With the character Teresa McNair, Berg introduces a modern approach to mortality that is rooted in the “death positivity” movement, a cultural push to demystify and destigmatize the end of life. The term is often traced to mortician Caitlin Doughty, who founded The Order of the Good Death in 2011. Using her own popular YouTube presence and her bestselling books, such as Smoke Gets in Your Eyes, Doughty argues that Western culture’s avoidance of death has left individuals unprepared to face their own mortality or that of their loved ones. 

As a whole, however, the movement draws its intellectual lineage from even earlier figures, such as Elisabeth Kübler-Ross, whose 1969 book On Death and Dying introduced the widely referenced five stages of grief and helped to launch the modern hospice movement in the United States. While the rigidity of Kübler-Ross’s five-stage framework has since been challenged by those who contend that the grieving process is individually variable and markedly nonlinear, her work nonetheless became an early voice in a movement that has since gained considerable traction. The movement has also resulted in notable legislation in jurisdictions such as Oregon, which passed the pioneering Death with Dignity Act in 1997.



More contemporary manifestations of “death positivity” include the phenomenon of Death Cafés, informal gatherings that were first organized in Switzerland by Bernard Crettaz and later popularized in London by Jon Underwood in 2011. In these venues, strangers meet over tea and cake to discuss mortality openly. The movement also encompasses various methods of advocacy for advance directives, green burials, home funerals, and the legalization of medical aid in dying. 

At the center of this cultural shift is the unique vocation of the end-of-life doula. As Teresa explains in Life, these doulas are non-medical professionals who have been trained to provide clients with holistic support as they contend with the reality of their own imminent mortality. Borrowing from the model of birth doulas (who provide non-medical support for mothers during and after the birthing process), end-of-life doulas focus on the emotional, spiritual, and practical needs that medical care may not address, and they typically work alongside hospice teams that handle a patient’s medical needs. Real-world organizations like the International End of Life Doula Association (INELDA), founded in 2015 by hospice social worker Henry Fersko-Weiss, train doulas to assist their clients with legacy projects, facilitate difficult conversations, coordinate vigils, and simply offer a consistent, comforting presence in a person’s final weeks and hours. Other organizations, including the National End-of-Life Doula Alliance and the University of Vermont’s Larner College of Medicine end-of-life doula certificate program, have helped to professionalize the field, which has grown rapidly in the years since the onset of the COVID-19 pandemic.

In the novel, Teresa embodies this role, stating that her work is to “assist [people] with the transition from life to death in as peaceful and mindful a way as possible” (4), and she also accepts the responsibility to “bear witness” (4) to a person’s passing. Her friendship with Flo is a direct application of these principles, creating a space for reflection, connection, and dignity.