I can't believe they are dead. Death and mourning in the absence of goodbyes during the COVID‐19 pandemic

Abstract

The circumstances surrounding the deaths during the COVID‐19 pandemic and the subsequent mourning process transpired in completely atypical conditions. This study analyses the experience of losing a loved one without traditional, culture‐specific rituals for saying goodbye, explores the different factors affecting the onset of mourning by family members and studies the existence of complicating risk factors associated with grief from this distinct type of loss. A qualitative, phenomenological and interpretive research study was undertaken through in‐depth interviews of 48 informants, key and general, in the autonomous Community of Madrid. The interviews were conducted between July and November of 2020 and were followed by an interpretive categorical qualitative analysis. The principal results include (a) the finding that deaths caused by the pandemic are, due to their characteristics, a complicating factor for bereavement, (b) evidence that the professionals who supported these deaths with a holistic approach, facilitating the process for the family members, have been a determining factor in enabling the beginning of the mourning process and reducing anguish for the family members and (c) the conclusion that a need exists for a resignification of the funeral rite. Finally, before future crises, it is recommended that access protocols be developed for relatives, including methods that permit them to say goodbye to their loved ones, no matter the situation.

“Hard to Say Goodbye Over iPad”

“…Other studies have also highlighted the risk of complicated grief and bereavement issues during the pandemic. [15][16][17][18] In another study, researchers conducted qualitative interviews among relatives of deceased individuals and health care professionals during the pandemic and found that not being able to say goodbye to a dying loved one is a complicating risk factor for bereavement. Most families experienced difficulties coming to terms with and processing the losses because of pandemic restrictions and were unable to connect themselves with the reality of the worsening health and subsequent death of their family members.…”

“…Provision of grief and bereavement support remained unmet and may have potentially ended in feelings of ambiguous loss and complicated grief among caregivers. Other studies have also highlighted the risk of complicated grief and bereavement issues during the pandemic 15–18 . In another study, researchers conducted qualitative interviews among relatives of deceased individuals and health care professionals during the pandemic and found that not being able to say goodbye to a dying loved one is a complicating risk factor for bereavement.…”

Low and No-Contact Euthanasia: Associated Ethical Challenges Experienced by Veterinary Team Members during the Early Months of the COVID-19 Pandemic

“…Family members who are not able to visit dying relatives to say goodbye are at higher risk of developing complicated grief and post-traumatic stress-like disorders [ 35 ]. Being unable to see a family member right before, during or immediately after death made it hard for some to accept that the person had died [ 38 ]. Given the attachment that many owners have to their animals, it is likely that veterinary clients who were unable to be present during euthanasia may be susceptible to similar negative sequelae.…”

“…Interestingly, some commentators attributed moral distress among healthcare workers during periods of extreme resource constraint during the pandemic to a shift in the predominant medical ethic toward utilitarianism [ 36 , 39 ]. Some human healthcare workers (such as veterinarians) breached no-contact protocols in order to “minimise the negative psychological effects caused by not being able to say goodbye and possible ongoing complications of mourning” [ 38 ].…”

“…In light of negative experiences and profound psychological harms suffered by bereaved family members, numerous authors emphatically recommend development of protocols, policies and guidelines to preserve of the ability of family members to visit dying loved ones in healthcare settings and/or be present at the time of death during this and future pandemics [ 33 , 37 , 38 , 65 , 66 , 69 ].…”