Death Doulas

What Do Death Doulas Do in Canada?

Death Doulas provide non-medical, emotional, spiritual, and practical support to individuals and families before, during, and after death. They work alongside healthcare providers, families, and communities to ensure a dignified, meaningful, and well-supported dying process. Their role is flexible, depending on each person’s needs and wishes, but may include:

1. Emotional & Spiritual Support

• Creating a safe space for conversations about death, dying, and legacy
• Offering spiritual support tailored to the individual’s beliefs and practices
• Holding space for reflection, reconciliation, and meaning-making
• Supporting loved ones through anticipatory grief and bereavement resources

1. Practical & Logistical Assistance

• Assisting with Advance Care Planning, including Personal Directives and Representation Agreements
• Helping individuals and families navigate Medical Assistance in Dying (MAiD), including emotional support and vigil planning
• Providing bedside presence and comfort in the final days or hours
• Supporting family members in caregiving roles

1. Honoring Individual End-of-Life Requests

• Facilitating discussions to clarify and document a person’s unique end-of-life wishes
• Ensuring requests for specific rituals, music, readings, or personal traditions are respected
• Assisting in the creation of a vigil plan that reflects the individual’s values and preferences
• Supporting choices around the physical environment at the time of dying (lighting, scents, sacred objects, or meaningful items)

1. Home Wake & Funeral Planning

• Guiding families in planning home vigils, wakes, and funerals
• Assisting with body care after death for those choosing home-based post-death rituals
• Coordinating with funeral service providers while ensuring the family’s wishes are prioritized
• Helping to plan personalized memorials or alternative funeral options (green burial, cremation, celebrations of life, etc.)

1. Education & Community Support

• Hosting workshops on death literacy, end-of-life planning, and home funerals
• Offering guidance on legacy work, including ethical wills, letters, and personal storytelling
• Providing information about grief groups, bereavement support, and community resources

Death Doulas do not replace healthcare professionals, funeral directors, or grief counselors, but they serve as compassionate guides, helping individuals and families navigate death with greater agency, understanding, and peace.

 

Death Doulas are legal in Canada, but the profession is unregulated, meaning there is no government licensing or official regulatory body overseeing the practice. However, many Death Doulas receive training and certifications from organizations such as:

• End of Life Doula Association of Canada (EOLDAC)
• Canadian Integrative Network for Death Education and Alternatives (CINDEA)
• International End of Life Doula Association (INELDA)

Key Legal Considerations:

1. Death Doulas Do Not Provide Medical Care
   • They do not diagnose, prescribe, or administer medical treatments.
   • They can, however, support individuals through Advance Care Planning, advocate for patient rights, and assist families in navigating Medical Assistance in Dying (MAiD).
2. Death Doulas Are Not Funeral Directors
   • They can assist with home vigils, body care, and funeral coordination but cannot perform legal funeral home services unless also licensed as a funeral director.
   • In some provinces, families have the right to care for their loved one’s body at home without hiring a funeral home, and doulas can help guide this process.
3. MAiD (Medical Assistance in Dying) Support
   • Death Doulas can provide emotional and logistical support to individuals choosing MAiD.
   • They cannot administer medications but can be present during the process if invited by the individual.
4. Advance Care & End-of-Life Planning
   • Doulas can help individuals create Personal Directives, Representation Agreements, and end-of-life care plans, ensuring their wishes are documented and respected.
   • They cannot provide legal advice but can guide individuals to the appropriate legal and medical professionals.

In Summary

Death Doulas operate legally within their non-medical, supportive role. While they are not regulated, they follow ethical guidelines and best practices set by professional organizations.

 

What Are Representation Agreements in Canada?

A Representation Agreement (RA) is a legal document in British Columbia that allows a person to appoint someone to make decisions on their behalf if they become incapable of making decisions themselves. It is part of Advance Care Planning (ACP) and ensures that an individual’s wishes are respected regarding health care, personal care, and, in some cases, financial matters.

Representation Agreements are unique to British Columbia. Other provinces use different legal documents, such as Power of Attorney for Personal Care (Ontario) or Personal Directives (Alberta, Nova Scotia, etc.).

 

In Nova Scotia, instead of a Representation Agreement, individuals use a Personal Directive to appoint someone to make decisions on their behalf if they become incapable.

What Is a Personal Directive?

A Personal Directive (PD) is a legal document that allows you to:
✅ Appoint a Substitute Decision-Maker (SDM) (also called a Delegate) to make personal and health care decisions for you if you are unable to do so.
✅ Outline specific instructions about medical care, end-of-life wishes, and personal care preferences.
✅ Include details about Medical Assistance in Dying (MAiD), though your SDM cannot request MAiD on your behalf.

How Is It Different from a Power of Attorney?

• A Personal Directive covers health and personal care decisions.
• A Power of Attorney (PoA) covers financial and legal matters but does not include health care decisions.

Why Is a Personal Directive Important?

• Ensures your medical and personal care wishes are followed.
• Avoids family conflicts by legally appointing a trusted person to make decisions.
• Helps doctors and caregivers provide care that aligns with your values.

Advance Care Directives & SDM Terminology by Province/Territory

Province/Territory	Advance Care Directive Name	Substitute Decision Maker (SDM) Title
Alberta	Personal Directive	Agent
British Columbia	Advance Directive or Representation Agreement (RA9 for health care decisions)	Representative
Manitoba	Health Care Directive	Proxy
New Brunswick	Advance Health Care Directive	Proxy
Newfoundland & Labrador	Advance Health Care Directive	Substitute Decision Maker (SDM)
Nova Scotia	Personal Directive	Delegate
Ontario	Advance Care Plan (not a legal document, but can be written)	Power of Attorney for Personal Care (PoA-PC)
Prince Edward Island	Health Care Directive	Proxy
Quebec	Advance Medical Directives (AMD)	Mandatary (if part of a Protection Mandate)
Saskatchewan	Health Care Directive	Proxy
Northwest Territories	Personal Directive	Agent
Nunavut	No formal legal directive (Health care decisions default to family hierarchy)	Substitute Decision Maker (SDM)
Yukon	Advance Directive	Proxy

Key Differences Across Provinces

• Some provinces, like BC, allow for Advance Directives, which provide specific instructions but do not appoint an SDM unless a Representation Agreement is in place.
• In Ontario, Advance Care Planning is a process, not a legally binding document, but individuals can appoint a Power of Attorney for Personal Care (PoA-PC).
• Quebec has a unique Advance Medical Directives (AMD) system, which allows individuals to document their treatment preferences for specific situations.

 

Advance Care Directive forms and resources for each Canadian province and territory:

Alberta

• Personal Directive: Alberta Government – Personal Directives

British Columbia

• Advance Directive: Government of British Columbia – Advance Care Planning

Manitoba

• Health Care Directive: Government of Manitoba – Health Care Directives

New Brunswick

• Advance Health Care Directive: Public Legal Education and Information Service of New Brunswick – Advance Health Care Directives

Newfoundland and Labrador

• Advance Health Care Directive: Government of Newfoundland and Labrador – Advance Health Care Directives

Nova Scotia

• Personal Directive: Government of Nova Scotia – Personal Directive

Ontario

• Advance Care Planning: Government of Ontario – Advance Care Planning

Prince Edward Island

• Health Care Directive: Government of Prince Edward Island – Advance Care Planning

Quebec

• Advance Medical Directives: Government of Quebec – Advance Medical Directives

Saskatchewan

• Health Care Directive: Public Legal Education Association of Saskatchewan – Health Care Directives

Northwest Territories

• Personal Directive: Government of Northwest Territories – Personal Directives

Nunavut

• Advance Care Planning: Government of Nunavut – Advance Care Planning

Yukon

• Advance Directive: Government of Yukon – Advance Care Planning

For comprehensive information and resources on Advance Care Planning across Canada, you can also visit the Advance Care Planning Canada website.

Please note that the availability and names of these documents can vary by jurisdiction, and it’s important to use the form specific to your province or territory.

 

Distinction Between Death Midwives and Death Doulas

• Death Midwife: Traditionally, a midwife is a medically trained professional who assists with childbirth. The term “death midwife” has been adopted by some to describe individuals who guide and support the dying and their families through the end-of-life process, including after-death care and home funerals. However, this title implies a level of medical training and professional regulation.
• Death Doula: A death doula, also known as an end-of-life doula, provides non-medical support focusing on the emotional, spiritual, and logistical aspects of dying. Their role is to offer companionship, facilitate discussions about end-of-life wishes, and assist with planning, but they do not perform medical tasks.

Legal Implications in Canada

In Canada, the term “midwife” is a protected title, regulated to ensure that only those with specific medical training and certification can use it. This regulation aims to prevent confusion and protect public safety.

A notable legal case in British Columbia highlights this distinction. A Victoria woman, who had been assisting dying individuals and their families for over four decades, referred to herself as a “death midwife.” The College of Midwives of British Columbia challenged her use of the term, arguing that it could mislead the public into believing she was a registered health professional. The court ruled in favor of the College, prohibiting her from using the title “death midwife”

timescolonist.com

This case underscores the importance of accurate terminology. While the services provided by death doulas and death midwives may overlap, especially in offering support during the dying process, the titles carry different connotations regarding medical training and regulation. In Canada, to avoid legal issues and ensure clarity for those seeking end-of-life support, practitioners are encouraged to use titles that accurately reflect their training and certification.

For those interested in pursuing a role in end-of-life care, it’s advisable to seek appropriate training and use a title that aligns with one’s qualifications and complies with regional regulations.