Many of my subscribers (via Instagram and e-mail) know that I refer to myself as a Buddhist EOL (end-of-life) caregiver, and I wouldn’t be surprised if you either wonder ‘wtf does Buddhism have to do with EOL care” or “what does an EOL caregiver do anyway?” To be specific, I am a Buddhist chaplain, although I often hesitate to use the term ‘chaplain’ without context because the term  often carries a lot of baggage for people who associate chaplaincy with Evangelical Christianity. 

Both death doulas and chaplains provide emotional, mental, and spiritual support to people going through one of life’s biggest transitions: Death. The way that we go about supporting people through those transitions, and the economic and legal context in which we are able to do it, depends on our background and training.

In this blog post, I will discuss the difference between chaplains and death doulas so that you can make a more informed decision for either your own training or for employment. At the end of the article, I discuss ways that chaplaincy training is beneficial to ALL organizations outside of end-of-life care.

1. Education and Training

One of the major differences between death doula and chaplaincy training is education. You can complete training as a death doula in four to twelve weeks.

Chaplains spend two to three years in graduate school as a part of their training. The type of graduate school a chaplain chooses depends on how they want to relate to their own emotional and spiritual transformation, as well as others’. Most chaplains attend either divinity school or seminary. Divinity schools tend to be more academic in their approach since they are often a part of larger academic institutions, while seminaries tend to function independently and are generally denomination specific (with a handful of exceptions). A third, less common path–one that I personally opted for as it ultimately resulted in less debt and frustration for me–is to complete an M.A. in Religious Studies or similar and attend a chaplaincy training program recognized by the APC, which certifies chaplains. I would say that my Buddhist Chaplaincy training felt more akin to seminary, whereas my M.A. was grounded in deep philosophical inquiry and academic rigor.

After completing their graduate education, chaplains are required to complete four units of Clinical Pastoral Education, each including 300 hours of clinical work (i.e. 1200 hours total). The clinical hours are separate from the group and supervisor hours.

People can either pay to take individual units of CPE (common for people who are completing CPE while working another job) or complete a one-year paid residency, which is what I did. CPE provides an opportunity for chaplains to put theory into practice under the guidance of a clinical supervisor and in the community with a group of peers who provide support and feedback. A key method within CPE training is the “action-reflection-action” model, in which chaplains serve a given community and write very detailed case studies to present to their group for feedback throughout each unit. The supervisor and the group provide feedback on what the chaplain did well, and what can improve, so that the chaplain can go into new situations with more awareness. The case studies also invite the chaplain to explore what was happening for them during an interaction in order to delve more deeply into how personal experience subconsciously informs action. CPE is a time of personal transformation where chaplains explore the theological/existential questions that brought them to this work while healing their own spiritual trauma–an extremely important but often undervalued aspect of our training, given that our personal transformation is ultimately the tool with which we transform the people and institutions we serve. The CPE process also involves many required projects and one-on-one discussions with a CPE supervisor.

As a Black woman who has taken the chaplaincy route, I can attest that there is a lot of Eurocentrism within CPE training, and both the academy and CPE training can be oppressively male- and Christian-centric. Still, I took this route so that I would have the flexibility to enter into institutions where PoC, LGBTQ+ folks, poor people, etc. were being systematically harmed without having an internal advocate who could support them. Though death doulas provide much of the same support and guidance to individuals and families, they do not have the same level of mobility within institutions, which limits access to economic and social resources needed for effecting change within institutions.

2. Certification

Death doulas have been around for a very, very long time. However, training and recognition are recently gaining popularity in the U.S. The death doula industry is highly unregulated, which is both a pro and a con. On one hand, it removes barriers to diverse, accessible care. On the other, it makes it more difficult to create a standard of care that holds practitioners accountable for their actions, even those done with the best intentions. Certification is recommended for a death doula, and INELDA requires around 36 hours of practice in order to become certified. Most death doulas function as independent contractors without certification since INELDA was only founded in 2016 and certification is not required.

Chaplains must complete graduate school and Clinical Pastoral Education (which includes 1200 hours of clinical training, not including group process, papers and projects, and one-on-one as a part of CPE) in order to be eligible to apply for Board Certification. Board Certification also requires attestation from an ordained minister in one’s denomination, and the process takes six months to a year and involves many written essays covering core competencies paired with interviews by a panelist of reviewers to determine one’s ability to take on the chaplain role (ethically and spiritually).

3. Accountability and Support

Chaplains are required to receive denominational support from their community in order to serve within an institution. This can be a non-denominational community, Buddhist, Quaker, Sikh, Ba’hai–you name it. This is why I call myself a “Buddhist end-of-life caregiver” or “Buddhist chaplain.” My endorsement (lay ordination) is through a Soto Zen sangha. I, personally know chaplains from all of the aforementioned backgrounds. The idea is that some community needs to be willing to take responsibility for you, and your actions, when you’re doing this work. Without denominational endorsement, a chaplain cannot serve within an institution.

Of course, the denominational endorsement method has its issues as well. As in other areas of society, men and white folks often have an easier time and are required to jump through fewer hoops when securing endorsement, and are given a wider latitude by authority figures for misbehavior or slow improvement.

Death doulas often rely on communities to keep them accountable (word of mouth, reviews, etc). I respect the attempt to decentralize power by using this community accountability model, even if there are pitfalls. If someone is doing harm without an organization to hold them accountable, it is difficult to prevent that person from continuing to inflict harm: the person can simply move to a different organization or city and continue the behavior. The certification process for chaplains involves a certain amount of external accountability in order to be able to serve. Not only must one complete graduate school and receive endorsements from one’s CPE supervisors, but one must receive denominational support before even undergoing the board certification process.

4. Ways of Making Meaning

The final major difference between death doulas and chaplains is how they make meaning of a person’s experience of sickness, death, and dying. For chaplains, this is not only shaped by their own religious tradition but the extensive religious and philosophical studies completed during graduate school, where they not only explored their own belief system more fully but also encountered how other religions and societies make sense of these traditions. As mentioned previously, this multi-tradition function is more often encouraged in Divinity School compared to Seminary. This, paired with CPE, should allow for a richness in insight and experience. To be clear, chaplains should not push a particular spiritual/religious practice, and BCCs (Board Certified Chaplains) are trained to function within multi-religious/spiritual contexts: the spiritual background is merely a lens through which the chaplain can engage themselves and those for whom they provide support.

Death doulas have more flexibility with the way they understand and practice meaning, often drawing upon their own experience/unique practices. Both doulas and chaplains recognize the importance of personal transformation and practice in doing this work, but chaplains are required to undergo much more exploration as a part of their training in order to minimize unintended harm (for example, conflating another person’s pain with our own).

Unfortunately, chaplains often get a bad rep due to evangelizing. This frequently happens when institutions hire chaplains who have not completed proper training. Despite the aforementioned standards, some hospices and hospitals look to save money by hiring chaplains as contractors as opposed to employees. Furthermore, they often attempt to underpay for these positions, and chaplains who have undergone extensive education and training understandably search for better-paying positions. When organizations cut corners by hiring folks who are neither board certified nor board certification eligible, they often choose clergy who have served within their community for 10+ years as both chaplain and clergy without any standard chaplaincy training; they substitute experience for training and education without assessing the quality of that experience. This is especially common in smaller towns where local clergy volunteer their services as chaplains. Congregational training and chaplaincy training are quite different, even if there is overlap.

5. Career

Chaplains have more readily available career paths via hospitals, hospices, corporations, military, etc. Admittedly, these organizations are also steeped in the sexist/Eurocentric standard I mentioned earlier. Medical institutions respect degrees from universities which are filled with internal barriers that place burdens on WoC, LGBTQ+ people, etc.

I believe that the training/route of becoming a death doula is intended to remove these barriers so that more marginalized people can occupy these positions. By removing barriers, people in the midst of transition have access to an end-of-life caregiver who reflects their lived experience. However, many death doulas have to tug on their entrepreneurial skills in order to make a living with the work unless it is paired with some other training/degree (e.g. social work) since death doulas frequently work as independent contractors, and must adjust their prices to match the income of the individuals they’re serving.

As I mentioned, I chose the chaplaincy route to be able to serve marginalized people within institutions. Still, it is difficult, as a marginalized person, to serve other marginalized people amidst their suffering while also navigating trauma inflicted against LGBTQ people and WoC by organizations.

Many companies and organizations do not take spiritual and emotional well-being seriously, in the same way, that social workers are not respected within the healthcare system. This results in companies essentially shifting the responsibility of providing sufficient care onto the patients and families they are serving; families and patients either make do with subpar care, go without getting their needs met, or pay out of pocket for a death doula who meets their needs (after extensive research/back-and-forth).

Conclusion

Death doulas make end-of-life care training and service accessible to underrepresented communities. The difference in in-depth training, supervision, and accountability can present downstream obstacles.

Chaplains are not merely trained to navigate death and dying. Our training around death, dying, and grief is invaluable because we bring unique insight into relationships, career, and personal dynamics, particularly as this relates to someone’s emotional and spiritual growth. Chaplains spend 80% of the job supporting the living as they struggle to heal, make meaning, and define purpose. This includes the family members and friends of someone who is sick and/or dying as well as staff within an organization. These same skills/training can be used in the absence of sickness, death, or dying to support those who are well and living in building a life of meaning.