Bronwyn's funeral

Taking care 'behind the scenes'

Abi Pattenden offers a funeral director's perspective on the importance of diligent care 'behind the scenes' and the value of thoughtful, proactive communication when something goes wrong.

Funeral directors have many responsibilities relating to the care of people who have died. These include ensuring that the setting in which they are kept is appropriate for each person and adequate for the number of people likely to come within their care. Funeral directing businesses should also have procedures in place to ensure that each deceased person is always identifiable, and that staff are well trained and able to follow these procedures.

Recording the location and movement of bodies

The UK's two main funeral directing trade bodies, the Society of Allied Independent Funeral Directors (SAIF) and the National Association of Funeral Directors (NAFD), both have codes of practice that make it mandatory for funeral directors to have procedures ensuring the location of the deceased person is always known to the client. They also emphasise that keeping a record of movements, such as those discussed in the case study, is essential in the good running of a funeral business. It should be noted, however, that funeral directors do not have to be members of a trade body.

Assuming what Geoff told Claire is accurate, the company he works for seems to have procedures in place for recording the movement of deceased people from one location to another. The problem of not being able to locate Bronwyn apparently arose because of the circumstances in which a staff member went off sick somewhat abruptly at a busy time and when usual arrangements were being modified because local death rates were much higher than usual. This suggests it could be important to review the procedures that the company was relying upon. It is relatively easy to develop processes on paper, but if they are going to work reliably, they need to reflect the reality of how the business operates in practice. It may also help to think of procedures not just in terms of their component parts but as whole activities from start to finish. Updating and passing on paperwork is important, and a body should not be moved if there is not the time or resources to complete the associated paperwork.

Honesty and other responses to errors

It is not possible to tell from the case story whether the company procedures would have involved Claire being informed about the moving of Bronwyn from the local branch to the central mortuary in advance of this taking place (or, indeed, at all) had matters not gone awry. There are no statutory requirements for Geoff to make Claire aware of the 'losing' of Bronwyn's body, and it is not clear from the case story whether Geoff was complying with a company policy or senior manager's request in doing so. From Claire's perspective, it seemed it was only due to Geoff's honesty that she was made aware that Bronwyn's body had been 'lost'. That Geoff was honest with Bronwyn is important. I feel that telling her was the right thing to do and it is to Geoff's (and perhaps his company's) credit that he made that difficult phone call.

However, I can't help but wonder how much investigation was done in advance of his phone call to Claire. How hard did they look for Bronwyn before alerting Claire to the problem? While it would have been inappropriate to delay indefinitely while conducting a possibly protracted search, a time-limited search to check there really was a problem to report may have avoided undue concern.

It's clear from the case story that Claire was reassured by Geoff's explanation to a certain extent, but she was also left with unanswered questions. I think Geoff could have usefully anticipated and proactively addressed some of these questions. For example, if his company was facilitating viewings at the time (some stopped doing this for a while, especially in the first year of the COVID-19 pandemic), he could have asked whether Claire or others would like to pay a visit to Bronwyn in the Chapel of Rest and explained where and how this could take place. Two of the main organisations which offer funeral advice in the UK, the Natural Death Centre and the Good Funeral Guide, suggest that people who are choosing a funeral director could usefully ask about the location(s) where deceased people are kept. Both suggest that if a funeral director seems unwilling to show a prospective customer their 'behind the scenes' facilities, that should be taken as a sign to steer clear of the company concerned. I tend to agree. In the context of what happened in this case, an invitation to view Bronwyn's body would also show that Geoff had confidence that Bronwyn had been correctly identified and that he did not believe there would be any further problems when Bronwyn's body was moved again (as it would, presumably, need to be if she would be visited in a branch). This could help to ensure Claire knew that this was an isolated incident and that she could still be confident in the company's other procedures.

Geoff could also have asked Claire if there were any other questions that she would like answers to. This offer and full answers to any questions Claire asked would potentially provide further assurance of transparency and good practice.

I would also like to know what Geoff and his company did about the incident beyond communicating with Claire. Does his company have procedures for the reporting and investigation of an incident like this? Will someone assess whether and how their practices should change to make such a serious procedural flaw less likely in the future? This would be good practice and would also provide reassurance for staff such as Geoff that the company had an interest in preventing errors and mitigating harms.

When something goes wrong: to tell or not to tell?

Vikki Entwistle shares some thoughts on being honest about mistakes and mishaps, including ideas from healthcare about a 'duty of candour'

In the case story, Geoff, the funeral director, found it hard to tell Claire that her mother's body was missing. He also worried about the reputational damage the incident might cause for his company. Claire thanked Geoff for his honesty then wondered whether she should tell her sister what had happened. The story raises various questions about whether, when, why and how funeral directors should tell clients about mistakes or shortcomings in their work.

Here I summarise some ideas about honesty as a virtue and consider how a 'duty of candour' that has been developed in healthcare could be relevant for deathcare contexts.

Honesty

Many of us aspire to be honest. Honesty is a characteristic of good or virtuous people. Honesty typically leads us to avoid telling lies and to own up, rather than cover up, if we make a mistake or if harm has been done. But honesty does not require us to blurt out all truths at every opportunity, and we value other things as well as honesty - including not hurting people and not causing distress for no good reason. Virtues of courage, diligence and kindness are also relevant.

It is not always easy to judge what to say (or not) and how in a particular situation. Sometimes, good people disagree about this because there are many things (and people) to consider, including various uncertainties, and some aspects of situations can quite reasonably be interpreted and prioritised in different ways.

Candour about mistakes - guidance in health and social care contexts

In some situations, laws and other policies guide and regulate information sharing, at least to some extent. In healthcare, a duty of candour has been developed as part of efforts to improve patients' safety. It aims in part to ensure healthcare professionals and services do not add insult to injury by not acknowledging mistakes or other problems that have led to patients being harmed. In the UK a duty of candour has been enshrined in several professional codes of practice and in laws which also apply to social care and social work.

As the Scottish Government summarises it:

“The organisational duty of candour procedure is a legal duty which sets out how organisations should tell those affected that an unintended or unexpected incident appears to have caused harm or death. They are required to apologise and to meaningfully involve them in a review of what happened.”

Guidance on the duty of candour stresses that an apology is not an admission of liability but expresses sorrow or regret about an unintended or unexpected incident and any harm a person may have experienced. It also notes the importance of listening to patients and families to help learn how similar incidents might be avoided in the future.

The legal duty of candour does not require organisations to tell patients or their families about mistakes that cause no harm. In cases of 'near miss' incidents which could potentially have caused harm but did not do so, the General Medical Council advises doctors to use their professional judgement and discuss with colleagues what, if anything, to say to patients. Relevant considerations include whether the patient concerned could benefit from knowing or might be harmed by knowing. In some circumstances, patients might be closely involved in the details of their care and perhaps aware that something was not quite right. There would be a risk in such a situation that they might lose trust or confidence in healthcare teams if nothing was said. They might feel badly betrayed if they later learn about the near miss from other sources. In other circumstances, telling someone about something that happened that did not and will not cause them harm could cause them unnecessary distress or confusion and bring them no benefit.

But even if it is not appropriate to disclose an incident to a patient, openness with professional colleagues and managers can still be important to ensure any lessons are learned and problems addressed for the safety and wellbeing of other patients and staff.

What about death care?

The kinds of harms that are the focus of the duty of candour in healthcare generally do not arise when the people whose bodies are being cared for are already dead. But unintended and unexpected incidents do occur, and harm and wrong can still be done in funerary practices. Questions about whether and what to say, and to whom, require us to think about the contexts and purposes of the services in which incidents occur, and the details and implications of those incidents.

When funeral directors take bodies into their care, they are trusted to look after them until the point of burial or cremation. Funeral directors typically purport to treat those in their care with respect and dignity. But people have different expectations of how a dead body should be prepared for a funeral, and different ideas about the status and significance of human bodies after death and what constitutes respectful and dignified treatment.

As with 'near misses' in healthcare, decisions about when, why and how it is appropriate to tell clients about incidents or shortfalls in the treatment of deceased people are likely to need careful professional judgement. Funeral professionals may find it helpful to reflect critically on the motivations behind their inclinations to tell or not to tell, and to consider what honesty and other virtues would tend to promote. It will often be appropriate to seek constructive input from colleagues, especially those with more experience and a positive reputation for doing things well.

Candour seems more likely than cover-up to reflect, sustain and develop good funeral service provision and public trust, but perhaps some of the honest conversations about incidents or concerns that might help funeral professionals improve their service would be more appropriately conducted with a volunteer group of previous and potential clients rather than with current clients who are more likely to be experiencing acute grief.

Link to information about the Duty of Candour