Can Dad Bring His Second Wife to Mom’s Funeral?

It’s uncomfortable having my dad be unhappy with me, but I have held my ground, because I think I did the right thing by my mother. As her second husband said, she wouldn’t have wanted Woman B there, and that was good enough for me. Was I right or wrong? Name Withheld

Funerals are not occasions at which people are at their rational best. You felt that your mother wouldn’t have wanted your stepmother at the funeral, and you said so. Did your stepmother not know that your mother continued to resent her? Or that, as your letter suggests, you do, too? If so, I can see why she might have been upset to discover this. You might consider the possibility that you were not at your rational best, either. I wonder if you had quite come to terms with your father’s new life, and whether you weighed his feelings enough when you spoke up. Still, once your stepmother discovered that she was unwelcome, I agree that she should have encouraged your father to go alone. Even if she thought it unkind or unwarranted to ask her to stay away, the feelings of the bereaved deserve respect.

She might have been hurt not just by your having made it clear that she wasn’t welcome but also by your father’s desire to go. She may still feel guilty too about her role in the breakup of your parents’ marriage, which makes your resentment to some degree justified. I would ask your father to convey to her that you hope she’ll come around and that you can understand why she was hurt by the decision to ask her to stay away. If she cares about him, she’ll probably come to see that she shouldn’t stop him from interacting with his children.

As new psychiatrists in an inner-city clinic, we face an ethical struggle. Insurance companies require “prior authorizations” with lengthy forms absurdly accepted only by fax, or endless phone calls, or they won’t pay for newer, costlier medications.

We spend hours campaigning against discriminatory insurance practices, hours that could be better used to provide psychiatric care to patients who can’t access it elsewhere because of critical shortages. After 25 years in practice, our supervisor, Dr. Claudia Baldassano, feels ill equipped to guide us in practicing in an increasingly adversarial and resource-starved system.

Prior authorizations create perverse incentives for doctors to change their prescription choices to avoid wasting hours on paperwork. Should we prescribe cheap medications with bad side effects or less effective medications to avoid prior authorizations so we can see more patients? Or should we push for the best medications for fewer patients and leave others without care? Drs. Claudia Baldassano, Behdad Bozorgnia, Lisa Jacobs, Katherine Riva, Puneet Sahota, Elyse Smolcic and Ashley Un, The Bipolar Disorders Clinic, Department of Psychiatry, University of Pennsylvania School of Medicine

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