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Some years ago I (BA) decided to start attending the funerals of patients. This was in response to having had a positive experience of attending a funeral where the family was very appreciative of my presence. Recently I attended the funerals of two patients who died within a few weeks of each other. Again, both funerals afforded me the opportunity to meet the extended family of the deceased and again, in both cases the family appreciated my attendance.
What stood out with the two recent funerals was that in both cases a close relative came to visit me in the clinic within a week. It was obvious these were not visits for any particular pressing medical problem but more of a social nature. The talk revolved around the funeral and, having been a participant, I felt I could make a meaningful contribution to the conversation. I was left with the impression that my attendance at the funeral was contributing to the resolution of grief in those two people. This was particularly rewarding and made the small investment of a few hours of my time worthwhile.
These recent events piqued our interest in the area of doctors attending their patients' funerals. It is not an area of much discussion (perhaps because doctors view death as a defeat?), but we had expected there to be literature on this topic to offer guidance. A Medline search was fruitless. Searching on Google was more illuminating, offering up anecdotal experiences which highlighted the value of attending patients' funerals, and provided some common themes of the value of doing this—namely, themes of appreciating the human and of ongoing caregiving.
Attending the funeral of a patient is a gesture of respect to the deceased and is generally interpreted as such by the patient's family. It also allows the doctor to gain a complete picture of a patient's life: often services are a real celebration of an individual's life and this is a positive and affirming experience. Long term patients often become fond fixtures in a practice and can even be regarded as good friends. Attending a funeral shows this important connectedness and it also enables a personal expression of grief.
Traditional viewpoints often persist among the community of patients, and, to many, having a doctor attend a loved one's funeral validates and emphasises the worth of that person. As Dame Cicely Saunders, a pioneer in the modern palliative care movement, once said: “How people die remains in the memories of those who live on.”1 This is true regarding the dignity of death that they are afforded, but also the celebration of life that they are given at the funeral service.
To many doctors–particularly those ascribing to the patient centred or family centred approach—a crucial point to emphasise is the recognition that in most cases our responsibility to the departed person extends to caring for their family in the wake of their death. As Elizabeth Kubler-Ross quite rightly emphasises, “Be available. The void and emptiness is felt after the funeral [when the busyness of preparations is over]. It is at this time that the family members may feel most grateful to have someone to talk to, especially if it is someone who had recent contact with the deceased. This may help the relative over the shock and the initial grief and prepare them for gradual acceptance.”2 The doctor's presence at a funeral service can pave the way for the family to have an opportunity to talk about their experiences surrounding the death. They may have questions about what happened in the last days or need reassurance or help with guilt. The family (or attending) doctor is the appropriate person to “be available.”3
Regular funeral attendance will not fit all doctors. Clearly, those in palliative care and some hospital disciplines may find this burdensome. It may be wise to avoid funerals when the family is unhappy with care, but asking the family for their permission to attend might facilitate reconciliation. Primary care providers usually have long term relationships with patients and their families, and we would argue that it is important to witness the end of the life journey of an individual. This is what we do for friends and family, and longstanding relationships with patients are in a similar category. Our experience indicates that there are personal and family benefits to be gained and little to be lost.
Competing interests: BA is on the advisory board for the Pharmac educational seminars (Pharmac is the government funded pharmaceutical purchasing agency in New Zealand) and is on the primary care committee of the Future Forum, an educational foundation funded by Astra Zeneca (UK).