Dr. Paul D'Alton:

I would raise a note of caution around bereavement counselling being required after the loss of someone. I really would be very cautious that we would give the message that anyone who experiences the death of a loved one needs to see a bereavement counsellor or psychologist. That is not the case. It comes back to a question that was raised in terms of a whole-system approach. We do not need necessarily to be focusing on specialists or specialist training, but we need to be thinking much more globally about how we as a culture interact with the loss of a loved one. It is unhelpful to put out the idea that when we lose someone we love we need to go and see a specialist. We do not. There are clear guidelines on when it is necessary. I constantly say to patients and family members that within the first year of loss one is quite entitled to do whatever one wants psychologically and if, in 12 months time, one is getting stuck there, then it is time to go and see someone. It is a little about the specialisation. We specialise loss, and that is not what we want to do at all. Coming again to the whole-system approach, in any setting, be it in nursing care or the training of doctors, we need to think broadly, and not so specifically, about skilling staff.

The other question that came up was around the research agenda and including those who are dying. We have a programme-of-research stream in St. Vincent's called Living with Dying. We have conducted three pieces of research where we have spoken to patients at the end of their life about their experience, first, of dying in an acute environment. Not to be insensitive, it is about going to the customer or person who is receiving the care, in this case, in an acute environment, and asking him or her about his or her experience, and that experience then informs our clinical practice.