Throughout The Book of Two Ways, Picoult confronts the topic of death from a variety of perspectives. Her choice to make Dawn’s character a death doula affords many opportunities to probe death—through her relationship with Win, her attitude toward her job, and the way she has come to understand dying all become a part of the narrative, informing the themes of the novel. Dawn has thought deeply about death, and her willingness to “get close to the things that make people uncomfortable” is what makes her profession possible for her (202).

At the time of the novel, the profession of death doula was relatively new, but quickly growing, in the United States. According to the National End-of-Life Alliance (NEDA), in 2022, approximately 1,300 death doulas were registered as members across the United States. In the late 1990s, the term “death doula” was adapted from birth doula, a person who supports a mother during the birth process and a profession that rose to prominence in the United States in the 1980s.

Dawn explains that “Doula is Greek for ‘woman who serves’—and just as birth doulas know that there’s discomfort and pain that can be managed during labor, death doulas do the same at the other end of the life spectrum” (51).