Aidan's funeral

Restricted service provision and care in communication

In this commentary, Abi Pattenden offers a funeral director's perspective on variations in service provision and what clients are told about these and how.

As a Funeral Director, I can see two distinct (but linked) issues presented within the case of Aidan's funeral. The first is the way Aidan's body was going to be treated (or not) by the first company Sinead approached. The second is how this was communicated to Sinead.

Restricted service provision

It's not clear from the case exactly when or where in the UK Aidan died in. In the first months of the COVID-19 pandemic, guidance for Northern Ireland was that COVID-19-positive deceased people should be placed in a body bag upon collection from their place of death. The washing, embalming and viewing of their bodies was discouraged, and the body bags were supposed to remain sealed except, for example if a medical device such as a pacemaker had to be removed before the body could be cremated[i]. The second company's different approach suggests the case comes from later in the pandemic or elsewhere in the UK, where guidance more quickly supported continuation of the usual tasks of preparing deceased people's bodies so long as rigorous infection control procedures were adopted.

Funeral companies vary in terms of what they offer and are willing to do. Where the dressing of a body was allowed, there were many reasons that a company might have decided not to dress people who died of or with COVID-19. In the early days of the pandemic, there was a lot of uncertainty about how the disease was transmitted and how infectious a dead body could be. Guidance from both government and trade associations changed rapidly and didn't provide all the answers. This was a frightening time for funeral professionals, as for other people. Although we came to learn that the health risks of direct and regular contact with deceased people were, in practice, small and could be mitigated with enhanced PPE (personal protective equipment) and changes in procedures, this was not immediately apparent.

It may be that the first company in the case story decided to err in the direction of extreme caution, perhaps because they felt unable to adequately assess the risks, perhaps because they had a shortage of appropriate PPE (which was as much a problem for funeral directors as for other sectors), or perhaps because they were trying to save person hours at a very busy time with potential high staff absence levels due to sickness or furlough of particularly vulnerable staff members. If this was a branch of a large organisation, policies may have been developed by people who had never worked in the front line of funeral service and proposed a policy of not washing and dressing bodies as a pragmatic approach to risk mitigation without appreciating the impact of this on bereaved people.

Care in communication

It's evident from the case story that the first funeral director's communication with Sinead was generally poor. His manner is described as 'rushed' and 'brusque'. This was not only unhelpful at the time but would probably prove counterproductive to any longer-term aim of arranging funerals successfully. Good communication can foster people's confidence in the ability of the company and its staff to fulfil the funeral as agreed. Building trust encourages openness from bereaved people, which means they are more likely to share, ask questions, and discuss possibilities for the funeral. This can lead to a greater understanding of what the funeral could look like, and in turn this may lead to it being more personally appropriate, which is what most people arranging funerals are seeking to achieve.

There may have been good reasons for this company's policy of not dressing people who died of COVID-19 in their own clothes, but in practice it should have been explained differently. Honesty is important and it's good that the first funeral director didn't lead Sinead to believe that Aidan could be dressed when this was not the case, but it is possible to be honest without being hurtfully blunt. For example, 'I'm sorry, but as your father died of COVID, our company policy is that we are unable to dress him' gives the same information without the details that Sinead found distressing. If the first funeral director had known that other firms were operating differently, they should also have advised her of that.

Variation in terms of the kinds of funerals funeral director companies provide and features of service they offer can help allow for different bereaved people's preferences to be met. For example, people might choose a company that they know is very familiar with the cultural customs or religious rites they require rather than having to explain their requirements to someone who is less aware of them. However, every funeral director in the UK has to offer at least a 'Standard Attended' funeral package as mandated by the Competition and Markets Authority, and they must advertise the availability of this package in set ways.[ii]

Within the constraints of legislation and the requirements of any trade body of which it is a member, any funeral directing firm can operate and speak to customers as it chooses. However, it seems counter-productive to communicate in ways that are not conducive to customers' needs, and I would argue that all funeral professionals have a duty of care towards those they work with. A duty of care to me includes explaining their service provision with honesty and appropriately to the needs of each customer. Making good judgements about how to communicate with whom is a skill that should be developed. It seems to me that enhancing communication skills with the aim of giving every individual a more appropriate and tailored service, is the main area for improvement which this case story highlights.

[i] https://www.publichealth.hscni.net/sites/default/files/2020-04/Guidance%20for%20Funeral%20Directors.pdf

[ii] https://www.gov.uk/government/publications/summary-of-the-funerals-market-investigation-order-2021/summary-of-the-funerals-market-investigation-order-2021

“That's just the way it is”?

In this commentary, Paolo Maccagno reflects on words that are sometimes used to support and console people who feel let down.

“That's just the way it is”. These words captured my attention when I read this case. They suggest resignation. Sinead feels angry and disappointed after talking with a funeral director who didn't want to dress her father and would not even open the bag in which his body was sealed. While Sinead is crying, her partner says: “if the COVID rules are that he can't wear his best suit, that's just the way it is.”

I wondered about the likely effects and the appropriateness of the words: “That's just the way it is” in this situation. Would they make Sinead accept the limited service the funeral director was offering? Would they make her resign herself to the idea that her father would not be smartly dressed for his burial? Would they console her? Or, on the contrary, would they make her determined to push for a better arrangement for her father? If she had not been able to find a different funeral director who was able and willing to provide the service she sought, would these words have led her to become even more angry and upset? What did Sinead's partner intend with his choice of words? To what extent was he simply offering a general, fairly standard response to another person in distress and to what extent was he really responding to Sinead in her particular pain?

Sinead had experienced a sequence of events that left her in a state of emotional turbulence. The shock of the death of her father (at a young age and in the particularly challenging circumstances of the COVID-19 pandemic) was followed by the need to navigate the series of unfamiliar formal procedures that follow a death. The first professionals Sinead encountered were less readily available and supportive than might have been expected - as exemplified by the funeral director's dismissive refusal to dress her father: “It's a COVID death, so we don't open the body bag”. Was just accepting all this the right thing to do? Sinead's reaction seems to express a deep and forceful sense that the situation is wrong - and perhaps unjust - in many respects. The different meanings of the word 'just' may be a source of discomfort here.

Sinead was trying, in keeping with her sister's suggestion, to give their father a good funeral. There are various ways in which a funeral can be more and less good, but what matters here are the views of Sinead and her family, including about what is appropriate for her father. Sinead's partner's words need to be understood in this context. In saying “That's just the way it is”, Sinead's partner might have been trying to persuade Sinead to accept the situation as it is. He might at the same time have been trying to offer her some consolation. If Sinead's partner was trying to persuade her to accept the situation as it is, we need to consider why he thought that this was the right thing to do, and whether he was paying sufficient heed to what mattered to Sinead and what she thought was right.

Anger is a strong emotion which sometimes cannot be articulated clearly in language. How can we best support and care for someone who is angry? Perhaps Sinead's partner wanted to spare her the possibility of the further suffering that he thought might come if she tried to fight against rules about a situation beyond her control. But this protective intent comes into tension with the idea that Sinead's anger could serve positively as a force for achieving a better outcome. It can be difficult to know how far to support someone fighting for a better outcome because the limit of what it is possible to achieve may be difficult to discern.

To the extent that the words used by Sinead's partner encourage us to accept what is offered without questioning, they can prevent us from finding a good - and just - way forward. These words seem to risk legitimising poor service or some of the reduced forms of funeral provision that were used during the pandemic without acknowledging any possibility of improvement.

I think it would be important to ensure Sinead did not feel inappropriately constrained from asking questions and seeking solutions to the problems that fuelled her anger. Rather than “That's just the way it is” I would suggest “That's the way it is. What do we do then?”

A risk-laden object and a person: the dead body betwixt and between

In this commentary, Arnar Árnason shares ideas from anthropology that can help us understand a need for caution when handling the bodies of people who have died of infectious disease while still expecting that those bodies are treated with respect.

I think that Sinead's distress - her dismay at the funeral director's words and what they imply about how he thinks of Sinead's father - is painfully understandable. One only need to imaginatively put oneself in Sinead's place, reluctantly as one might do so given what that implies, to recognise the distress Sinead expresses. What is more challenging, and maybe more interesting, is if one might extend ethical understanding to the funeral director in the case story.

I am going to dismiss from my consideration the possibility that the funeral director may have been 'rushed off his feet'. That, in and off itself, would not excuse what appears as callousness. Rather, I want to use an idea that we consider in anthropology and to ask you to think of a dead body - Aidan's body in this case story - as a borderline phenomenon, as between and betwixt two categories of things.

The anthropologist Mary Douglas noted some time ago, that dirt is only really matter out of place. A pile of soil out in the field is just that: a pile of soil. The same pile of soil found on my living room floor is clearly dirt: it is matter out of place. Douglas articulated this idea while thinking through the prohibitions spelt out in the Book of Leviticus. Her argument was that humans seek to establish a conceptual order over the world by classifying the phenomena in it. Our efforts at classification will, however, always throw up ambiguities because the world is, after all, messy. The prohibitions on food Leviticus speaks of, Douglas suggested, apply to things that cross or undermine conceptual boundaries. Those things are dirty because they do not fall clearly into a category. They are in that way out of place. Dirt, Douglas continued, is in a sense the same as pollution, it suggests an unnatural, or unholy mixing of things that should be kept apart. And pollution, she added, has a certain potency, a certain power that is evident in its very capacity to upset categorical distinctions, in how it escapes human efforts to effect conceptual control. Sources of pollution, consequently, must be managed carefully.

Where am I going with this, you may well ask. What is the relevance of this short account of a particular anthropological idea - an idea now going back more than fifty years moreover - to the story of Aidan's funeral?

I suggest that Aidan's body can be understood as not falling clearly into a single category. After Aidan's death, his body is presumably, still clearly recognisable as Aidan's body. At least initially, I would also think that for Sinead and her family Aidan's body is still Aidan - to some extent. Still, something has changed. The responsiveness that was Aidan has gone. We might say that Aidan is both still a person and at the same time now a body without the person. As such Aidan can perhaps be considered as being between two distinct categories.

The idea that death in general and dead bodies in particular are polluting is commonplace. What anthropologists might call the ethnographic record is full of examples of this idea from all around the world. In many contexts those closest to the deceased are required to isolate socially following the death because they are understood to be too close to that source of potential pollution. In many contexts, only certain groups of people are thought to be able to handle the dead because of the pollution that might otherwise spill over and affect others. One might suggest that funeral directors are one of these groups of people.

I think it is fair to say that funeral directors are expected to treat the dead with respect and dignity, with care in a word, because the dead were and can still be considered as human beings, as persons. Still, we know, indeed expect, that funeral directors will in some ways treat our dead in ways that are ordinarily not visited upon human beings while they are alive. Funeral directors - and the same goes for hospice and hospital staff - have to simultaneously treat the dead both as if still a human person and as a body that they need to prepare for a funeral. They have to treat the deceased with dignity and respect while sometimes doing things to their body that would not ordinarily be seen as marks of dignity or respect if the person was alive.

When the COVID-19 pandemic first hit, there was uncertainty about how the virus spread. Funeral directors found themselves in a position where they were being called upon to attend to people who had died of a disease that was clearly quite contagious, quite dangerous and as yet rather unknown. However, funeral directors are not unfamiliar with managing potentially dangerous bodies. If some individual funeral directors may lack that experience, the profession surely carries the institutional memory of such work and how to carry it out. And so one would hope that the funeral director in question would have the resources to inform a more considered response to Sinead, one that would recognise how a reference to a 'body bag' will likely be heard by a grieving daughter and would find a different way of saying what this funeral director may feel needs to be said. While I am suggesting a sympathetic understanding of the circumstances this funeral director find them self in, I think it clear that they have done harm by their rather careless way of talking about Aidan and where he is now.