Death Doula

     In the same way midwives and doulas help babies come into the world, I consider it a great honor and privilege to help people die.

     The power of death to positively transform people's lives is one of life's greatest gifts. If you or someone you love is dying, then you may well understand how death can bring whatever is most important to the forefront.

     As Rilke says, “Love and death are the greatest gifts given to us, but mostly they are passed on unopened." When I work with people who are close to death, my goal is to help them open these precious gifts while there is still time.

     As a "death doula" or midwife, I provide personalized, practical levels of emotional and/or spiritual support through the entire dying process. This support can begin at the point of initiation (e.g., diagnosis of a terminal illness or following a trauma that may result in death) and continue through the dying process and beyond, including followup and bereavement work with the person's loved ones.

     My skills as a death doula include individual and family counseling, spiritual counseling, liaison work with hospice and hospital personnel, and help in preparing end-of-life documents. Most importantly, my primary role as a death doula is to be fully present with the person who is dying, up to and through the actual transition into death.

     Whenever possible and with the permission of the dying individual, my work as a death doula can be greatly enhanced through the participation of supportive family and friends. If the dying person is unable to grant this permission directly through conventional modes of communication—as in the case of coma or other mind-altering states of consciousness—I can use nonverbal communication techniques to help the dying person express his or her preferences in more subtle, nonverbal ways (click here for more information).

     Nonverbal communication techniques can also be used to help determine a verbally and/or mentally impaired person's preferences in relation to treatment choices, life support issues, and other important decisions that may or may not have been clearly communicated prior to the onset of the dying process.

     Even when a Health Care Directive and other essential documents are already in place, it can be immensely comforting for family and friends to know what their loved one truly wants in the moment, when death is an imminent possibility, as opposed to a hypothetical consideration.

     I encourage supportive loved ones to be present during my nonverbal communication work with the dying person, so they can see for themselves what the dying person truly wants in whatever ways he or she is still able to communicate.

     For more information about my background and areas of expertise, please click here.

     If you would like my help for yourself or a loved one who is facing death, feel free to email me.

     To assure the fastest response in time-sensitive situations, please also leave a phone message for me—day or night—on my 24-hour confidential voice mail at (206) 329-0125.

     For information about fees, including pro bono arrangements, please click here.


Financial Arrangements

     My fees for end-of-life care services are negotiable on a case-by-case basis. Because this work tends to be time-intensive, I strive to make it affordable for those in need at a time when medical and other caregiving expenses can be daunting.

    For those who are in financial need and/or wish to be part of my post-doctoral field research, my services as a death doula or coma worker are available free of charge (donations accepted). Please let me know when you contact me if you would like to receive my services in this capacity.

     To assure the fastest response in time-sensitive situations, please email me and also leave a phone message—day or night—on my 24-hour confidential voice mail at (206) 329-0125.


Home, Hospice, and Hospital Support

     I am available to serve dying people and their families on site in their homes, in hospice or nursing care facilities, or in hospitals in the Seattle area. In addition to my various roles as described on this page, I am also available to serve as a liaison for individuals and their families in relation to medical or other caregiving professionals.

     To request my support for yourself or a loved one who is facing death, please email me.

     To assure the fastest response in time-sensitive situations, please also leave a phone message for me—day or night—on my 24-hour confidential voice mail at (206) 329-0125.

     For information about fees, including pro bono arrangements, please click here.


End-of-Life Documents

     I teach a three-hour class called "Rest in Peace," which shows people simple and practical ways to prepare their essential end-of-life documents, including a Will, a Health Care Directive, a DPOA for Health Care, a DPOA for Finances, a Disposition Authorization, and other documents specific to a person's unique situation.

     Over many years of research for the class, I developed a "Free Tip Sheet for End-of-Life Care," which synopsizes the information and presents it in an easy-to-follow, do-it-yourself format. To view this Free Tip Sheet, please click here.

     One of the main resources I share in my class is People's Memorial Association, a nonprofit organization founded in 1939, of which I've been a member since 1974. PMA provides Washington residents with dignified, inexpensive cremation and burial services. It also offers education and advocacy services regarding end-of-life care.

     As part of PMA's education outreach, the organization regularly offers an excellent three-hour class called "Got Your Ducks in a Row?" I've taken the class and highly recommend it, especially because PMA offers its class more regularly than I offer mine. For more information about PMA's class about end-of-life care documents, please click here.


Spiritual Counseling

     For many people, death has a way of bringing deeply personal values to the forefront. Whether or not people consider themselves "religious" or "spiritual" may not be as important as getting whatever support they need to resolve unfinished business and make their transition with as much grace as possible.

     As a nonsectarian minister and pastoral counselor since 1985, I'm well-practiced in the art of "holding the space" for candid conversations about any and all life-or-death issues—whether I'm talking with people who are agnostic, atheist, or adherents of a specific religion or spiritual discipline.

     If you'd like spiritual support for yourself or a loved one who is dying, please contact me anytime.

     To assure the fastest response in time-sensitive situations, please also leave a phone message for me—day or night—on my 24-hour confidential voice mail at (206) 329-0125.

     For information about fees, including pro bono arrangements, please click here.


Coma, Critical Care, and Nonverbal Communication

     As noted in the "Death Doula" section above, I can help comatose or otherwise verbally impaired people to convey their needs and wishes nonverbally when they are unable to communicate in more conventional ways.

    When a loved one's regular style of communication is not possible, family members and friends may experience confusion or distress in their attempts to determine what the comatose, critical care, or dying person actually wants and needs. Even in cases where a Health Care Directive is in place, unforeseen situations may arise that require in-the-moment decisions by caregivers.

    For example, a person's designated Health Care Agent (or "Proxy") may not feel comfortable proceeding with the terms of a Health Care Directive once it becomes time to act on its terms. In other cases, people who are comatose or dying may change their minds about what they want, once they encounter situations that were only hypothetical to them before.

     In addition to facilitating nonverbal communication, I also seek to provide an "agenda-free" atmosphere, which can greatly help people respond more honestly about their true wishes. Although legal proxies and physicians are supposed to honor Health Care Directives, it's unrealistic to expect them not to have any degree of personal or professional agenda in these highly charged situations. Of course, the degree to which caregivers are aware of—and responsible about—their agendas varies greatly.

    Caregivers' biases can and sometimes do override a dying person's true wishes—either directly by way of the caregivers' actions, or indirectly, if the dying person feels pressured to respond in a certain way in order to please others.

     For example, physicians may be invested in a dying person's recovery because of their own (the doctors') fear of "failure." Or an exhausted or estranged family member may want to "pull the plug" in order to avoid additional caregiving duties or—as harsh as it sounds—to avoid further expense and/or receive an inheritance sooner than later.

     In the face of difficult decisions at the end of life, my only agenda is to facilitate the expression of an individual's true wishes in current time. Any and all choices are given equal respect—whether a person wants to use extreme measures to stay alive, or cease all medical interventions and let nature take its course, or receive physician aid-in-dying (in states where this is legal).

    In addition to helping with these difficult decisions, I also offer my nonverbal communication skills to dying people who may need help to work through "unfinished business" related to their personal (inner) process and/or their relationships with other people. When someone is comatose or otherwise verbally impaired, others may assume it's not possible for that person to work through and complete unfinished business. However, in most cases, this work is possible with tender patience and the right kind of support.

     For those who are unfamiliar with nonverbal communication, it may be helpful to know that the techniques I utilize are not magical, mystical, or psychic in any way. Rather, they are practical and effective methods of nonverbal communication I have gleaned from numerous disciplines over 30-plus years of personal and professional research. This background includes my longtime practice of Process-oriented coma work principles pioneered by world-renown psychologists Arny and Amy Mindell, authors of Coma: The Dreambody Near Death and Coma: A Healing Journey.

     In my nonverbal communication work with comatose people, I encourage supportive family members and friends to be present, so they can see for themselves what their loved one is expressing. I am also happy to teach people some basic nonverbal communication techniques, so they can experience firsthand a more direct connection with their loved one. This in itself can be enormously comforting for all concerned.

     Once a person's needs and wishes are effectively conveyed and understood by family members and caregivers, my job is over. It is not my intent nor my responsibility to interfere with any medical or legal decisions related to a person's care, although I remain available for counseling or consultation support as needed.

     To request my help with nonverbal communication for a loved one who is comatose or facing death, feel free to contact me via email anytime.

     To assure the fastest response in time-sensitive situations, please also leave a phone message for me—day or night—on my 24-hour confidential voice mail at (206) 329-0125.

     For information about fees, including pro bono arrangements, please click here.

     A personal note: If you'd like to read a personal memoir that includes my nonverbal communication work with my own father before his death in 2004, please click here.


Cat Saunders, Ph.D., is a counselor and consultant, death doula, and nonsectarian minister in private practice in Seattle, Washington. She is the author of Dr. Cat's Helping Handbook (available at Click here to contact Cat or learn more about her work by returning to the home page. To schedule in-person or telephone consultations, please email Cat or call her 24-hour confidential voice mail at (206) 329-0125.