Doula: Old and New

I recently had the privilege of being interviewed about my work as an end of life doula. In our discussion I thought about the origin of the word “doula” and the way in which caring for someone at death is both similar and different today than it was even just a few decades ago.

As someone that uses the title “doula” I think it’s important to remember that in the original Greek “doula” meant “female slave.” Many people use the word servant, but although slavery in Ancient Greece was markedly different from chattel slavery, it still denotes a woman who was brought into a family to serve a role. It is most likely she could not choose which family she worked for, nor when her time of service with a particular family was over. Or, even perhaps, when her time of service itself was over.

So that’s an important difference and one that should not be forgotten: the modern doula chooses their work, their clients, their terms of service, and time of service.

At some point in time the family caregiver subsumed the role of doula. While there may have midwives who assisted birthing women and their female relatives, or people who dressed the dead, tending to the dying was the responsibility of the family.

The service we choose to provide as modern doulas- personal, emotional, spiritual, and practical support to someone who is dying and their loved ones would probably baffle family caregivers even just two generations ago.

While it was common for a family to care for their dying loved ones, the concepts of personal dignity, autonomy, and spirituality were not. Practical care was centered on tending to physical discomfort. Any spiritual needs in the hands of trained spiritual advisors (or dictated in the Ars moriendi). Personal and emotional support varied from family to family.

Today we recognize, almost to a fault (but that’s for another post), the value of independence and the very personal definition of suffering that goes beyond physical discomfort. It’s not that physical discomfort is not important or that trained spiritual advisors don’t have a place, it’s that both of those things are part of a larger whole when it comes to tending someone who is dying.

It’s become quite common for women to have a birth plan, but for all the talk of advance care planning it’s still rare for someone to have a death plan. And yet, we recognize a person’s right to make their own decisions about their dying, create meaningful rituals for dying and after death, and define dignity and suffering for themselves.

And that’s why I feel as though it is much easier to be of service as an end of life doula to someone who has done work to come into relationship with their own mortality and thought about how they as an individual need to be supported through their unique dying process.

I guess that means as a modern doula I am also hoping for modern patients.


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