On 8 September 2022, I recall switching on the television in the afternoon and being greeted by the headline ‘The Queen dies’, with her portrait on the TV screen. This message was clear, short and succinct-there was no mistaking what had happened. Having been critical of the use of euphemisms in the past, and their potential to distort the reality of death, the message by the broadcasters was poignant and most welcome. It was direct and honest communication to the nation and the world at large. Normally, euphemisms are considered substitutes to convey an indirect meaning to minimise the harshness of what has happened. They are thought to remove the bluntness of the message conveyed when something unpleasant has happened (such as a death). However, while the intention in the use of euphemisms is understandable, they often distort the reality of death.
Although the death of the Queen was not a total surprise, due to reports of her reduced mobility and feeling fatigue, resulting in her having to either miss or cancel events or ask her family members to represent her, it was indeed sad to realise that, after 70 years of her reign, she was no longer going to be with us anymore. The Queen had been a constant in our lives, and perhaps the human mind expected her to be there forever. Hence, for many, her death brought a mixture of sadness and celebration of a life well-lived with dedication to duty.
As I write, most television channels are running stories about the life of the Queen, both in her official capacity and private life. Her death is juxtapositioned with all the great things she has done, her leadership of the nation during difficult times-such as the recent COVID-19 pandemic. There is a whole week of mourning/reflection, and many people are paying their respects in different ways across the UK and the world over, before her state funeral on 19 September, when a number of world leaders are also expected to attend.
For healthcare professionals (HCPs) in and around palliative care, it is important to reflect on the Queen's death and learn important lessons to help those patients we care for as they approach their own death. The point to rehearse is that death should be treated as a normal part of life. Therefore, healthcare professionals working beyond palliative care settings should strive to talk openly about death to patients and their friends and families. Like the signs and symptoms reported about the Queen's deteriorating health, our patients often present with similar symptoms, deteriorating gradually, which offer HCPs a focal point to discuss dying not only with the patient, but with their families too. The success of such conversations starts with HCPs being comfortable in themselves to talk openly about death and dying. If we constantly remind ourselves that death is the end of life (and the only certainty in life), it would not be that onerous to talk to patients and their families about death. What is obvious to see with the death of the Queen, is how children and young people were included and lined up the streets to view the coffin and were encouraged to talk openly about their emotions. TV presenters should be given praise for affording children the platform and space through interviews to articulate and share their own feelings.
Understanding grief
Whether expected or not, death often provokes grief in those left behind. Grief is a normal reaction to a painful loss; in this case, it is the family of the Queen who will inevitably experience it the most. Because the Queen was well known in the UK and worldwide, people outside her immediate family may also experience grief, which again, is a natural reaction to such a loss. Like the Queen once said herself to the American people when comforting them following the 9/11 terrorist attacks, ‘grief is the price we pay for love’. It is understandable and only normal to feel ‘emotional pain’, as many people had developed attachment bonds (Bowlby, 1998) with the Queen. While Bowlby's study was based on children, his conclusion of attachment bonds is applicable to adults. It is also true that grief does not get lighter, but, over time, we get used to carrying it.
It is my sincere hope that the death of the Queen can inspire the nation, as well as healthcare professionals working with dying patients and palliative care specialists, to feel more confident to openly talk about and discuss each and every death with the person who is dying and their close relations. When we talk openly about death, it encourages disclosures of inner feelings and wishes and, with that, enhanced quality of life, leading to a dignified death. Equally, the bereaved may find grief much more bearable going forward.