The changing landscape for End-of-Life Doulas in Australia

This was a challenging piece to write and I imagine it will be challenging to read for some. Challenge isn’t always bad; good things can come from hard conversations.

In the last few years there have been many developments and offerings which have both strengthened and stretched the role and position of End-of-Life (EOL) Doulas.

Across the USA, England, New Zealand, Canada and Australia there are hundreds of people who have worked for decades to reclaim death from the industries and institutions that sought to monopolise it, and every person we serve; every relationship we form, is woven into the web of the legacy that they created.

One thing we have seen grow very slowly here in Australia is an increase in choice - of EOL Doula (and Doula-adjacent) training; of services, collaboration, peer support and networking. Choice is always good, and it doesn’t hurt to work alongside each other instead of existing in competition with each other, but in business, we know that monopolies are unhealthy and not supportive of a diversity of service. There can be no robust, informed decision making if there is no need to educate people about options because there aren’t any. Choice is good for business and good for community, but all too often businesses step into the fear mindset and want to be the only providers or the only people controlling the narrative, which goes against community ethics, and it won’t work in death.

I have talked to people in Australia and overseas about the development of the EOL Doula in Australia; about the changes I have seen and the challenges that are flowing from them, and of the complicated tapestry of interconnected relationships between community and corporate. And there are lessons I can see laid bare from those countries that are ahead of us on the journey of developing this role as a modern offering in our society – in all the complexity of what that means.

A shifting landscape

There are only a handful of training offerings for EOL Doula work in Australia. The vast majority of these are privately-run courses/workshops. Each training is very different and has a different focus. I have been lucky enough to know most of the trainers and participate in most of the trainings, and I often tell people who ask, ‘Call each of them and talk to them about their values and ethos. Choose once that feels right and fits you, because they are all so very different’. It remains good advice in my book. 

The introduction of Australia’s Cert IV EOL Doula, the first government-accredited EOL Doula training in the world, has the potential to fundamentally reshape the landscape, and the changes have already begun. At the time of writing, there are around three people in the country that have that qualification with another twenty or so due to graduate, plus quite a few others who have completed the skill set as well.

As a result, we now see emerging discourse about accredited and non-accredited EOL Doulas and discussions about what level of training will be acceptable and what won’t in various situations.

Will government facilities and private institutions allow EOL Doulas to work or operate in their spaces if they have the option to require that the EOL Doula hold the Cert IV qualification?

If so, where does that leave the EOL Doulas and communities who don’t have that Cert IV, or don’t want it, or don’t care? This level of professionalisation is a double-edged sword: on the one hand, it has been an important step to getting EOL Doulas employed by hospitals and nursing homes, but it could also make things difficult for those who want to work in the community and don’t feel called to gain the qualification to do so.

The role and function of an EOL Doula is, first and foremost, a community and grassroots function. It is a service we have done for each other for much longer that governments have been accrediting training courses.

The diverging streams between accreditation and no accreditation has the potential to do damage to the majority of EOL Doulas who do not have and/or can’t access the formal training for various reasons including cost, travel, time etc, and the real losers will always be the people who need an EOL Doula the most, because professionalisation comes at a cost. Fees go up; people have more of a competition mindset, a hierarchy forms and suddenly you have an ‘industry’, so we need a way to anchor these streams and orient them firmly around community – to cement the validity of and the place for the community and the grass roots services alongside the professional services and have them both equally represented.

A potential way forward

I have raised the following potential ways to cement community in the conversations with academics, community, business and practitioners across the world.

• Propagate an international EOL Doula Charter to cement an international conversation and to set an international baseline for commonality: no matter who you have trained with or where your values sit, this would be an agreement that people and professionals alike could sign to show their commitment to and willingness to operate within this ethical framework so no one EOL Doula is ‘bigger’ or ‘better’ than another.

• Emulate our colleagues in the USA and introduce an independent proficiency exam for all EOL Doulas. 

• Initiate an international conference dedicated to this community-based work – both EOL Doula and Home Funerals – to springboard the collaborations and partnerships required to foster growth.

My three reasons why

1. Firstly, dying and death is universal as much as it is deeply personal and individual, and a conversation we need to respectfully be having on an international platform. Until we are having international conversations rather than localised, there is the risk of reinventing the wheel.

2. Secondly, we all want to be doing ‘the work’ and for a decade now we have been elbow-deep in the community education required to get society to a point where we can ‘do the work’… Sadly, often that education takes up so much time that we don’t then have time to do ‘the work’. So let’s be united and think big conversations, big conferences and partnerships that can provide a platform for greater community recognition for, education about and acceptance of ‘the work’.

3. Thirdly, because of the natural division that I notice forming in the EOL Doula space, we need to find a way to foster unity. One way to do this is to create an even playing field for all the people in the space who are called to do the work. It doesn’t matter where people get their training; what matters is that all EOL Doulas have a recognised standard basic level of skill and knowledge to give the dying comprehensive, holistic and meaningful support.

How would it work?

Once an EOL Doula completes training, they would sit a standardised proficiency test to have their level of skills and knowledge validated as meeting the national proficiency.

Validation builds public confidence, unifies the EOL Doula movement and importantly, builds transparency and integrity because it asks all trainers to deliver their offerings to the standard (at least) that will see their EOL Graduates pass as proficient.

Now is the time to be having this conversation, while the space is still emerging and we don’t yet know the extent to which the Cert IV will change the landscape, and while we are not overrun with courses and trainers and while the space is still small enough that many of us already know each other.

A representative body  

Australia needs a representative body for EOL Doulas that makes space for all voices and serves everyone as equals that would also include all the different EOL Doula training entities that want to be a part of building a bigger movement. This body could educate EOL Doulas on the gaps that some trainings currently do not fill (like local and state by state legislations etc) but they could also hold the proficiency standards and run the tests.

Importantly, the body would need to be completely independent and representative of the movement as a whole. It won’t work with a controlling interest. It needs to be a true and collaborative weaving of likeminded (and hearted) people working in their commonality despite their differences. A tall order? Perhaps. But if anyone can do it, EOL Doulas can.

In closing

The development of EOL Doula training has been fantastic and the fact that it has been in response to a growing demand for people who want to do this work is nothing short of brilliant. The recent introduction of the Cert IV to the EOL Doula landscape was an exciting and positive addition to what we are all building here in Australia. We already have a system in our modern society based on medical models of care and we now need ways of introducing the non-medical roles and supports into these systems, because it will only create better outcomes for people, and this Cert IV fills that need.

The conversation, however, is much broader because there are EOL Doulas who don’t necessarily want, or need, to be part of accreditation systems and models, and there are people who want to show up in community and do the work because they have the heart for it, not the piece of paper. An advocacy body that represents all forms of EOL Doula equally and is representative of all the different trainers and pathways into the work would be the next positive step for the movement.

This article is a synopsis of a more in-depth piece by Rebecca. Click here to read the full, inspiring article.