Sebastian Walsh: Refusing “ash cash”

The completion of a cremation form is a service that takes time and knowledge, and in any other walk of life a service demands payment.

But I am not in another walk of life, I am a NHS doctor in England. And because our healthcare system is free for all, and reliant on goodwill and trust, I believe that the special relationship between doctor and patient is fundamentally altered with the addition of financial gain for specific tasks like cremation form completion.

Our relationships with patients don’t conclude when they die, just as they don’t end at discharge. They don’t end at discharge because we involve ourselves in discharge plans, we advise on secondary prevention, and we organise outpatient appointments. Similarly, after death we are involved in the comforting of patients’ families, we explain events, and we complete the documents necessary for the final wishes of our patients to be fulfilled.

The cremation payment (ash cash) process involves the family/estate of the deceased making payment to the undertaker, who passes the fee on to the mortuary office, and finally the doctor. It is possible that, for some doctors, the indirectness of this process eases the moral dilemma that accompanies receiving payment for completing cremation forms. If the process was different and doctors collected their fee directly from deceased patients’ relatives, would there be more doctors who declined payment?

While we should certainly be obliged to help fulfil patients’ final wishes, I strongly feel that we should do so without tarnishing our patient relationships with financial incentive.

My senior colleagues have advised that if I don’t want to be paid for completing cremation forms, I should collect the money and pass it on to charity myself, as there are stories about undertakers charging families despite doctors’ refusal of payment, and the money getting lost in the system. I have tried to overcome this potential problem by making arrangements with the hospital mortuary office for my fee to be transferred directly to the hospital trust fund.


Sebastian Walsh is a junior doctor in Shropshire between foundation and specialty training

Competing interests: none declared