This is the second in our four-part series on Death, Dying and Grief.

The United States has a fascinating—some might say “distant”—relationship with death. Yet, while some find the subject uncomfortable, a growing number of people are now planning for their end of life. A 2013 Pew Research Center report found that while one-sixth of adults documented their wishes for end-of-life decisions in 1990, a full third of U.S. adults had done so in 2025.

Hand in hand with that statistic, many look for professionals to help them die with grace and dignity and without regrets. Enter the death doulas and conscious dying coaches—professionals trained to help people better prepare for and navigate the often complicated, painful and spiritually challenging task of dying. The work of the two professions overlaps in several areas, as each offers companionship for the final journey.

Death Doulas

Pamela Carter

“End-of-life” or “death” doulas often provide holistic, hands-on support for someone who is dying or who has received a terminal diagnosis. Pamela Carter, the executive director of the International Doula Life Movement from 2020 to 2025, has more than 45 years of experience as a death doula. She’s often engaged either by someone who is dying or a family member a month or two before their passing, and she is often in the room at the time of passing as well. For her, the work is about helping someone with their spiritual preparation and their connection to those around them.

“You have to plan for your end of life, and in planning … you talk about what is important to you, not just medically, but spiritually and emotionally. Who do you want with you when you die?” says Carter.

She also helps the family navigate the complicated U.S. health care industry. The U.S. Centers for Medicare & Medicaid Services spent $23.9 billion for hospice care in 2022, according to their reporting, a figure that is expected to more than double by 2032. For families with a loved one nearing the end of life, navigating this system can be especially stressful, and it can help to have a knowledgeable and empathetic guide to turn to.

Carter describes the role of the doula to be an advocate for the dying first and foremost. “My sole purpose is to make sure that they are getting what they want [and] that they are being treated ... the way they would choose to be treated,” she says.

“I do it all,” she says. “When I arrive, the families ask me, ‘What are you going to do?’ And I say to them, ‘Tell me what you need.’”

Conscious Dying Coaches

Susan Patterson 

(Photo: Robert Patterson)

Conscious dying coaches, on the other hand, frequently focus on spiritual preparation and reconciliation before death is imminent, often working with clients who haven’t received a terminal diagnosis. Susan Patterson, a conscious dying coach and the founder of Gifts from the End Coaching in Atlanta, runs preparatory discussion groups for people interested in discussing and preparing for their eventual end.

“I’ve had people from their 30s to their 80s participating in these programs,” said Patterson. “I think there are seasons in life when we feel compelled to ask ourselves big questions, some of which are spawned by things that are happening in our lives.”

Patterson said that one of her group participants is a woman in her early 30s who recently became a mother. Her newfound responsibility brought new anxieties about death, along with questions about what would happen to her newborn child should she pass. Another woman who was much older began attending the group when her husband received a terminal diagnosis.

Patterson offers a course in which she uses rituals and reflections to help participants examine their lives through the lens of their own mortality. This preparatory model comes from the Conscious Dying Institute, an organization that trains coaches. Their practice, “The Art of Conscious Dying,” guides people to prioritize what matters most if they had only three days or three months to live and covers topics around emotional and spiritual well-being as well as legacy wishes.

One of the practices in Patterson’s course includes a shared ceramic bowl placed in the center of a discussion circle. “It becomes a focal point ... to speak to the bowl. If you’re feeling really tender about sharing things ... you can offer it to the bowl, and the bowl will hold it,” Patterson explains.

According to Patterson, this preparatory work has become very important for Americans because over the past hundred years, the death experience has shifted from a “family event” to one overseen by medical institutions. While she clarifies that modern medical advancements are absolutely beneficial, they have made many Americans view death as a purely medical issue and something to be simply handed over to doctors and hospices.

“When is it not a medical issue anymore? And when is it more of a psycho-spiritual event of realizing that this body is not going to be cured? That’s the part that’s really hard for us now,” says Patterson. And that is one of the parts coaches and doulas work to make easier.

Spirituality and Dying Without Regret

Doulas and coaches can provide two types of service: practical and spiritual. Carter estimates that 85 percent of her work is spiritual, often involving helping individuals reframe their life narratives as they approach death. A large part of the process involves addressing the regrets of the dying and helping them recognize their own value. This often involves sitting with clients and providing space for them to disclose deep regrets that have weighed on them for many years.

The following are the other three articles in our series on Death, Dying and Grief.

Aromatherapy and the Sacredness of Death & Dying

Death, but make it sacred? 🌿 Discover how scent, touch, and simple rituals can ease fear, support the soul, and transform the final moments into something deeply peaceful. Read More » 

The Other Side of Grief

What if grief isn’t something to “get over”? This powerful piece reframes loss as a lifelong relationship—one that can deepen meaning, connection, and even joy. Read More » 

Sadhguru: On Death and Dying

Sadhguru is an Indian yogi/mystic who founded the Isha Foundation, which is dedicated to human well-being through yoga, education and environmental initiatives. Read More » 

She recalls one client—a mother who always wanted to travel the world, but never did. “I drew the conversation back to the successes they’ve had in [their lives],” she says. She helped them realize that traveling was ultimately less important and fulfilling than building their life with their family. “That’s something they held on to, but they lost sight of the fact that what they have done has been tremendous.”

In another instance, Carter recalls a man dying of pancreatic cancer who asked her, “Pam, do you think God’s through with me?” In response, she reframed his journey as a transition. “No, God’s never through with us. You may have completed your journey here, but your journey is not over,” she told him. After their conversation, he said, “I’ve never thought of it this way... I think I’m looking forward to dying now.”

A Family Affair

The work with the dying often involves helping them forge new ground in their relationships with their families. Carter recounts working with a veteran in his 80s who kept his background as an interpreter in the army who helped people escape the Iron Curtain a secret, feeling they wouldn’t be interested. But upon learning his history, Carter encouraged the man to share his medals and stories with his sons, both of whom were in the military. “Seeing their reception of taking [the medals] from him, the pride that they had in that—he would have missed that totally,” notes Carter.


Help with forgiveness also plays a big role in a doula’s spiritual work. “When people talk about forgiveness, they fail to recognize that the person you have to forgive is yourself ... I have to forgive myself ... in order to free myself of that hurt,” Carter explains. It might mean forgiving oneself for certain actions or behaviors that affected their families, or it might have to do with failing to accomplish goals they held dear. While reconciliation is nice, it is often out of the control of the dying, as the other party might not be ready, able or present for it.

Unfortunately, Carter says that some family members don’t prioritize the dying person’s emotional well-being, and she often has to help family members navigate difficult or emotionally taxing conversations. In one instance, she shepherded a young heiress from the room when the heiress repeatedly, and within earshot of the dying, asked how much money they would receive in the will.

By spending time working on their relationships with their family members, doulas and coaches are not only able to help clients die with more peace, they can leave families with a greater sense of connection and appreciation for their departed.

The Practical Scaffolding

Terron Estes

While her spiritual work is often the reason people hire Carter, what she offers also comes within a framework of practical support. When people call her, they’ve often been overwhelmed after receiving a list of hospice providers and specialists, and one of the first things they tell her is, “I don’t know what to do.” An experienced doula can help them make sense of their options from a practical perspective.

“A lot of people are the sole caregivers for a family member … and they get really exhausted,” says Tarron Estes, a conscious dying coach and founder of the Conscious Dying Institute in Boulder, Colorado. “A lot of people go through struggles with family members who are divided on … their agreement around what to do with their family member’s finances or … where they’re going to live out their lives,” says Estes. “They have trouble making decisions around that, and often the family members get really frustrated with each other and need coaching and counseling around that.”

Estes insists on correcting the misconception that doulas and coaches are involved with the drafting or distribution of the will. In fact, they are not. However, discussions with a coach can include topics such as funeral arrangements and different methods of laying a body to rest.

Creating a “healing environment” is another practical yet spiritually significant intervention. “We can help them bring pictures of their loved ones into the room ... helping them just put [essential oils] on their forehead ... bringing the music in that they love,” Estes says. This helps shift what can be a clinical or overwhelming space into something that can facilitate spiritual growth and connection at the end of one’s life.

Perhaps one of the most valuable practical supports is simply the doula’s presence as they fill in gaps in care. Some doulas can stay overnight when family members are exhausted or mediate difficult family dynamics at the bedside—although this is entirely dependent on one’s relationship with their doula.

Estes says that the practical considerations are often, on the surface, why she is hired, while the deeper reasons are often spiritual. Decisions that seem practical—like what hospice service they want to use—can quickly lead to emotional and spiritual deliberations about end-of-life wishes and debates around length of life versus quality. And these are what coaches and doulas are trained to facilitate and guide.

Enabling a Peaceful Letting Go

Ultimately, whether in the preparatory phase, a practical planning session, or the final vigil, the work of doulas and conscious dying coaches converges on a single purpose: enabling individuals to die with a sense of peace and completion.

“Our job as an end-of-life doula is to be able to answer the questions that most people have no idea [how to answer],” says Carter.

However, Patterson makes it clear that life, in many ways, is the most important part of death. When asked what a good death looks like, she had this to say:

“I’m not totally in favor of the term “a good death” … I think I’m going to get what I get, so I don’t want to impose expectations on what I’m going to get when I die. However, I think that my willingness to engage myself—to deeply think about the fact that I am going to die—enables me to release the hard grip on life that’s easy to have, and so I think it enables me to live in a more compassionate way … I think the things that I’m learning about how to live my life are going to serve me as I’m dying, I feel a real connection with other people, not just those that I love, but perfect strangers that I didn’t feel before.”

If we can be honest with ourselves and genuinely connect to those around us in life, says Patterson, then perhaps, just as Carter’s client was able to do, we, too, can one day look forward to dying. ❧

Noah Chen is a writer and journalist who covers health, culture and media. He splits his time between New York City and Atlanta. He’s probably working out of a coffee shop right now.