By Adrian Molina
What does it mean to be truly seen at the end of life?
As a gay man and end-of-life doula, I’ve spent much of my life thinking about visibility, belonging, and safety. But those questions become even more urgent when someone is approaching the end of life:
- Will I be seen for who I am?
- Will my partner or chosen family be recognized?
- Will I be treated with dignity and respect?
For many LGBTQ+ older adults, these are not abstract concerns, they are lived realities shaped by a lifetime of discrimination, resilience, and advocacy.
That’s why participating in the SAGE and INELDA LGBTQ+ Inclusive Death Care Training was so meaningful to me, not just professionally, but personally.
Why LGBTQ+ Inclusive End-of-Life Training Matters
As someone working in hospice care, end-of-life doula services, and caregiver support, I believe education is one of the most powerful tools we have.
Through my work with patients and communities, I’ve seen how culturally competent care for LGBTQ+ individuals can transform the end-of-life experience for both the individual and their loved ones.
This training deepened my understanding of:
- LGBTQ+ aging and healthcare disparities
- Inclusive communication and identity recognition
- The role of doulas in affirming care environments
- How historical trauma impacts end-of-life decisions
Even today, many LGBTQ+ people still worry they will need to fight to be recognized even in their final days.
Understanding LGBTQ+ Identity Through a Lens of Humility
I was born in Buenos Aires, Argentina, at a time when conversations about:
- Sexual orientation
- Gender identity
- HIV/AIDS
- Mental health
were rarely discussed openly.
Like many in the LGBTQ+ community, I grew up navigating a world that often-assumed heterosexuality as the norm.
What surprised me most about this training was realizing that even within a community I belong to; I still have more to learn.
In particular, I gained deeper insight into the lived experiences of:
- Transgender individuals
- Nonbinary people
- Gender-diverse older adults
This reinforced an important truth: cultural competency is ongoing work, not a one-time achievement.
LGBTQ+ History and Its Impact on End-of-Life Care
One of the most powerful parts of the training was exploring the intersection of LGBTQ+ history and the evolution of hospice and palliative care.
These movements share a common thread:
Both challenged systems that overlooked human dignity
Both advocated for compassionate, person-centered care
Understanding this history helps explain why many LGBTQ+ older adults may:
- Hesitate to disclose their identity
- Fear discrimination in long-term care
- Distrust healthcare systems
- Worry about being misgendered or ignored
For many, this distrust is deeply personal, shaped by experiences such as:
- Family rejection
- Housing or employment discrimination
- Stigma during the HIV/AIDS epidemic
- Negative healthcare interactions
This context is essential for anyone providing end-of-life care, hospice services, or senior living support.
The Role of End-of-Life Doulas in LGBTQ+ Inclusive Care
For those unfamiliar, end-of-life doulas provide non-medical support to individuals and their care networks.
We help with:
- Navigating difficult conversations
- Clarifying values and end-of-life wishes
- Supporting emotional and spiritual needs
- Creating space for reflection and connection
In LGBTQ+ affirming care, doulas also play a critical role in:
- Advocating for identity recognition
- Supporting chosen family structures
- Ensuring inclusive communication
- Building trust in care environments
We don’t replace medical providers we enhance care by centering humanity.
Why Inclusive Language in Healthcare Matters
One of the most actionable takeaways from this training is simple:
Language matters.
Using the correct:
- Name
- Pronouns
- Terms for relationships
can immediately communicate respect and safety.
For LGBTQ+ older adults, these are not small details, they are foundational to dignity.
In contrast, incorrect language can:
- Reinforce stigma
- Create emotional distress
- Lead individuals to withdraw or hide their identity
In healthcare and end-of-life care, inclusive language is a core competency, not an optional skill.
Meeting LGBTQ+ Individuals Where They Are
At its core, person-centered care means meeting people exactly where they are.
In end-of-life work, this includes recognizing that each person’s story is shaped by:
- Identity
- Relationships
- Trauma and resilience
- Cultural and societal experiences
Some individuals may carry:
- Experiences of rejection
- Complicated family dynamics
- Distrust of institutions
- Deep resilience and pride
Our role is not to define those stories, but to create space where they can be honored.
Building Truly Inclusive End-of-Life Care Systems
This training reinforced a powerful idea:
Inclusion is not a destination, it’s a practice.
Providing LGBTQ+ inclusive healthcare and end-of-life care requires ongoing commitment:
- Learning LGBTQ+ history and lived experiences
- Challenging personal assumptions
- Practicing inclusive communication
- Creating affirming environments
- Listening with humility
For professionals in:
- Hospice and palliative care
- Senior living and long-term care
- Home care and caregiving
- Healthcare systems
This work is essential, not optional.
Everyone Deserves Dignity at the End of Life
If there’s one takeaway from this experience, it’s this:
Good intentions are not enough.
Education, awareness, and action are required.
Everyone, regardless of sexual orientation or gender identity, deserves:
- Respect
- Recognition
- Compassion
- Dignity
At the end of life, no one should question whether they will be seen.
Because in the end, being seen is part of being human.
About the Author
Adrian Molina is a writer, trauma-informed coach, yoga teacher, and end-of-life doula based in Miami Beach. With over 20 years of experience supporting trauma-affected communities, including work in hospitals, shelters, prisons, and hospice, his work is rooted in both lived experience and professional practice. Originally from Buenos Aires, he began teaching yoga in New York City before expanding into trauma recovery and end-of-life care.
