Thanadoulas are changing the way we approach end of life

“I’m in my garage, sorry!” Cynthia says as our video call begins. There is nothing to apologize for. Behind her, an entire wall is filled with artfully arranged dried flowers in vases of all shapes and sizes.

“Crafting, walking in the woods, spending time in nature, that’s what restores me,” she says. “I gather flowers all year long. Even in winter, you can find the most beautiful weeds.”

It makes sense that she speaks about reconnecting with nature and noticing everyday beauty. Cynthia works alongside grief, illness, and death. She accompanies people at the end of life, but that is only part of her work. Her calling is to support life’s major transitions: pregnancy, birth, end of life, death, and grief. Cynthia J. Brunelle is a doula and, more specifically, a thanadoula.

Supporting life’s most profound transitions

Historically, the word doula referred to a woman in the community who supported others through significant life passages. The word thanadoula combines Thanatos, the Greek god of death, and doula.

“In my practice, I use ‘thanadoula’ when I’m offering end-of-life services and ‘doula’ for birth and perinatal care. It helps me keep the two roles distinct. Some people simply say ‘end-of-life doula.’”

Her services are available to the person who is dying, their loved ones, or both. She provides emotional support, compassionate listening, and respite care before death, during the final stage of life, and after, depending on what is needed.

The situations she encounters vary widely. Some involve medical assistance in dying. Others center on grief support, legacy planning, or navigating estate matters.

“There can be family conflicts. Old wounds that were never healed. Deeply different beliefs within the same family. And medical assistance in dying is often at the heart of those tensions. A thanadoula has to hold space for all of that.”

For some exhausted caregivers, what they need most is a break. Cynthia stays with the person at home so the caregiver can rest. Others need emotional support to talk through their fears or to begin preparing for what comes next.

End-of-life planning is another important aspect of her work. Do I want to die at home? What happens if I am sedated in the hospital? How much pain am I willing to tolerate? Do I want to remain conscious until the very end?

“My role is not to handle legal paperwork,” she explains. “It’s to remind people of what needs attention, offer resources, and refer them to the right professionals.”

Caregivers are never an afterthought

“I can still name every caregiver in the families I’ve supported. That connection stays with me. It’s incredibly meaningful.”

From the first meeting, caregivers are included in the process. Cynthia typically begins by spending time with both the caregiver and the person who is ill. If the person nearing the end of life wishes to continue on their own and is able to do so, Cynthia works one-on-one with them while staying in touch with the family.

Often, caregivers need just as much support as the person who is dying.

“There have been times when I supported a caregiver for months and never actually met the person at the end of life. The caregiver needed space to breathe, practical tools, and someone who would truly listen.”

Thanadoulas can also help facilitate difficult conversations. They act as neutral third parties when tensions run high. They can explain medical terminology in everyday language.

“At its core, this work is emotional support. People need to feel heard by someone who isn’t directly involved.”

Leaving something behind: the emotional legacy

One aspect of her work often sparks curiosity: the emotional legacy.

“It’s what remains after someone dies,” she explains. “Handwritten letters. Videos. Photo collections. Recipes. Stories. Pieces of a life.”

Conversations tend to unfold naturally in her presence. Trust builds quickly.

Cynthia also offers life reviews in the form of a written biography. The person shares their story with her, and she crafts it into a narrative that is later given to the family.

“It gives people the chance to complete one last meaningful project,” she says. “It reminds them that they are still very much alive. In palliative care, visitors sometimes arrive already in tears, as if the person were gone. Writing their story brings them back into the present. It reconnects them to who they are.”

Cynthia, who is also an instructor and director of the Faculty of End of Life at École Cybèle, is careful to clarify that thanadoulas are not psychologists. Their work does not replace therapy or mental health services. Instead, they occupy a unique middle ground. They are not family members, and they are not part of the medical team.

A thanadoula is accessible. Conversations feel natural.

“My role is to be present,” she says. “I welcome whatever needs to be said. I speak in the language of slowness. There’s no rush. Let’s come back to this. Let’s stay here, in this moment. It’s about gentleness.”

A career change rooted in personal experience

“In 2015, my grandmother passed away, and my mother was diagnosed with cancer. She was ill for four years. My sister, my father, and I were there the whole time. Then she spent three months in palliative care. I fell in love with that environment.”

At the time, Cynthia had been working in automotive parts management for nearly ten years. After her mother’s death, she began to reassess everything.

“It was an incredible gift,” she says. “To choose myself. To put my life back into perspective. To give myself permission to pursue what I truly wanted.”

She began training in 2020. At that time, only one school in Quebec offered end-of-life doula training, along with another at Douglas College in British Columbia.

“I completed both programs and joined the End-of-Life Doula Association of Canada. Since then, the field has grown tremendously. There are now several training options.”

A profession still finding its place

As our conversation comes to an end, a few questions linger. How do caregivers find thanadoulas? Are they recognized within the public health system?

Recognition varies depending on the region.

“There’s no professional order governing our work. Occasionally a nurse will refer someone to us, but it’s still rare. This profession is very much emerging.”

She draws a parallel with birth doulas.

“There was hesitation at first there, too. Now they’re widely accepted. I truly believe that in 15 or 20 years, thanadoulas will be recognized in the same way.”

In Quebec, RITMA includes accompaniment and support professions under its umbrella and provides a code of ethics and training standards. Some end-of-life support services may be eligible for reimbursement through certain group insurance plans.

Before we end the call, one final message for caregivers.

“Even if you feel like you’re managing, prepare ahead of time,” she says gently. “Identify resources before you’re in crisis mode. You don’t have to reach out right away. But know what’s available. Think of it as a small safety net you put in place for yourself.”

Many thanks to Cynthia J. Brunelle for this thoughtful and compassionate conversation. Since 2022, she has served as Vice President of the End-of-Life Doula Association of Canada (EOLDAC).