Core Concepts for Grief-Sensitive Care

Disenfranchised grief can occur when the legitimacy or significance of a relationship is not acknowledged. The examples below highlight some situations in which relationships may go unrecognized or unsupported.

• Non-biological family - When chosen family are not formally recognized, the grief that follows their loss may go unacknowledged or unsupported.
• Patient/  provider- When a patient dies, providers’ grief may go unrecognized.
• Pets - Although human–animal bonds can hold significant emotional meaning, losses involving companion animals, including death or separation, such as being required to surrender a pet when entering a long-term care facility, are often not socially or clinically recognized.

Disenfranchised grief can also occur when the loss itself is not socially acknowledged or validated. The examples below highlight some situations in which relationships may go unrecognized or unsupported.

• Infertility - Infertility can involve a deep, often unrecognized form of grief. The loss centers on anticipated roles, identities, and imagined futures, and repeated cycles of hope and disappointment can intensify distress and isolation. 
• Gender-affirming care - Grief often includes emotions that feel contradictory. While gender-affirming care can be empowering, some individuals may also grieve aspects of a former identity or body, such as familiar roles, expectations, or physical traits associated with sex assigned at birth. 
• Older adults - Grief following the death of an older adult is often minimized due to the mistaken belief that age or illness makes the loss easier to accept. Even when a death is medically anticipated, the loss can be deeply destabilizing, as anticipation does not lessen attachment or diminish the significance of the relationship.
• Pregnancy loss - Pregnancy loss can bring profound grief that is often underestimated or minimized. Because pregnancy loss is common yet rarely spoken about openly, many patients experience their grief in isolation or feel pressure to move on quickly. 

Sometimes the challenge isn’t the loss itself, but whether the griever is seen and supported. The examples below highlight some situations in which relationships may go unrecognized or unsupported.

• Children - Children can be excluded from grief conversations due to the belief that they are too young to understand or are less affected by loss. 
• Older adults - Grief in older adults is often minimized by assumptions that loss is easier with age or life experience. These beliefs can deepen isolation, particularly when combined with health changes, limited mobility, or shrinking social circles, making grief more likely to go unseen.
• People with disabilities - People with physical, developmental, or intellectual disabilities are sometimes excluded from grief conversations or rituals based on incorrect assumptions about their understanding or emotional capacity. 
• People experiencing homelessness - Grief among people experiencing homelessness is often invisible. The person grieving may be perceived as less deserving of support due to stigma, poverty, or systemic bias. 
• People who are incarcerated - People who are incarcerated may receive delayed notification of a death, be unable to attend funerals or participate in mourning rituals, and have limited access to emotional support. 
• People with mental illness - People living with mental health conditions may experience their grief being questioned or misunderstood. Emotional responses to loss are sometimes misattributed to symptoms of a diagnosis rather than recognized as a natural human reaction to grief, which can lead to unmet support needs or inappropriate clinical responses. 

Stigmatized loss refers to grief that is dismissed, judged, or met with shame or silence, such as losses related to suicide, overdose, or homicide. Grief in these circumstances is often disenfranchised, with social and systemic stigma deepening isolation and making it harder to express grief or receive support.

Bias often shapes responses to stigmatized loss. When a death is perceived as avoidable or linked to “lifestyle choices,” it can influence how others, including healthcare professionals, respond to grief. Survivors may experience implicit judgment or blame, even without explicit comments, which can compound grief with guilt and shame.

The termination of a pregnancy can involve complex and deeply personal grief, often compounded by assumptions about how someone should feel or judgments about the decision itself. It is also important to recognize that not all pregnancy terminations are by choice, such as in cases of termination for medical reasons (TFMR). Because experiences vary widely and may include relief, grief, or both, projecting expectations or personal beliefs can increase isolation and make it harder for individuals to grieve openly or access supportive care.

Grief following the death of someone with a larger body is often shaped by societal weight stigma. The loss may be framed, including by clinicians, as a consequence of body size rather than acknowledged as the death of a whole person with meaningful relationships. This framing can deepen grief for those left behind and contribute to shame, guilt, or isolation, particularly for people who share similar body characteristics.

Diseases linked to smoking, such as lung cancer or COPD, can come with assumptions or implicit blame, even when the person quit smoking long ago or never smoked at all. These assumptions can influence how others respond to the grieving person, leading to minimized empathy or judgment-laced remarks.

Despite medical advancements, people living with or grieving someone lost to HIV/AIDS may still face harmful stereotypes rooted in outdated or discriminatory beliefs, including assumptions about sexual behavior, drug use, or morality.

Grief following homicide is often shaped by stigma, scrutiny, and blame. Survivors may encounter questions, assumptions, or implicit judgments about the circumstances of the death, which can leave them feeling examined rather than supported. This dynamic can be especially pronounced for people from marginalized communities. These added layers can compound grief with fear, anger, and shame, making it harder to mourn openly or access compassionate support.

Lack of understanding about the complexity and neurobiology of substance use can lead overdose deaths to be framed as personal failings rather than health-related losses. Survivors may encounter blame, minimization, or silence, which can compound grief with shame and isolation.

Misunderstandings about mental health can lead to the false assumption that death by suicide is simply a choice, increasing judgment and reducing empathy for those left behind. Survivors of suicide loss may face intrusive questions, assumptions about responsibility, or pressure to explain the death, which can intensify feelings of guilt and shame.