Lifespan Doula Association (LDA) has defined a Scope of Practice for End-of-Life Doulas. It is inspired by and adapted from the DONA International scope of practice for birth and postpartum doulas and includes both Standards of Practice and a Code of Conduct. DONA International is the premier professional doula training and certification organization in the world. They were the first to articulate a scope of practice for doulas. All LDA-certified doulas have agreed to abide by the scope of practice.
Benefits of a Defined Scope of Practice
- Creates a framework for transparency regarding the doula’s role that benefits all concerned–the doula, consumers and medical/hospice care providers
- Establishes professional boundaries and expectations
- Encourages consistency in how doulas represent themselves across the doula profession
- Helps to limit liability for the doula
Standards of Practice
The Role of the End-of-Life Doula
- The essence of doula care is to provide non-medical, non-judgmental support and guidance to individuals and families through times of critical, transformative life change.
- Doulas nurture, inform, support, guide, empower and comfort.
- End-of-life doulas work in tandem with other caregivers and members of the hospice team.
- Doulas foster self-determination in their clients by assisting in the gathering of information and encouraging them to make informed choices that are right for them.
- For client needs outside of the doula’s scope of practice, the doula makes referrals to appropriate professionals and community resources.
- Doula support is focused on, and adapted to, the unique needs and requirements of each family served.
Limitations to Practice
- As non-medical care providers, end-of-life doulas do not perform clinical tasks (e.g., monitor vital signs, administer medication).
- The doula refrains from giving medical advice or from persuading clients to follow a specific course of action or treatment.
- The doula refrains from imposing his/her own values and beliefs on the client.
- Doulas do not undermine their clients’ confidence in their caregiver(s). However, in cases where clients are initiating a discussion about a caregiver’s advice or expressing dissatisfaction with a caregiver’s practice or attitudes, the doula uses good listening skills to support clients to consider their options.
- Doulas do not usurp the role of other professionals and caregivers such as the hospice nurse, social worker, chaplain, home health aide, etc.
- Doulas do not facilitate assisted suicide.
Considerations Regarding Multi-Credentialed Doulas
- While understanding that doulas will draw from their full range of knowledge, skills and life experience, it is important to realize that offering enhanced or blended services may send a mixed message to the consumer regarding the role of the doula. The doula cannot, for example, be a non-clinical care provider and simultaneously “prescribe” an herbal regimen or assume responsibility for wound care.
- If a doula wears more than one professional hat and is seeking to leverage a blended skill set (e.g., nurse, social worker, pastor, herbalist, massage therapist) in the course of providing doula services, then she/he is obligated to make her/his additional roles and credentials transparent to the client.
Code of Conduct
Ethical Duty to Clients
- In all professional interactions, the doula demonstrates the highest level of personal integrity by accurately representing her/his level of experience, training and credentials.
- Doulas should establish clear communication with clients, both verbally and in writing, regarding their availability, services included in their care, limitations to services, backup doula policies and fees (including amount charged, retainers, terms of payment and refund policy).
- Doulas have a duty to complete services as promised, according to the terms of the agreement. If the doula is unable to complete services to a family (through personal choice, emergent need or unavoidable conflict), then she/he is obligated to: (1) give the family as much advance notice as possible; (2) help the family get their needs met by activating backup doula support in accordance with her/his stated backup doula policy; and (3) if backup support is unavailable, the doula must refund all client fees paid in advance for services not rendered.
- Volunteer doulas who agree to provide services for no cost or reduced cost have no less of a duty to complete services to the client as agreed.
Duty to Maintain Client Confidentiality
- Doulas promise to maintain absolute confidentiality regarding the client’s personal information, photos and story. If seeking to share client-related information for any purpose, including to publish photographs, or to share the client’s story, the doula must obtain the client’s permission and abide by their wishes.
- The doula’s promise of confidentiality also extends to family members and to other care providers involved in the client’s care.
- When given permission to share personal information, all identifying demographic information should be omitted, unless the client has given express permission to be identified.
- Special care must be taken in the use of social media to protect client confidentiality.
Duty to the Doula Profession
- Each doula represents the doula profession as a whole and carries the duty to do so in a responsible, ethical and professional manner.
- Doulas have a duty to ensure that the information and resources they are sharing with clients are evidence-based and up to date.
- Doulas understand that they are part of a worldwide community of doulas and will treat one another with respect and kindness, regardless of affiliation.