The patient’s prognosis was uncertain from the outset. An initial diagnosis of vague abdominal pain, but ultimately a pancreatic malignancy with the full spectrum of symptoms as the cancer inevitably spread. Despite the best efforts of a team of doctors from specialties ranging from intensive care to oncology, emergency physicians to general surgeons, the patient died within a few months of presentation. My role was as the patient’s anesthesiologist. I often acted as the bridge between the medical team and the family. Together, we navigated the tortuous terrain of mortal illness, which sponsor optimism and courage in one hand, pain and death in the other. I was privy not only to that family’s most frightening experiences but also to their greatest hopes; I was a first-hand witness to the raw emotion that spills over with the coming of death. It was a normal professional doctor–patient relationship; in relative good health, we connected over shared life experiences, places, and even people; in ill health, I was the face of continuity in the sea of medical professionals that were involved in delivering care. As death approached, so too did the rollercoaster of natural emotions for family and clinicians alike. I wondered whether it would be appropriate to attend the funeral of that patient. Even after the worst had happened, I didn’t have the answer. It didn’t feel right to walk away from the family without paying my respects.
The death of a patient is an emotional and isolating experience for both the family and for the doctors involved in their care. The opportunity to attend the funeral, write a card, or embark on a condolence call can prove a cathartic process for family and doctor alike. However, there is little research, even for general practitioners, involving the ethics, wisdom, or efficacy of attending a patient’s funeral. Most of the relevant advice is anecdotal—the result of personal experiences. And perhaps it is because there is no clear-cut answer; perhaps the right course of action for one doctor may not be the correct course for another.
Professor Bruce Arroll, general practitioner and lecturer at The University of Auckland, believes that patient-centered care must remain a priority to the practitioner at the end of the patient’s life, and should encircle both patients and their families. In a 2007 personal view,1 Arroll wrote that he felt his attendance at a patient’s funeral acts as a gesture of respect for the deceased and their family. It is a means to express personal grief at the loss of someone who had become a personal friend, and to provide comfort and ongoing care for the bereaved family.
In her book On Death and Dying,2 Elisabeth Kübler-Ross spoke of “the void and emptiness that is felt most keenly after the funeral.” It is at this time that family members might be most grateful to have someone to talk to. We might consider it the general practitioner’s responsibility to provide holistic support after death, to assess the severity of the family’s grief, and to resolve any lingering misunderstandings. Does an anesthesiologist have a similar responsibility?
Ros Thorburn, consultant community pediatrician, can provide a personal perspective from the patient family side of this dynamic.3 Before her son, aged 25, died from cancer, Thorburn found the presence of the nurses and doctors who cared for her son to be a comfort, and noted that their care was an important part of her healing process as a bereaved mother. For this reason, she makes every effort to attend the funerals of the children who die under her care, for she says, “We cannot always cure, but we can care.”3
However, attending a funeral might stir up problems rather than bring solace. The presence of a doctor at the funeral can be traumatic for the family. It can invite inappropriate questions, recriminations, and even anger toward the clinicians that the family members hold responsible for the life they have lost. It can disturb the very personal and private grieving process of a family that is already struggling to cope. Moreover, the presence of a patient’s doctor might have wider ranging implications pertaining to patient confidentiality.
Such concerns might be particularly pertinent for anesthesiologists, whose clinical role or interaction with a patient or their family may be so limited that attending a funeral may not seem warranted or misinterpreted. It is uncommon for an anesthesiologist to build long-standing professional relationships with patients and their families, and they are more likely to stand as a symbol, rather than a comfort. What’s more, thanks to continued advancements in anesthesia safety and monitoring, even the most medically complex patients have a high chance of surviving the intraoperative course. Deaths in the operating department are infrequent, and, when they do occur, are unsurprisingly traumatic. Is it right for the anesthesiologist to dredge up this trauma by attending the patient’s funeral?
Regardless of whether it is in the patient’s family’s best interests for a physician to attend the patient’s funeral, there are many psychosocial barriers to attendance. As doctors, we are taught to survive, to be objective, to not show our emotions around our patients. This culture of toughness, of coping independently, sits uncomfortably alongside the idea of supporting patient families and ourselves through the grieving process. In fact, Dr Sofia Zambrano, a psychologist at The University of Adelaide, conjectured that peer pressure is a major barrier to funeral attendance among doctors: the environment that a doctor works in, the attitudes of their colleagues, and the indoctrinated doctor–patient relationship can all play a role in determining funeral attendance. Zambrano found that 71% of general practitioners had attended at least 1 patient funeral, but that this figure dropped to only 52% among surgeons and 22% among intensive care physicians.4 Notably, there are no documented figures for the percentage of anesthesiologists who attend patient funerals, despite the fact that anesthesiologists comprise one of the single most populated hospital based specialties.
What, therefore, is the answer? What is right for one family or one doctor is certainly not always going to be right for another. Anesthesiologists, particularly, tend to interact with patients and their families in unique and challenging circumstances, and often at the extremes of life. It is therefore natural that emotions and depth of feeling can run high. Attending a funeral might be one way that both the family and the doctor can reconcile such feelings.
And as for me? I attended the funeral. And then I wrote this story. Because ultimately, it felt the right thing to do.
Name: Katrina Barber, MBChB, FRCA.
Contribution: This author helped to review the literature and write the manuscript.
Name: Laurence Weinberg, MD.
Contribution: This author initiated the idea, was responsible for the management of the patient, performed the literature review, and wrote the manuscript.
This manuscript was handled by: Richard C. Prielipp, MD.