IT WAS TIME TO END CHEMOTHERAPY, Jilmarie Chapple decided in March. The breast cancer she beat years ago had returned and metastasized throughout her body. It was only a matter of time before she would die.
The chemo ended, but so did the support she and her husband, Mike Legg, received from the hospital medical team. That all disappeared, Legg says, sounding a bit frustrated at the memory.
The couple was not alone on the challenging journey, however. Monterey-based end-of-life doula Laurie Wheeler was standing in the gap.
“I had never heard of an end-of-life doula before, but Jil – facing what we were facing – I don’t know where she got the idea, but she was the one who researched it,” Legg says. Chapple’s research in June 2024 led her to Wheeler, who seemed to be the right fit, both from reading her profile, and after Chapple, Legg and Wheeler met in a coffee shop in Scotts Valley, near the couple’s home in Boulder Creek.
In the year before Chapple died at the age of 67, Wheeler was her go-to for advice, resources, guided meditations to allay anxiety, or just to talk, via the phone and video calls.
“She provided a lot of comfort to my wife,” Legg says.
In June, Wheeler assisted both Chapple and Legg in the final days, and then Legg in the weeks afterward as he prepared for Chapple’s celebration of life. Legg says he can’t imagine what it would have been like without the doula’s support.
Wheeler is part of the growing number of end-of-life doulas, as she calls herself, or death doulas, an older term that is still embraced by some. The doulas mirror their counterparts, birth doulas, who provide assistance before, during and sometimes after a child is born.
No matter the term, end-of-life or death, the doula’s mission is to offer compassionate nonmedical comfort, care and dignity for people transitioning from this world into the next.
Several years ago, it wasn’t easy to find a death doula in Monterey County – only one was listed on a national database. Their ranks are expanding. The National End-of-Life Doula Alliance (NEDA) reports membership has grown from 260 in 2019 to over 1,500. Other organizations have launched in recent years with their own members as the demand for training and support has increased.
That more people are getting into the career of caring for others at the end of life is a positive sign, but it’s also a challenging time for what is an unregulated industry. There is no standard for training or government oversight. There are organizations like NEDA or the International End-of-Life Association (INELDA) that expect members to abide by a code of ethics, but for now it’s up to consumers to vet the doulas they reach out to.
“I wouldn’t call it a wild west, exactly, but there’s a very open space as things evolve,” says Linda Anne Goulet, who works and volunteers as an end-of-life doula and leads grief workshops locally. “It’s a really interesting time in this field.”
For the uninitiated, it can be confusing to sort out the differences between hospice and doula services. Settling our affairs and making a plan while we are alive and well is always best, doulas say. It is the ultimate gift to loved ones, to make practical decisions ahead of time and emotionally, to leave nothing unsaid.
There can be “a beautiful death,” says Carmel-based death doula David Hahklotubbe (pronounced “hawk-low-tubby”), and that’s where doulas can be of service. He started in 1998 and has seen an interest in doulas grow in recent years.
“It’s in the consciousness right now,” he says, “and it’s gaining a lot of momentum.”
BENJAMIN FRANKLIN FAMOUSLY WROTE IN A LETTER TO FRENCH PHYSICIST JEAN-BAPTISTE LE ROY in 1789 that nothing in life is certain except death and taxes. In the U.S. we have little problem with talking about taxes. We’ve been more reticent when it comes to talking about our own deaths, or the death of someone we love.
“Not many people that I know really know how to be with someone who is facing such a horrible situation. Many people want to rally and say, ‘You’re going to beat this,’ or ‘rah rah’ and cheerlead, and that’s really not helpful,” Legg says.
Doulas can provide a nonjudgmental, listening ear when loved ones aren’t ready to face reality. They can also, with permission, talk with friends and family and offer emotional support and resources.
It’s just one of many ways that end-of-life doulas assist their clients. Different doulas will provide different services based on what they do best. Goulet points out that there are many ways doulas can be of service, depending on each doula’s strengths, offering help with things that go beyond the confines of what hospice workers and other professionals provide. (Hospice is a specialized form of medical care at the end of life, either in-patient or in a home setting, whereas doulas provide non-medical support, similar to how birth doulas – also non-medical practitioners – help with things like birth preparations and postpartum care.)
“There are people who love – and are great at – helping someone organize their paperwork and their finances and their planning. And then there are people who want nothing to do with that but are very much into physical support and helping plan for the great transition,” Goulet says. Other doulas may specialize in grief support for families.
“Doulas have a kind of spectrum of services, and so there’s so much room for people who want to be of service, to find their niche,” Goulet adds. Some doulas provide advice about advanced health care and end-of-life planning, as well as help clients review their life and have meaningful conversations with loved ones.
Dr. John Hausdorff is an oncologist and director of Hospice of the Central Coast. “[Doulas] provide a kind of navigation in territory where there isn’t anybody doing navigating,” he says. Hospice wasn’t designed to help with the types of services doulas provide. Having a doula work with a hospice team would be ideal, he says, and he sees them as valuable guides in advance to help clients make the decision to transition from palliative care into hospice.
In the final days, many doulas offer “vigil support” by creating a calm and serene atmosphere and incorporating elements that are important to their clients and their families, and by helping manage visitors, if necessary.
“It is a focus on every sense that the person has,” Wheeler says. “So visually, what are they seeing? Can we shift their bed so they have a beautiful view? Can we move their special artwork and mementos within their field of vision? What are they hearing?… What are they touching?”
It’s a way of giving clients some control over a process they have little to no control over, to respect their choices and to give them a final voice.
HAHKLOTUBBE – whose Choctaw last name means “one who listens before the death” – carved out a unique niche in providing death doula services.
(Hahklotubbe resists the change to the term “end-of-life” that has been gaining traction in the field. “We need to take the word ‘death’ and change how people feel about it, rather than allow them to continue to not address the ‘D’ word. So I am a death doula and I will always be a death doula,” he says.)
One example of the type of support he has provided to clients – he’s helped over 1,020 in their time of transition – comes in the story of a young man in Utah with an aggressive terminal illness that made travel complicated but the man wanted to see his two young children smiling and laughing at Disneyland one last time. The man’s hospice caregivers said it wasn’t possible and refused to help him.
“I boldly told him to fire his hospice. ‘I have a hospice company that operates in your state that operates a remote office in Orange County,’” Hahklotubbe recalls telling the man. A plan was created to get him from the plane directly to the theme park.
“Two weeks later I got a text stream of photographs of him and his kids at Disneyland,” he says. “It takes empathy, it takes creativity, it takes an interest in creating a quality of life to make those maneuvers, and it also takes being allergic to the word ‘no,’” he says.
Hahklotubbe recalls another client, a woman who had always wanted to go to Hawaii but never did. He and his team brought in buckets of sand from Carmel Beach, figured out how to warm it up, and lined the bed she was in with the sand. (He admits he learned the hard way that warming beach sand in the oven also warms up the tiny bits of kelp. The house didn’t smell great afterward. “I learned along the way, don’t ever do that.”)
They looped 24 hours of uninterrupted scenery from Hawaii on a big-screen TV, set up an oscillating fan blowing warm air and played Hawaiian music.
“The husband was just in shock, first of all, and then in tears,” Hahklotubbe says. “‘You just gave her the best exit that she could possibly have,’” he recalls the man saying. “So that’s my niche. I go out of my way.”
IT’S UNLIKELY THAT ANYONE STARTS OUT LIFE THINKING THEY’LL BE A DEATH DOULA. For Wheeler, it was a deep desire to do something more to help others that led her to the career.
“I had a prior career in finance, and then I took a significant amount of time off to be a mom. And then as I was approaching my 60th birthday, I thought, ‘What am I going to do with the rest of my life?’” she recalls asking herself.
Wheeler had been a volunteer with the American Red Cross and Meals on Wheels of the Monterey Peninsula, “and I kept thinking, ‘I can do more,’” she says. She became a hospice volunteer with the Central Coast Visiting Nurses Association.
“I felt I desired meaning at this point in my life, and that would provide me with significant meaning,” she says.
It was through her hospice volunteering that she heard about end-of-life doula training. She chose to receive training through INELDA, one of the oldest and more established organizations which has been training doulas for over 10 years.
Located in New Jersey, INELDA offers in-person and virtual courses. Wheeler chose virtual training, with 10 to 12 hours of pre-course work, 24 hours of live classwork and three to four hours of postwork, in 2023. She started her own company, Compassionate Hearts End of Life Doulas and launched a website, compassionateheartsdoulas.com, with resources for people who want to learn more about end-of-life care.
Soon people were finding her website and contacting her for help. She also gains clients through word of mouth. Over the past year she’s assisted over 20 people as they’ve died, both as a volunteer and through her private practice. In her practice, she charges on a sliding scale, depending on their ability to pay. (The range of what doulas charge ranges from approximately $75 an hour to as high as $400 an hour.)
“People will often reach out to me as soon as they receive a terminal diagnosis,” she says. The help might be intermittent, sometimes briefly or up to a year or more, providing emotional support and planning assistance.
Hahklotubbe originally started out as a gerontologist, a professional who studies aging and its social, cultural, psychological and social aspects. From there he built care facilities specifically for seniors with dementia, “but more specifically, the folks who had problematic behaviors that no other communities would undertake,” he says.
Being in that business, he experienced a lot of patients dying, and noticed “a gap between where hospice ended and where the client really needed some assistance in the exiting process,” Hahklotubbe says. “And when I say client, I mean the whole family system. It’s the client who’s passing but it’s also the living that go through the more difficult part of the process, which is the grieving process.”
His first “client” in 1998 was a beloved uncle who had a highly aggressive brain tumor. “It put a light bulb over my head. This is what I want to do,” he remembers saying. He acted as a death doula at the care homes he owned for 27 years.
Currently he serves as a content contributor for the end-of-life doula certification program at the Robert Larner, M.D. College of Medicine at the University of Vermont. Hahklotubbe says when he first started contributing five years ago, there were about a dozen participants. Now there is a waiting list.
Hahklotubbe has also shifted his career toward speaking and writing books, although he still provides doula services. He has two books coming out in 2026: Urgent Messages from Just Up the Road, featuring curated wisdom from people on their deathbeds, and Go Fly Your Kite, about working through grief and regret.
For Goulet, it was experiencing extreme grief after losing six people close to her within about eight months that started her on a journey toward becoming an end-of-life doula. After sobbing uncontrollably for a weekend, she went to an emergency room where she was given a prescription for Prozac. A pharmacist friend told her to throw out the pills and gave her the name of a good therapist. “You’re grieving,” the friend told her.
“My spirit being what it is, I thought: I better dive into this and familiarize myself with, what is this death and dying thing?” Goulet recalls.
She started volunteering with a hospice and loved it. She did that for 14 years, before taking a break for about five years. She later returned to volunteering with Jerry’s Place, a nonprofit social model hospice in Seaside, offering a home-like atmosphere for people who are dying but for whatever reason do not have a home where they can be in their final days.
“There is something particularly meaningful about helping someone with your presence to step into something unknowable. It’s a scary time for most people, and if you can be in what I consider a real honored position of just witnessing and being compassionately present in that moment – for me that’s about the best spiritual employment that I can imagine,” Goulet says.
As she approached retirement from teaching in public schools, Goulet decided she wanted to dive in further to the work around death and dying. She began training with the company Lifespan Doulas, which originally was focused on training, certification and continuing support to birth doulas when it was founded in 1999. The company later added training and certification for death doulas. Some doulas provide both kinds of services.
“To me it’s sort of the same,” she says. “You come in and have some assistance in as non-intrusive a way as possible, in a supportive, loving entrance. I like to think that you could do the same for the outro.”
ONE EXPLANATION FOR WHY DEATH DOULAS ARE MORE SOUGHT AFTER could be explained by the decline in membership among faith communities in the U.S. A Gallup study in 2021 found that church membership among Americans had fallen below 50 percent, the lowest point in 80 years. Clergy and lay clergy historically provided emotional and spiritual support as families faced the prospect of a death.
Legg says he and Chapple had never belonged to an organized religion, but they were spiritual. “We’ve always been meditators. It was nice to have someone non-denominational and yet had a real spiritual persona,” he says
Part of the doula code of ethics includes respecting clients’ beliefs and remaining neutral. “We honor and support whatever spiritual beliefs a person holds, as well as their cultural rituals and customs,” Wheeler says.
Hahklotubbe agrees. “As a doula you’ve got to be neutral, and your job as a servant leader is to give the person what they want,” he says.
For the last few years, Central Coast VNA & Hospice has been offering volunteer death doulas as part of meeting requirements by Medicare that volunteers be part of the hospice team, which includes a registered nurse, social worker and chaplain or spiritual counselor.
“Not everybody wants to have a chaplain come to visit them, so the doulas are for those who don’t identify as religious and they want something that they don’t perceive to be threatening,” says Trevor Jones, VNA’s bereavement and spiritual care supervisor.
VNA started out with one doula and now has three, in response to greater demand.
IT’S UNCLEAR EXACTLY HOW MANY DEATH/END-OF-LIFE DOULAS THERE ARE IN MONTEREY COUNTY – there are several listed on national databases and there are also volunteer doulas working around the county, like those in conjunction with Central Coast VNA & Hospice. One local company, Peggy’s Home Care, is now offering the service.
That death doulas/end-of-life doulas are gaining in popularity “is both a good thing and a bad thing,” Hahklotubbe says.
“The good thing is it’s in the consciousness and people are aware now and they’re thinking premeditatively, because that’s the key to a successful exit for all parties – doing the research and knowing what you’re doing before you go into crisis level,” he says.
The pitfall, he says, is that people are jumping into it with potentially not enough training and with no oversight or regulation. “It’s buyer beware,” he says.
Hahklotubbe sees a “glimmer of hope” in New Jersey, the only state that covers death doulas under Medicare, in addition to there being private pay doulas – all other states only have private pay end-of-life doulas.
“Those death doulas [covered by Medicare] have to go through a lot of scrutiny, and they have to qualify,” he says. New Jersey is “leading the way into the future and at some point doula services will be covered, similar to hospice.” (California is already allowing coverage of birth doula services under Medi-Cal, the state’s version of Medicaid.) He hopes that one day there will be a regulatory body that vets doulas and requires education.
Despite the fact that doulas are becoming more sought after, they still see resistance in the culture to face up to the eventuality of death.
Wheeler says one thing she wants people who are in fear or denial to understand is that once they take small steps toward planning and reading information “it actually lessens fear, and it can be gently done,” she says. First steps include completing an advanced health care directive – a legal document communicating wishes for medical treatment or appointing someone should one become incapacitated – and sharing with family what medical interventions are acceptable or unacceptable.
“Whatever planning we do in advance is a gift to our loved ones, and it sets the stage for a more peaceful passing, both for us and our family members,” she says.
Planning ahead for the inevitable can also help people feel less fear, and live life in a way that resolves the regrets of the past. It’s something Hahklotubbe urges people to consider.
“Tomorrow’s not promised,” he says, “and the folks who are the most fulfilled are, number one, the ones who die with the least regret and, number two, the ones that die without fear.”