Psychiatrists often develop long-term relationships with their patients, but what happens when a patient dies? Should the psychiatrist attend the patient’s funeral?

It’s a question Ashley Pettaway, MD, faced as a medical resident in the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia.

For 2 months, Pettaway was involved in the day-to-day care of a woman in her 40s who ultimately died. As part of that care, Pettaway had regular meetings with the patient’s husband and family members.

“The patient was about my mother’s age, so I naturally was kind of attached to her,” Pettaway told Medscape Medical News. After she died, her family invited Pettaway to the funeral.

“While I couldn’t make it to the funeral, it got me thinking. Should I go? If I go, what do I say? Who do I sit with? How do I introduce myself?” Pettaway wondered.

She turned to the literature but found very little regarding psychiatrists attending their patients’ funerals. “This was surprising to me because in psychiatry, you can get so engrossed in patients’ lives,” Pettaway said.

Given the lack of rules or formal guidance on psychiatrists attending patients’ funerals, Pettaway and a colleague, Gabrielle Marzani-Nissen, MD, conducted an informal survey of 12 supervising psychiatrists at the University of Virginia.

The survey results were presented at the virtual American Psychiatric Association (APA) 2021 Annual Meeting.

Ten of the 12 psychiatrists who were surveyed were caring for a patient who died while under their care. Five of those psychiatrists reported going to at least one patient’s funeral over the course of their career.

Among the psychiatrists who attended a patient’s funeral, their attendance was often based on their clinical intuition, their relationship with the family, or whether the patient was an established presence in the community. In the latter case, the psychiatrist attended as a community member.

The number of years in practice also mattered. Less senior faculty reported that they would be hesitant to attend and that they would not attend without a formal invitation from the family. Senior career psychiatrists were more likely to attend and felt that an invitation was not required.

None of the psychiatrists surveyed had received training or guidance on attending patients’ funerals at any point in their career.

Given the absence of formal recommendations, Pettaway believes increased conversation on this topic as part of residency training programs would help psychiatrists navigate these complex situations.

A Complex Issue

Commenting on the topic for Medscape Medical News, Paul S. Appelbaum, MD, professor of psychiatry, medicine, and law at Columbia University, in New York City, said this is an “interesting and important topic that is under-discussed.

“I don’t think there’s a right answer that applies to every situation,” said Appelbaum, a past president of the APA.

There will be times, he said, when psychiatrists or other mental health professionals have worked closely with a patient for many years and may have interacted with the family over that period.

“When that patient passes away, they may feel, and the family may feel, that it would be comforting and appropriate for them to be at the funeral,” said Appelbaum.

However, he added, it’s important that psychiatrists “take the lead from the family.”

“There are obviously a number of complexities involved. One is how the family feels about the relationship with the psychiatrist, whether they were accepting of the reality that the patient had a mental disorder and was in treatment,” he said.

There is also the question of confidentiality, said Appelbaum.

“If it’s a large funeral and the psychiatrist is just one face in the crowd, that’s not likely to be an issue. But if it’s a relatively small group of mourners, all of whom know each other, and an unknown figure pops up, that could raise questions and perhaps inadvertently reveal to family members or friends that the deceased had a psychiatric condition and was in treatment. That needs to be taken into account as well,” he added.

In cases in which the family invites the psychiatrist, confidentiality is not a concern, and attendance by the psychiatrist is something the patient would have wanted, said Appelbaum.

How the patient died may also be factor. When a patient dies by suicide, it’s an “emotionally charged situation for both sides,” said Appelbaum.

In the case of a suicide, he noted, the deceased was often an active patient, and both the psychiatrist and the family are dealing with strong emotions ― the psychiatrist with regret over loss of the patient and perhaps with questions as to what could have been done differently, and the family with sorrow but “also sometimes with suspicion or anger in that the psychiatrist somehow failed to keep the patient alive,” Appelbaum noted.

“In this situation, it’s even more crucial for the psychiatrist or other mental health professionals to take the lead from the family, perhaps to initiate contact to express condolences and inquire delicately about the funeral arrangements and whether their presence would be welcomed,” he said.

The research had no specific funding. Pettaway and Appelbaum have disclosed no relevant financial relationships.

American Psychiatric Association (APA) 2021 Annual Meeting: Presented May 1, 2021.

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