Gemma's first experience with death at the age of 13 was almost traumatic. Not so much due to the loss of her father, but because she couldn't say goodbye to him. "To protect me, I wasn't told he was dying," she recalls. That led her to question the meaning of existence. From then on, her relationship with death changed. She decided not to push it away and became interested in helping others accept when the end comes. "There is so much beauty in death. When we don't deny it and embrace it, an incredible window opens: fear relaxes, and we can live more fully, without deceiving ourselves, without pretending we won't die."
Gemma Polo dedicates herself to "emotionally, physically, and spiritually accompanying" those at the end of their lives and their families, offering support in that process. What she does has a name: death doula. It is not a regulated or formally recognized profession in Spain, but it responds to a growing social demand. More and more people are interested in this figure. Even Nicole Kidman is training as one, motivated by the death of her mother, with whom she realized the importance of having a compassionate person by her side at the end.
The term doula comes from ancient Greek and means "woman who serves." In the 1970s, the concept was revived in the US to refer to women who accompany others during childbirth. Over time, the word expanded to also encompass the end of life. Gemma knows the history well. "Around the 1990s, a birth doula who was getting older realized that death is another door," she explains. From the 2000s, the term was enhanced with the death positive movement, "death in a positive light, not just accompanying but with the aim of transforming how we view death in our society."
The work of a doula depends on each situation and can be before, during, and/or after death. Similarly, costs vary according to the client's needs. "We can provide support by services or by hours. For a one-hour session, we charge between 40 and 70 euros."
They also offer packages for "end-of-life planning." "It includes two sessions, drafting the advance healthcare directive with post-mortem treatment preferences, and planning one's own funeral; it would be around 150 euros." If the deceased's loved ones wish, the support continues after the passing. The service portfolio includes washing and preparing the body, organizing the wake or funeral. "If they want our presence and support, it ranges from 400 to 700 euros."
However, Gemma clarifies that each doula sets their own prices and usually adapts "to the client's economic capabilities." "We are entering nursing homes and hospitals through the people who have trained with us. In those cases, the user is not charged directly, but they apply the wisdom of doulas to their profession."
The doulas do not oppose healthcare services. "We are not against doctors, nurses, or psychologists," clarifies Gemma, a Barcelona native who has been accompanying end-of-life situations for 25 years. "We spend quality time with families... We are a support tool to give meaning to one's life," continues the Catalan doula. They also do preparatory work to ensure "a peaceful death": "For example, working on forgiveness and creating situations for [the person nearing death] to reunite with a long-lost sibling."
Psychologist José González, specialized in grief and recognized nationally and internationally, confirms that the death doula figure responds to a social need. "We live in a death-phobic society that avoids talking about death, medicalizes the end of life, and has expelled the emotional aspect from the process. In this context, figures emerge that seek to restore humanity, ritual, closeness." He considers this latter aspect as "positive." However, he emphasizes the need to "be rigorous": "Accompanying the end of life is not just being there, caring, or listening. It is a space where anticipatory grief, anxiety, fear of death, guilt, family conflicts, even trauma, can arise. And that requires specific, deep, empirically validated training supervised by someone with experience and qualifications."
He does not reject the doulas. On the contrary, he believes they "bring back something we had lost: the human, ritual, and communal dimension of dying." But he points out that the problem arises when they are presented as an alternative to psychological intervention. "Emotionally supporting is not the same as clinical intervention. And at the end of life, often both are necessary. The value lies in well-defined complementarity, not in substitution," he justifies.
For González, the red lines of professional intrusion are in three aspects. First, the complexity of suffering: "When intense symptoms appear (overwhelming anxiety, pathological guilt, trauma, suicidal ideation...), we are in clinical territory." Secondly, the intention of the intervention: "Listening is supporting and is useful in normal grief processes, but intervening in complicated grief requires a deeper specialization." Lastly, the sense of responsibility: "A healthcare professional is ethically responsible for what they do. They have training, supervision, and boundaries."
In Spain, the community of doulas has recently followed the US and started offering training for end-of-life accompaniment. Gemma Polo states that she was the driving force behind the first comprehensive training for death doulas in the country. Thus, in Catalonia, for the past three years, in-person training programs have been offered. The sessions, available in Spanish or Catalan, take place in a nature-surrounded environment. The course price is around 1,490 euros and includes accommodation, meals, and access to online training material.
It also includes practical training. For this, they have an alliance with the Costa Brava Hospice foundation —which offers "help and support to people in their end-of-life process"— so that their students can do "volunteer work." At the end of the activities, Gemma and her co-facilitator Sophia Style issue a certification that is not officially recognized. Something they do not rule out happening in the future: "In the US, they are working to standardize training hours, to have it recognized as a profession, but they are 30 years ahead of us in this matter," Gemma points out. Upon completion, there is the option to join a directory where people can request the services of a doula.
"Doctors, teachers, psychologists sign up..."
The profile of those who enroll in the program is very diverse. "It is very interesting because doctors, nurses, psychologists, school teachers, people who work in elderly care facilities," and in general, "people who simply want to do it for personal growth" sign up. Gemma details that in three years, they have trained 250 people, mostly women. However, men are also welcome to participate. In fact, 15 have attended the workshops.
The training is proving successful. A new edition with full slots starts this week. "It's really crazy," confirms Gemma. "I started by organizing weekend retreats, called Embracing Death, Celebrating Life, as an experiential journey with no formal training aspect... Now we offer six training sessions a year, we can't take on more."
The training program is proving successful. This week, a new edition begins with all places filled. "It's truly crazy," confirms Gemma. "I started by offering weekend retreats called 'Embracing Death, Celebrating Life,' as an experiential journey with no formal training component... Now we're offering six courses a year; we simply can't take on more."
"The training has been very beneficial for me," affirms Teresa Benítez, a nursing assistant and former student of Gemma's. She decided to join the program because of her experience observing how death was handled in the nursing homes and hospitals where she worked. "I saw a void, a very cold approach. This training allows you to see that process differently, to help make that journey a little more humane... Not only caring for the body but also caring for the emotional aspect."
"The way people die changes"
Now Teresa puts what she's learned into practice working as a death doula in the private sector. Specifically, she's accompanying a 98-year-old. She's with her 24 hours a day, six days a week. She says she charges between 1,100 and 1,200 euros a month for this service. "I act as a bridge between the family, the patient, and the PADES service (Home Care and Support Teams Program)... Many times, it's not about doing anything, but simply being present." Teresa says she's witnessed the difference between when someone dies with the assistance of a doula and when they don't. "The way they die changes; the person surrenders, lets go, and it's like falling asleep. The family also accepts it, learns to let go, and saves themselves a lot of pain."
Psychologist González warns of the risks of people without medical training intervening in the care of terminally ill patients and their families. Among these risks, he mentions emotional iatrogenesis—"wanting to help and causing more harm"—and failing to detect warning signs, "such as depression, suicidal risk, complicated trauma." "Accompanying grief without the necessary tools is like entering an operating room without training: the intention may be good, but the risk is high," she warns. "Complementary support, well-defined and coordinated with professional teams, is something else entirely." Along these lines, Gemma maintains that end-of-life doulas are there to support healthcare teams.
González, in his book *Sadness Heals*, which will be released next month, reflects on what end-of-life support should look like. "In a society that avoids death and numbs unpleasant emotions, accompanying grief requires more than good intentions. It requires a clear clinical approach, concrete tools, and, above all, the ability to maintain a safe space where grief can unfold without being corrected or accelerated," he explains. For him, the essential element in this work is "knowing how to be present without intruding, to support without saving, and to accompany without directing. The end of life doesn't need grand speeches: it needs presence, honesty, and permission to feel." These qualities, according to the doulas, are also part of their approach.