When Hospice Volunteerism Becomes Extraction
Anyone who has spent time as a hospice volunteer knows how this role is often perceived from the outside: quietly revered, almost untouchable in its perceived goodness. “You’re a hospice volunteer?” people say, often with a pause of awe, followed by some version of, “I could never do that.” And in many ways, that reaction points to something true: hospice volunteerism is one of the most intimate forms of service, where community members offer their time, presence, and care at the end of life without expectation of return, fully aware that grief will remain long after the people they accompany have died.
The generosity and compassion at the heart of this work are real. And yet, over time, I’ve found myself returning to a more complicated question beneath that narrative: when does freely offered service begin to shift into something closer to extraction? Not only in the obvious sense of labor or resources, but in quieter, more subtle ways as well. The ways death doulas work are taken up. The ways emotional and professional capacities are relied upon. The way lived experience is absorbed into systems without clear acknowledgment or reciprocity. It is in that space between care and consumption, between contribution and appropriation, that many death doulas working and volunteering within hospice systems find themselves. And I find myself asking, more directly now: is hospice volunteerism ever a form of extraction?
Defining Extraction
When I use the word extraction, I’m not only talking about money. I’m talking about the taking of labor, ideas, creativity, or lived experience without clear acknowledgment, consent, or reciprocity. Extraction can look like unpaid time, but it can also look like intellectual work being absorbed into institutions. It can look like emotional labor being expected but not named. It can look like community-based offerings being replicated, reframed, and rebranded without tracing where they came from. And often, it doesn’t feel like taking in the moment. It feels like contributing. It feels like being part of something meaningful, which is precisely why it can be difficult to recognize while it is happening.
Lived Examples of Extraction in Practice
In practice, this has taken several forms over time. I developed a death doula program within hospice volunteer services that was later transformed into a proprietary, monetized training program. I wrote an end-of-life doula informational handout that was distributed without attribution. I facilitated a community book club for five years that is now being replicated within the hospice organization. I also witnessed a “death over dinner” style gathering (originally hosted by another volunteer) being introduced in a similar format through hospice programming shortly after.
Even more recently, a photograph of me with a privately paying doula client, an image that reflects the intimacy, consent, and relational nature of our work, was used in a hospice annual report and marketing materials without credit or acknowledgment, to promote services that directly overlap with and compete with my own private practice.
Taken individually, each of these moments might seem small or incidental. But together, they begin to form a pattern: the absorption of ideas, practices, and even imagery from independent or volunteer contributions into institutional offerings, often without attribution or reciprocity.
The Pattern Beneath the Examples
What becomes visible across these experiences is not a series of isolated incidents, but a repeated movement: work offered in contexts of care and trust is later taken up, reshaped, or institutionalized in ways that obscure its origin.
This is where the dynamic becomes harder to name, because nothing in the moment necessarily signals loss. The exchange feels relational and collaborative. Even affirming. The recognition often comes later, when similar ideas, structures, or materials reappear in institutional spaces without clear acknowledgment of where they began.
And in that gap, between offering and recognition, between contribution and attribution, a larger question begins to form about how care-based labor is held, and what becomes of it once it enters systems that have the capacity to scale and reframe it.
Professional Labor and the Blurred Boundary in Death Work
There is also a deeper layer to this that extends beyond individual experiences or isolated organizational practices: the way professional labor itself is understood within death work, and specifically within hospice volunteer systems.
Death doulas are often expected to bring not only time and presence, but their full range of training, skill, and lived expertise into volunteer spaces. The work is framed as service, but the contribution frequently includes capacities that would otherwise be recognized as professional labor in nearly any other context: education, emotional containment, ritual design, family support, and systems navigation.
What is often left unexamined is how different this expectation is from how similar roles function within the same broader system. Within hospice, chaplains are not typically expected to volunteer their professional services indefinitely. Nurses are not recruited as volunteers and then asked to develop educational curricula, mentor emerging practitioners, or build internal programming without compensation. Their expertise is clearly situated within defined professional structures that include accountability, boundaries, and remuneration.
But for death doulas, whose work often exists adjacent to, rather than fully integrated within, institutional systems, those boundaries are less consistently defined. And in that ambiguity, the expectation to give expands. We freely give our time and are asked to donate professional training. We volunteer our presence and are recruited to develop frameworks. We offer care, but that is mined for the intellectual and relational labor that shapes how care is delivered and understood.
This is where the line between volunteerism and professional contribution becomes blurred in a way that is not always acknowledged, but is nonetheless felt in practice.
Is there another industry where this is the norm? Are accountants expected to donate their professional labor to the tax system? Do law schools encourage their new graduates to volunteer at Legal Aid to gain experience without compensation? Do doctors donate their professional expertise to Medicaid-funded hospitals, as an industry norm? Why is this issue specific to the work of death doulas within the modern hospice system?
Reciprocity and What a More Ethical Structure Could Look Like
If there is something this experience has brought into sharper focus, it is not only what feels misaligned, but what might be possible instead. Because the issue is not simply whether people should or should not volunteer in hospice spaces. The deeper question is how care-based labor is recognized, held, and returned within systems that depend on it.
A structure rooted in reciprocity would begin with acknowledgment. It would clearly name where ideas, tools, programs, and practices originate, especially when they emerge from community members, volunteers, or independent practitioners. It would distinguish between participation and authorship, between contribution and creation.
It would also create pathways for consent when work moves across contexts. When materials, frameworks, or program designs are adapted or expanded, there would be transparency about origin and collaboration, rather than silent absorption or rebranding.
Just as importantly, it would recognize when labor being offered is not only relational but professional. In those cases, reciprocity might include compensation, formal partnership, or clear boundaries around how expertise is used. Not all contributions are the same, and not all forms of giving should be held as if they are interchangeable.
At its core, reciprocity is not about limiting generosity. It is about ensuring that generosity is not quietly transformed into something else once it enters institutional systems. It is about making visible the exchanges that already exist, and asking whether they are mutual or merely assumed.
Lastly, those entrusted with stewarding volunteer programs (volunteer coordinators and program directors) hold a unique position within this system. In its most ethical form, their role is not only to support the organization’s mission but to protect volunteers from exploitation and ensure that their contribution is met with clarity, respect, and appropriate recognition.
Many of these individuals are deeply compassionate. They are often the relational heart of the institution, the ones who welcome volunteers in, nurture connection, and sustain engagement in work that is profoundly meaningful.
And so the question is not about their intention, but about their position: what becomes possible when care is directed not only toward sustaining the system, but toward holding it accountable to the people whose labor and ideas it relies upon?
Can we imagine a hospice system where volunteer coordinators are not only facilitators of participation, but advocates for reciprocity? Can we see into a future where the work of volunteers is recognized, credited, and meaningfully returned, rather than absorbed, adapted, or quietly replicated?
I believe this is possible.
But naming it requires us to stay honest about something more difficult: that without intentional structures of accountability, care can still become a site of extraction. Not because the people within the system lack integrity, but because systems themselves shape what is taken, what is returned, and what disappears into use without acknowledgment.
To talk about reciprocity, then, is also to stay willing to name extraction when it occurs. We must name it in moments of obvious harm, but also in the quieter patterns where labor, ideas, and relational work are taken up and reused without attribution or return.
Hospice work asks us to stay close to what is real at the end of life. This work asks the same of us in another way: to stay honest about what we are participating in, what we are offering, and what becomes of it once we do.
The question is not whether care exists in these systems. It does.
The question is whether care, once given, is held with accountability or allowed to become invisible once it is absorbed.
And in that space, we are still left with the original question: when does care become extraction?
Wondering if your hospice volunteerism is care or extraction? Get the free reflection guide here.
Jade Adgate is a death doula, educator, and advocate. Through her work at Farewell Fellowship, Farewell Education, and Farewell Library, she guides others in exploring mortality and cultivating understanding, reflection, wonder, and care around life and death.
