Inside American End-of-Life Doula Trainings through Analytic Autoethnography: A Social Movement for Death Positivity Manifests in a New Profession

Abstract

End-of-life doulas (EOLDs) represent a rising profession and are becoming increasingly well-known through pop culture, yet associated scholarship is scant. Through a “sociology of professions” lens, this research adds value by expanding and enriching scholarship on EOLDs—by further illuminating their training, functions, and scope of practice. To understand a largely feminine profession, this study employs a feminist epistemology that situates the knower as a featured player in knowledge generation. Through use of analytic autoethnography, this analysis of two American EOLD training programs employs a first-person narrative in which the researcher: (a) is a full member of the group or setting under examination, (b) is visible as such in published texts, (c) engages in reflexivity, considering the dynamic, interactive effect their presence has on the research itself, (d) incorporates insights from other group members, and (e) seeks to develop theoretical understandings of broader social phenomena. Both trainings frame their education in terms that are hallmarks of the Positive Death Movement, including normalizing death as a nonmedical event, emphasizing person-centered care, and affirming that facing death is an opportunity for personal growth. Each emphasized the nonclinical nature of the EOLD role while highlighting listening and intuition as primary skills for successful doula work. These programs also discussed the boundaries of doula services and portrayed EOLDs as a complement to hospice care. Expressivity at the end of life was lauded by both programs, but one entity encouraged proactive pursuit of psychosocial emotional work with clients; the other underscored receptivity to clients’ initiation. One training entity better equipped EOLDs to mindfully address isms by offering shovel-ready curriculum that fostered in-depth consideration of bias, diversity, equity, and inclusion.