A growing number of Australians are looking beyond their clinical teams for help in the quest for a good death.

As the challenge of supporting patients and their families grows in an increasingly pressurised health system, non-clinical end-of-life doulas say they can help provide better care for people in their final days.

Doulas have been on the scene for years, but as patient interest increases, the industry is formalising and pushing harder for these kinds of supports to be more formally integrated into hospitals, palliative and aged care settings.

It’s a trend emerging against the backdrop of Australia’s ageing population, which clinicians acknowledge is resulting in more patients with more complex needs at the end of life.

Palliative Care Australia’s most recent workforce survey pointed to the resource challenge, in an environment where the number of deaths is expected to rise by 30% by 2040.

The tough task of helping patients negotiate the emotional aspects of their final days was a key focus at the 2025 COSA meeting last November. Senior staff specialist at Southern Adelaide Palliative Services, Dr Peter Allcroft, highlighted doulas as an emerging profession and the importance of working out how to work with them within the palliative care sector.

“They are growing in number and they are becoming organised and actually become more professional, I see that we should be working in collaboration with them,” he told the event.

But Dr Allcroft also highlighted the difficulties in negotiating this relationship, noting a university-like qualification may become important for integrating these workers in future.

Founder of end-of-life doula training business Preparing the Way, Helen Callanan, said there are four key things her trainers emphasise doulas can’t do.

“We don’t diagnose – that’s the purview of the medical world,” she told the limbic. 

“We don’t recommend starting or stopping treatment. We don’t administer medications. And the biggest piece is we don’t give advice – we explore options.” 

But while medical care is beyond the remit of these workers, Ms Callanan said they occupy one of the only roles that moves with a patient and their family across the many stages of illness and treatment, providing one key support from diagnosis to bereavement.

“Doulas provide authentic continuity of care,” she said.

Palliative care groups also acknowledge the increasing demand for these workers, and provide information to help patients decide who to engage.

“Palliative Care Australia recognises the growing interest in end of life doulas as part of a broader community movement to support compassionate, person-centred care at the end of life,” the organisation’s CEO, Camilla Rowland, told the limbic. 

Formalising the path

There’s no doubt patients are interested in new kinds of support to navigate their final days – the question now is whether doulas can go mainstream.

The lack of a compulsory training or registration process has limited the ways these doulas can be incorporated into healthcare systems, leaving patients to hire these workers privately, even if the rest of their care takes place in the public system.

It’s also difficult to collect national data on how many Australian patients are utilising these services.

While the workers are regulated National Code of Conduct for unregistered health care workers, this has been gradually rolled out across each Australian state.

The industry knows it’s at a turning point, and is moving to formalise training pathways and advocacy in hopes of playing a bigger role in healthcare settings.

Helen Callanan, co-founder of Preparing the Way, designed Australia’s first registered training for end of life doulas.

Ms Callanan was behind the design of the world’s first externally accredited training program, the Certificate IV in End of Life Doula Services, which has been enrolling participants since 2022.

A peak body, Holistic End of Life and Death Care Australia (HELD), has developed a code of conduct for those working in this space and paved the way for lobbying of state and federal governments to recognise doulas as providers within sectors like aged care.

At the 2025 Oceanic Palliative Care conference in Brisbane last May, Ms Callanan and HELD chair Shannon Beresford presented their vision for the future of doula services in Australia, highlighting a successful pilot of doulas undertaken in UK in 2022. 

Ms Callanan told the limbic there was definitely appetite to incorporate these models of care into hospital systems, but acknowledged any public funding would have to set clear parameters. 

“There has to be criteria – they’ve got to be registered and they’ve got to have insurance,” she said.

In the absence of any formal criteria or referral pathways, patients are left to research and engage these workers independently.

“People thinking about engaging a doula can ask about the person’s background, qualifications, the services they offer and any fees,” Palliative Care Australia’s Camilla Rowland said. 

“Each individual doula may offer different supports, and there are currently no formal education or registration requirements for this role.” 

The organisation has compiled a list of questions patients can ask before employing a doula, including requesting a breakdown of costs, availability and their scope of activities [link here].

The minister for health was contacted for comment on the government’s monitoring of end-of-life doulas and whether their role could be better incorporated into health systems across the country.

In a statement, a spokesperson for the Department of Health, Disability and Ageing said the use of end-of-life doulas was a matter for the states.

“This workforce are not registered health professionals. Under the National Health Reform Agreement, state and territory governments are responsible for the provision and delivery of end-of-life care,” they said.

“On this basis, the use of end-of-life doulas is a decision for each jurisdiction.”