Palliative care experts have developed a new deathbed etiquette to cope with the COVID-19 pandemic, when loved ones cannot be at the bedside.

Dr Amy Gadoud is Senior Lecturer in Palliative Medicine at Lancaster University’s Medical School and a consultant for both Blackpool’s Trinity Hospice and Blackpool Teaching Hospitals NHS Foundation Trust.

She said: “That's the bombshell that we've all been hit by in this coronavirus crisis. Also if people are dying of some other disease at this time, it's possible that one relative may be allowed into the hospital or care home. It's possible- it’s also possible you may not.”

Dr Gadoud is one of the contributors to a new guide entitled Deathbed Etiquette for COVID-19 from the Centre for The Art of Dying Well at St Mary’s University.

The guide has been written to help families and friends feel close to a loved one, even if they are apart or together only on screen.

Deathbed Etiquette for COVID-19 recommendations:

· Do what you can to help you feel close to your loved one even if you are apart.

· Think about what your loved one would think and say. They will not want you to worry

· Communicating virtually may be an option.

· What can I say? Speak from the heart.

· Trust in the good care of the doctors and nurses. They are there for your loved one and for you.

· Take care of yourself. It is important that you keep well.

· Draw on your inner strength. Do what is helpful to you.

· Don’t let feelings of guilt take over. Accept your feelings and let them pass. Think of the good advice you might give to someone else and then take it yourself.

· Keep up with family, friends and those who will lift your spirits.

At St Oswald’s Hospice in Newcastle, for example, patients with COVID-19 are allowed to have a visitor although they will be asked to wear personal protective equipment, keep their distance or stay for a shorter time.

Dr Jo Elverson from St Oswald’s said: “For many of our patients the difficulty is that visitors may be unable to come in because they live in another part of the country, have to stay at home because they themselves have COVID-19 symptoms, or may be in a vulnerable group where they have been advised that the risk is too great.”

For those who cannot be physically present, the team at St Oswald’s are trying to make sure people have access to phones or tablets where they can view see their loved ones on screen.

Dr Gadoud said: “Healthcare professionals are never going to desert the dying. The contact will always be there, but it might be a little different.”

If someone is dying at home, touch may be possible in a different way, with good hygiene and the use of appropriate equipment.

“There is no rule, there's no right or wrong way of doing things. It’s best to be guided by the relationship that you've always had with (your loved one) and to do things that you always would.”

Dr Elverson encourages relatives to talk to staff and to find out the best way to keep in touch and to send in messages.

“You can always write a message, send a text, send an email or something, or ask the staff to pass on messages of love. I know that certainly everyone that I've spoken to, would be more than happy to be that messenger, and to try and convey that care and that love, that you want to pass on to your loved one.”

When touch is not possible, eye contact is extremely important - although for some cultures this may be different.

“I think there’s something about the eye contact, there's something about just being physically present. We quite often say to people just keep talking, even if their loved one is asleep or doesn't seem to be strong enough to listen to them, actually having the sound of their voice in the background is really helpful.”