Should Professionals Attend the Funeral?

Dear Editor:

The grief of a professional can be intense when a patient dies and deaths may have a significant long-lasting impact. It is, therefore, important to acknowledge the emotional impact of a patient's death and provide support for staff in managing this. The decision about whether or not to attend the funeral of a patient is one that many professionals have to make and yet it is given little attention in day-to-day practice, training, and in the literature. Is attendance a compassionate act, what is its purpose, and how do staff decide whether it is appropriate to attend?

To try to answer these questions, we sought the opinion of professionals attending an International Paediatric Palliative Care conference. Twenty professionals completed a questionnaire comprising seven questions requiring both “tick-box” and free text responses.

The results suggest that those working in pediatric palliative care do see a role for professionals attending a patient's funeral, reflecting the needs of professionals—“need to say goodbye to the patient”; the needs of families they care for—“support to family and show how much their child is valued”; and to show respect for relationships built between the two—“felt right in context of relationship and needs of family.” Some respondents also observed that professional attendance at the funeral can support the grieving process for the family—“it helps when providing on-going bereavement support for family and siblings.” This is a view shared by Arroll ¹ who reflected that attendance at funerals resulted in a positive “contribution to the resolution of grief for the family, making the small investment of a few hours worthwhile.”

However, respondents also raised caution about the potential moral, psychological, practical, and ethical difficulties—“it cannot be a never ending role for all staff and all deaths—not sustainable,” “the needs of living patients takes precedence over attendance at a funeral.”

Many voiced the need to train and support professionals, 7/20 participants said that they had little or no training, 16/20 said that they would like more training, and 19/20 said there should be discussions about funerals on training courses—“I have learned on the job, but training or guidance would be helpful.” Some mentioned the need to implement clear and appropriate boundaries, and the importance of acknowledging the impact on staff—“more support for professionals as we suffer too.” This mirrors the views of others, for example, Zambrano et al. ² suggest the need for a balance between connection with the family and maintaining a position of objectivity, and Baverstock ³ writes that providing accessible and constructive support for staff is essential.

All respondents (20/20) felt that whether they attended a funeral should be a matter of choice, 19/20 felt that funeral attendance should be supported by managers, and 13/20 felt that it should be considered as a “paid part” of their professional role. Others mentioned dilemmas of attendance if the funeral fell on “a non-working day.”

Of the 20 participants, 14 reported a lack of service policy, and this along with the other results led the authors to suggest (1) that national guidelines should be developed addressing these issues, (2) that services are encouraged to develop their own policies and support structures for staff, and (3) that this topic is routinely included in professional training courses.