LGBTQ+ stands for lesbian, gay, bisexual, trans and queer. We’ve used the term LGBTQ+ on this page, but we realise this may not cover all the ways people define themselves. Scottish Trans and Stonewall Scotland list many more terms.

When supporting LGBTQ+ people around bereavement, there are some particular considerations to be aware of.

It may be difficult for someone if incorrect (or negative) assumptions are made about their relationships, if interactions highlight difficult family dynamics, and / or if there are fears about them being misremembered or there are conflicts about how they are remembered.

LGBTQ+ peoples’ relationships or chosen families may not exactly resemble the expectations of those working in health and social care. E.g. a person may be polyamorous and have multiple partners or have a close-knit circle of friends who they consider to be their family, but who may not be given the traditional level of access and input that a blood relative might experience in a health or social care setting.

It may not be evident or known that a person is LGBTQ+ so it is important that care is delivered, and communication conducted, in a way that is inclusive, affirmative, respectful and avoids making assumptions. This page focuses on bereavement rather than care before death.

Fears about death and bereavement

People who are LGBTQ+ may have particular fears regarding death and bereavement. These might include:

• Fear of being outed in death, e.g.

   

  • 14% of trans and 24% of non-binary people are not out to anyone in their family
  • 11% of trans people who are out to family, aren't supported by any family members [1]
• Fear of inappropriate curiosity regarding themselves or their body
• Fear about who will be handling their body after death, and concern that they will be treated with a lack of respect
• Fear of having to hide sexual orientation and/or gender identity
• Fear that their relationships and/or gender will not be acknowledged
• Fear of being misgendered (e.g. at death registration), deadnamed (e.g. on a headstone or memorial), or being misremembered perhaps due to:  
  • lack of certain legal documentation 
  • lack of support from their relatives
  • lack of recent contact with their relatives
  • disagreement, lack of acquaintance or awareness between their chosen family and the family in which they were raised
  • genuine uncertainty around how / if they can be remembered in the way that they would want
• Fear about who will organise the funeral or memorial service and that these will not be in keeping with their wishes
• Concerns regarding the funeral or memorial service, in terms of discrimination against some mourners e.g. 
  • the safety of those who wish to attend
  • some people not being allowed in (despite them being close chosen family or a partner)
  • some people being prevented from contributing to a eulogy or speech, or not being named, or recognised as part of the person’s life

A UK survey of lesbian, gay and bisexual adults revealed that “24% expected to face barriers relating to their sexual identity when planning a funeral” (Bristowe et al, 2016).

The expectation of discrimination or negative experience can be very difficult for people, especially for those who may have already experienced it in other areas of their life. They may feel that they have no reason to expect any different in death. Similarly, someone may have seen friends or others in their communities go through this or be misremembered in death. As a result, they may be concerned about the same happening to them.

[1] YouGov survey for Stonewall, LGBT Britain: Trans Report, Stonewall, 2018, p14.

If you don’t know how to refer to the person who has died, it may be most appropriate to be guided by the language those closest to them use, or by asking:

• “how would X have wanted to be referred to” or
• “how would X have described their gender?”

Use your discretion in terms of echoing the language that relatives use, if you think this may not reflect the language of the person who has died. Health and social care staff may experience situations that are challenging when navigating conversations with people who were related to, or close to an LGBTQ+ person who has died. At times staff could potentially feel as though they are in the middle of individuals, or groups who have different perspectives and views, e.g. partner(s) and chosen family vs family of origin, and they may encounter situations involving conflict.

Experiences of bereavement for LGBT+ partners

Interactions with staff around the time of a death can have a profound effect on a partner’s bereavement experience, positively or negatively. Avoid the assumption that someone is a friend, instead ask how they knew the deceased; e.g.

• “How would you and X describe your relationship?”
• Asking, e.g. “Who was important to X?” can also be helpful

Particularly for older LGBTQ+ people accessing services, prior experience of stigma and pathologisation in professional or institutional settings means that there may be considerable barriers to being ‘out’ in those environments. This can lead to re-entering the closet and / or experiencing decreased mental wellbeing at a time of increased vulnerability, such as in bereavement. It may then take longer for some people to feel comfortable sharing details of their relationship with the deceased with staff, and so it’s important to allow them to take things at their own pace and build trust with staff. Displaying subtle signs of being LGBTQ+ supportive (e.g. wearing a Progress Pride flag on a lanyard, and / or mentioning it casually in conversation) may help to make someone feel more comfortable.

Recognition of a partner’s needs and asking about their wellbeing can be a source of great support for individuals. Sensitively explore a person’s identity in line with their preferences for disclosure and consider signposting LGBTQ+ partners to additional sources of bereavement support. Social isolation and loneliness can be compounded when coping with bereavement in the absence of LGBT+ affirmative support.

Chosen family may welcome particular support in engaging with the deceased person’s family of origin. They may wish to avoid being outed, and / or they may be keen to ensure they can play an important role in handling the practical matters following death.

Staff may also receive requests for information from within a person’s community. This may be particularly prevalent if the person died without a partner or close relatives, or if the community is aware that they had an LGBTQ+ identity that should be respected. Although the Data Protection Act does not apply after death, these requests can be challenging to manage. It is important to ensure that clinical confidentiality, which is a professional responsibility, is maintained, while also acknowledging the importance of trying to enable those who are bereaved to honour the deceased and participate in grieving rituals. There are circumstances where relevant clinical information can be disclosed - see: The General Medical Council Guidance to doctors about disclosing information after a patient has died.

In some situations, a person’s chosen family or community may not feel comfortable or safe to attend a funeral or memorial service. In this and other scenarios, relatives and chosen families may choose to hold separate services or commemorations.

Death in the LGBT+ community

LGBTQ+ people are at higher risk of experiencing poor mental health, suicidal ideation and suicide [2].

Trans people in particular have been noted to have a higher rate of sudden death and also face higher rates of depression and anxiety, suicidal ideation and suicide [3]. This, compounded with the lasting effects of the HIV/AIDS crisis, means that the trans community do not have many older trans role models and many trans people cannot imagine themselves growing old.

LGBQT+ people aged 50+ are also at increased risk of social isolation [4].

Key points for staff

1. LGBTQ+ people and their partners may have particular fears about death and bereavement
2. Take a person-centred approach and do not make assumptions about a person’s sexual orientation, gender or relationship status
3. Interactions with staff can shape experiences of bereavement - be sensitive (a bereaved partner may be expecting to face discrimination) and foster trust and empathy which will likely make it easier for people to discuss and disclose their needs
4. Use neutral language such as ‘partner’ or ‘spouse’ rather than ‘husband’ or ‘wife’ (unless otherwise specified)
5. Use inclusive language e.g., pronouns that the deceased person had chosen for themselves
6. Acknowledge and affirm the relationships that the deceased person had. Consider the wellbeing of a person’s partner(s); ensuring that discussion and decision-making includes them (when appropriate) and signposting them to appropriate sources of bereavement support
7. Be aware that relationships between those who are bereaved may be complicated and non-harmonious
8. Clinical confidentiality regarding a person’s LGBTQ+ status must be maintained in line with legal regulations after a death, noting that there may be situations where information sharing is necessary
9. Where possible, communicate with, and support all those who are bereaved (e.g. next of kin, family of origin, chosen families and a person’s community) in line with confidentiality restrictions

References

[1] LGBT in Britain – Trans Report (2018)

[2] LGBTQ+ communities and suicide | Samaritans

[3] LGBT in Scotland – Health (2018)

[4] Pride in Ageing: Isolation – LGBT Foundation