundaries, safety, scope of practice, training and accountability,” she says. “Good standards should not control the soul of the work. They should protect it.” 

Kangaroo Island based EOL Doula Heidi Greig, one of very few doulas subcontracted to a community palliative care team, sees such standards as imperative.  

“We are one doula away from the whole profession going under,” she says. “It’s just going to take one rogue doula to go out and do some woo-woo thing and it’ll end up in the papers and then that’s it for all of us. We owe it to each other to get that standard of practice and scope of practice absolutely clear.”  

Arguably, the nursing profession faced a similar dilemma in the nineteenth century. Once ‘nurse’ simply meant ‘to nourish’; ‘doula’, from the Ancient Greek, means ‘woman who serves’. It is only since the 1970s natural birth movement in the United States that it’s been used for those providing non‑medical support at birth – and, since the early 2000s, at death as well.  

Services vary

“In a nutshell, I say that we provide non-clinical, non-medical education, support and resources to people aging or approaching end of life, after death and the people around them,” says Callanan.

But there is still no consensus on precisely what that entails. Currently, the support each doula offers can vary widely. Grieg, for instance, does some personal care such as showering or washing. Others argue that should be left to a nurse. Grieg does not agree. 

“It’s just a caring thing to do,” she says. “If someone has soiled the bed, I can’t just leave them lying in a soiled bed.” But she recognises that she has the confidence thanks to her background as a registered nurse and ambulance officer. 

Likewise, after death care. Ben Gibson came to doulaing through holistic funeral directing and is comfortable in what he describes as “the pointy end” – what it means to actively die at home as well as care for the body after death. But he recognises that is not for everyone.  

“There are some doulas who sit most comfortably just doing advanced care planning and the legalities of what it means to have your affairs in order before your end of life,” he says. “Some people love helping families or individuals de-clutter their houses and do death cleaning. So, the breadth of what is available to people is quite broad.” 

Across the spectrum of offerings, Callanan says that the principle is to give back “the three C’s”: Choice, Capacity and Control which she says have been largely compromised through a century of outsourcing and institutionalisation. 

Talking about dying won’t kill you

The 2014 Grattan Institute report Dying Well said that, while 70 per cent of Australians said they wanted to die at home, only 14 per cent actually did – half the number of comparable nations: the USA, New Zealand, France and Ireland.  

One reason for this, the report says, is the lack of advance care planning. Dr Michael Barbato, a retired palliative care physician and former medical director of Sacred Heart Hospice in Sydney, has seen how adversely this affects people with chronic illness who end up dying in hospital. 

“Treatment often takes precedence over presence,” he says. However, he explains, treating the symptoms and keeping someone comfortable is often not the most difficult problem: “The most difficult problem is what I will simply label as suffering.”  

Over his 30 years in palliative care, Barbato has seen how end‑of‑life suffering is as much a result of emotional, social or existential anguish as physical discomfort. This kind of suffering, he says, is better alleviated through the kind of consistent one-on-one human presence and listening doulas can offer.  

Knowing that death could come knocking for any of us at any time, why do we avoid making ‘our arrangements’? Barbato says that the main barrier is not the end‑of‑life planning itself, but the prospect of confronting our own mortality – having to talk about the fact of death and dying. 

Callanan is frank. “You know that you can’t get pregnant talking about sex, right?” she says, “Well, you can’t die by talking about death either. Otherwise, I would have been dead decades ago!”  

Despite that rationale, the subject is still taboo. “It is like we will hasten it on ourselves or others by discussing it,” says Gibson. 

But he also sees the gift that planning gives people who sit opposite him when a loved one has died: “There’s no regret, there’s no second-guessing decisions. They might make a few adjustments here and there, but the framework is set, and they’re just like, ah.” 

Growing need for more end-of-life support

The Grattan Institute report says that, in the next 25 years, those aged 85 and over will increase from 2 per cent to 4 per cent of the population. As a result, the number of people who die each year will double. Hospitals, hospices and aged care homes across Australia are already nearing capacity.  

With palliative care teams now stretched thin, Barbato sees the need for people who are simply there to advocate and support. In his view, the sooner doulas are regulated the better so medical teams can refer to them and families can hire them with confidence. 

Callanan says doulas need to be recognised as part of the end‑of‑life care team alongside other allied‑health roles so they can be accessed by everyone and paid appropriately for their work.  

Holistic End of Life Death Care (HELD), the peak body for doulas and holistic death‑care workers, is working towards self‑regulation of the profession and developing micro‑credentials to make referral pathways safer and clearer.  

“This work deserves to be a recognised profession for those who want it to be. It is why I designed and developed the accredited qualification in the first place,” says Callanan. 

But not everyone trains as a doula to build a business. Some are retired and want to volunteer; others, like Kidman, have watched a loved one die and want to learn how to support others better.  

On a recent online information session for Preparing the Way, 68 people logged on from all over Australia – retired palliative‑care workers, nurses, hairdressers, alternative‑therapy practitioners, social workers, counsellors – all with different questions:  

• “How do you step into a stranger’s home?”
• “Can you specialise?”
• “How do you separate a clinical background from this work?”
• “How well known is it?”
• “How do you even begin to market yourself?” 

The role is still working out some of these questions. It is early days. As Ben Gibson alluded, uptake for doulas is still proportionally low. Yet, with the government’s new End‑of‑Life Pathway and Support at Home package, it seems some choice is returning to our dying days – at least for those who are prepared and can afford it.