Dual Identities of Family Physicians Caring for Their Dying Family Members: An Interpretative Phenomenological Analysis

ABSTRACT

Introduction

Although professional guidance generally discourages physicians from treating their own family members, family physicians often become involved in caring for dying relatives. However, little is known about how they experience caring for dying relatives. This study aims to explore how family physicians made sense of caring for a dying family member while simultaneously inhabiting the roles of physician and family member.

Methods

We conducted an interpretative phenomenological analysis (IPA) of family physicians in Japan who had cared for a dying family member as the primary physician. Participants were recruited through purposive sampling. Semi‐structured interviews were conducted and analyzed iteratively according to the methodology of IPA, focusing on how participants made sense of their experiences.

Results

Seven family physicians participated. Participants described a dynamic interplay between two identities, physician and family member, throughout the process of providing end‐of‐life care. Four interrelated themes were identified: negotiating for practical family needs, leading decision‐making within the family contexts, redefining the best care, and using the physician role as both protection and connection. Participants fluidly navigated and integrated these identities. Care was guided less by biomedical correctness than by relational considerations, with participants balancing responsibility and emotional burden.

Conclusions

Caring for a dying family member involves not only role conflict but also the integration of professional and familial identities. This duality can enable context‐sensitive and meaningful care while introducing ethical and emotional complexity. Rather than focusing solely on prohibiting such involvement, support should help physicians navigate these roles in practice.

1. Introduction

Despite widespread professional guidance advising physicians not to treat members of their own families [1, 2], family physicians often provide medical care to relatives due to practical and contextual realities [3]. For example, a survey in Japan found that approximately 80% of family physicians had treated family members or relatives [4]. In particular, the perception that a relative is not receiving adequate care can strongly motivate physicians to intervene [5].

Caring for family members often involves significant ethical dilemmas and role conflicts. Physicians must navigate the dual identity of clinician and family member, facing conflicting expectations and complex ethical challenges [6, 7]. They may also be concerned about incomplete history taking, limited physical examination, or biased clinical judgment [8]. In addition, care within family relationships involves both benefits and burdens arising from close social and cultural ties [9, 10]. Consequently, decisions about whether to treat family members are often shaped by contextual factors such as illness severity and care setting [11].

These tensions may be particularly pronounced in end‐of‐life care. End‐of‐life care involves repeated decisions under prognostic uncertainty, balancing life‐prolonging treatment with comfort, and supporting both patients and families through the dying process [12, 13]. Because these decisions are deeply shaped by patients' values, family relationships, and social context, they cannot be resolved solely through biomedical expertise. Family physicians frequently provide end‐of‐life care across home and community settings because their practice emphasizes comprehensive, relationship‐centered, and community‐based care. As a result, when a family member nears the end of life, family physicians may find themselves called upon by family members or feel a professional responsibility to become involved in the care. In Japan, this issue is particularly relevant in the context of an aging society and the growing role of community‐based palliative care. However, participating in the care of a dying loved one entails both unique opportunities and ethical challenges, particularly when physicians may undertake actions unavailable to non‐physician family members [14]. Understanding these experiences may help family physicians reflect on and prepare for caring for their own family members at the end of life.

This study used an interpretative phenomenological approach to explore how family physicians made sense of caring for a dying family member while simultaneously inhabiting the roles of physician and family member. By illuminating these meaning‐making processes, we sought to deepen understanding of the ethical, relational, and professional complexities of this experience.

2. Methods

2.1. Interpretative Phenomenological Analysis

This study used interpretative phenomenological analysis (IPA) to explore how family physicians made sense of their experiences of caring for dying family members. Such experiences should be emotionally complex and under‐explored, making IPA an appropriate methodological approach [15].

Grounded in Heideggerian philosophy, IPA understands individuals as shaped by their lived worlds and experiences [15]. Both participants and researchers are inevitably influenced by their contexts and prior experiences, and meaning emerges through their interpretive engagement. This study therefore explored how participants made sense of their experiences, including meanings not immediately apparent.

IPA combines careful phenomenological attention to lived experience with a hermeneutic interpretation, enabling in‐depth engagement with participants' narratives [16, 17, 18]. Using a double hermeneutic approach, where researchers interpret participants' interpretations, we examined how participants understood their experiences.

2.2. Setting and Participants

IPA emphasizes detailed examination of individual cases, using small, homogeneous samples (4–6 participants) to enable in‐depth understanding [16, 17, 18]. We used purposive sampling to recruit family physicians in Japan who had served as the primary physician for a dying family member. Family medicine in Japan emphasizes comprehensive, continuous, and relationship‐centered care that integrates biomedical, psychological, family, and community perspectives. Family physicians therefore commonly provide home‐based and end‐of‐life care and often develop long‐term relationships with patients and families. JM recruited participants through personal connections and social media.

During recruitment, a family physician who had cared for and witnessed the death of a family member at home while a medical student volunteered to participate. Although this experience preceded formal family medicine training, the participant subsequently became a practicing family physician. We included this individual as a comparative case, not to broaden the sample, but to illuminate how the absence of an established physician identity shaped the experience. During analysis, this case was interpreted alongside the other participants while paying particular attention to both convergent and divergent patterns. Rather than generating a separate theme, it served as a comparative case that refined our interpretation of the role of professional identity across the dataset.

2.3. Data Collection and Analysis

JM conducted online, semi‐structured in‐depth interviews between September and November 2025. The interview guide was developed by the research team based on the study aim and the IPA approach, which seeks to explore how participants make sense of significant lived experiences. Initial questions focused on participants' experiences of providing end‐of‐life care for a family member while serving as the primary physician. After the second interview, the guide was refined to explore emerging concepts in greater depth. Table 1 shows the summary of the interview guide (See File S1 for detail). Each interview lasted approximately 1 h and was audio‐recorded and transcribed.

TABLE 1.

Summary of the interview guide.

Domain	Example interview questions
Overall experience	Can you describe your experience of caring for a family member at the end of life as their primary physician?
Context	Can you describe the setting in which care was provided?
Involvement	In what ways were you involved in your family member's care?
Family relationship	How did your family relate to you during this time?
Interprofessional relationship	How would you describe your relationship with other healthcare professionals?
Decision‐making	How did you approach end‐of‐life decision‐making?
Role conflict and integration	How do you now understand any tensions between your roles as a physician and as a family member?
Bereavement	How have your feelings about your family member's death evolved over time?
Meaning‐making	What does this experience mean to you now?

Following IPA, we analyzed each case idiographically before moving to the next, bracketing insights from previous interviews to remain open to new interpretations. The first and second authors collaboratively refined interpretations through iterative discussion according to the following process [18]:

1. Reading and re‐reading: We immersed ourselves in each transcript through repeated reading to develop a holistic understanding of the participant's narrative.

2. Initial noting: We recorded exploratory comments at descriptive (what was said), linguistic (how it was expressed), and conceptual (interpretive reflections) levels.

3. Developing emergent themes: We reviewed these notes to identify concise experiential themes that captured psychologically meaningful aspects of how each participant understood and interpreted their experience. Each theme remained grounded in the participant's own account while incorporating the researchers' interpretive insights.

4. Searching for connections within each case: We examined relationships among emergent themes and organized them into conceptually related clusters, producing a coherent account of each participant's lived experience.

After completing the analysis of individual cases, we compared patterns across participants to identify both shared experiential structures and important variations. Through iterative discussions, related theme clusters were integrated into higher‐order themes that captured the dynamic processes common across cases while preserving individual nuance. Finally, findings were interpreted in relation to relevant theoretical perspectives and presented using illustrative quotations and interpretive commentary. Participants reviewed summaries of the findings.

2.4. Reflectivity

The first author (MD, PhD) is a family physician and researcher in health professions education (HPE). In June 2024, he diagnosed his father with advanced cancer and subsequently assumed dual roles as physician and son, providing inpatient and home‐based palliative care. He was present at his father's death in March 2025. Reflecting on this experience, he recognized the burden of holding responsibility for both medical and familial decision‐making. This experience informed the study. As an interviewer, he listened openly while occasionally sharing his own experience to facilitate reflection.

The second author (MD, PhD) is also a family physician and HPE researcher. Unlike the first author, the second author had no comparable personal experience of caring for a dying family member. During analysis, the first and second authors discuss emerging interpretations repeatedly. The second author questioned interpretations that appeared to reflect the first author's own experience rather than the participants' accounts and encouraged consideration of alternative explanations grounded in the data. Differences in interpretation were explored until a shared understanding was reached. These discussions enabled the research team to distinguish participants' meanings from the first author's prior assumptions and strengthened the credibility of the analysis.

2.5. Ethical Considerations

Participation was voluntary, and written informed consent was obtained. Interviews were anonymized. Participants can receive a voucher worth 2000 JPY as an incentive. This study followed the Consolidated criteria for reporting qualitative research (COREQ) [19].

3. Results

Seven family physicians participated (Table 2). Participants described a dual identity, physician as a family member and family member as a physician, throughout the process of deciding to provide care, delivering care, and witnessing death. These dimensions interacted dynamically and complementarily.

TABLE 2.

Participants' demographics.

No	Age	Sex	Years of professional experience	Patient (time)	Care situation
1	37	Female	14	Grandfather (5 years ago)	Hospital/Nursing care facility
2	41	Male	18	Grandfather (8 years ago)	Home‐based care
3	71	Male	41	Father (16 years ago)	Hospital
4	48	Male	24	Father (16 years ago)	Hospital
5	62	Male	38	Father (5 years ago) Mother (2 years ago)	Home‐based care
6	73	Male	50	Father (4 years ago)	Hospital
7	44	Male	12	Mother (15 years ago)	Home‐based care (He cared for his mother when he was a medical student.)

3.1. Negotiating for Practical Family Needs

Participants often assumed responsibility for care when family members' conditions worsened based on practical considerations:

When I saw my grandfather restrained in another hospital, I thought his condition would deteriorate. I arranged his transfer to my hospital. (Participant 1)

When my father suddenly became ill, I took him to my hospital so I could coordinate care, even if a transfer to another tertiary hospital became necessary. (Participant 3)

They also negotiated workplace arrangements to enable care:

My parents asked me to provide end‐of‐life care at home for my grandfather. It was about an hour from my clinic. I asked my clinic if I could visit on my days off without burdening staff. […] Without me, home‐based care would have been unrealistic. (Participant 2)

In this way, participants actively negotiated clinical, logistical, and professional constraints to meet the practical demands of caring for their dying family members.

3.2. Leading Decision‐Making Within the Family Contexts

Participants often assumed leadership in decision‐making:

My sister told me that, since I was taking care of our father, I should decide. […] I made all the decisions myself. (Participant 6)

They believed this reduced the burden on other family members:

I avoided discussing details because my family was overwhelmed. I shared the overall course and prognosis, but I didn't go into specifics like IV fluids or lab results. (Participant 4)

Decision‐making was not always straightforward. Their dual role enabled a deeper understanding of the family context, while prompting caution against unilateral decision‐making:

We understood my father's wish to care for my mother and decided against surgery. (Participant 5)

Although I explained that hospitalization could improve my grandfather's infection, he insisted on dying at home. […] while medically appropriate treatment was not accepted, I could understand this as a family member. I was also convinced that the rest of the family felt the same. […] At the same time, I had better involve other healthcare professionals to avoid carrying everything alone and making decisions in isolation. (Participant 2)

Participants often emphasized the uniqueness of family contexts. They recognized their inseparability from care:

Our family relationships are quite distinctive. (Participant 1)

I'm not sure explanations would be fully understood. (Participant 2)

3.3. Redefining the Best Care

Participants believed that they were uniquely positioned to provide the best possible care because they combined professional expertise with intimate knowledge of their family members and accepted responsibility in both roles:

I can take full responsibility for what is best for my family. (Participant 4)

Participants reported that end‐of‐life care does not primarily seek biomedical correctness, and perceived greater advantages in the care of their family members:

Neither my parents nor I were seeking a medically correct answer. Objective correctness is not the priority. I was in the best position to provide care. (Participant 5)

Participant 5 further described how this commitment to providing the best possible care ultimately blurred the distinction between caregiver and care recipient:

I provided various forms of care, hoping to ease things, even if my mother might not have wanted them. She accepted them without resistance. It felt like a reversal of roles: I was the one relying on her. […] I wanted to do everything I could, and she generously allowed me to do so.

3.4. Using the Physician Role as Both Protection and Connection

Participants described how their professional identity sometimes buffered the emotional strain of witnessing a family member's death:

As my father was nearing death, I assessed him calmly from a medical perspective. That helped protect me. […] After the funeral, I was suddenly overwhelmed by fatigue I hadn't felt before. (Participant 4)

To deepen our interpretation, we drew on the comparative case (Participant 7), whose caregiving experience occurred before establishing a professional identity as a family physician. Unlike the practicing family physicians, Participant 7 described profound distress when unable to act as a healthcare professional. This contrast highlighted how an established physician identity could function as psychological armor, helping participants engage with impending loss while maintaining a sense of agency. Rather than representing a separate experience, this case sharpened our understanding of the protective role of physician identity observed across the dataset:

I felt I couldn't do anything for my mother right in front of me. I was terrified. It didn't feel real. […] I felt I shouldn't even be there if I couldn't help medically. It was a fear that shook my sense of self. (Participant 7)

At the same time, participants described a deepening of familial connection. Some found meaning and a sense of fulfillment in being present as both physician and family member, and believed their loved ones valued this:

Seeing my grandfather daily during rounds, I learned things I wouldn't have known as just family. […] It was a precious time that allowed me to be with family I usually couldn't spend much time with. (Participant 1)

My father had a difficult life, but I believe he found some fulfillment in being cared for by his physician son at the end. (Participant 3)

4. Discussion

This study explored how family physicians made sense of caring for dying family members while inhabiting dual identities as physician and family member. When family physicians care for dying family members, they do not simply experience role conflict; they inhabit and negotiate a fluid dual identity as both physician and family member. These identities were not fixed or opposing but dynamically enacted, integrated, and at times redefined across the trajectory of care. Rather than undermining care, this duality often enabled context‐sensitive, responsive practice. This process was reflected in participants' efforts to negotiate practical needs, assume responsibility for care, redefine what constituted the best care, and ultimately use their physician identity both as protection and as a means of deepening family relationships.

Social identity theory proposes that people hold multiple social identities, and that different identities become salient depending on the social context [20]. In this study, participants enacted both physician and family identities, with clinical situations foregrounding the physician identity and relational situations foregrounding the family identity. Rather than simply alternating between roles, they often integrated them, constructing a hybrid approach to care. In fact, participants did not merely alternate between roles; they blended them, creating a hybrid mode of care that combined biomedical expertise with intimate knowledge of the patient's life. This dynamic identity negotiation was evident, as participants negotiated practical constraints to become involved in care (Theme 1) and later assumed leadership in family decision‐making (Theme 2). This finding may call into question guidance that frames such involvement primarily as ethically problematic [1, 2].

Professional identity formation describes the ongoing process through which physicians integrate professional roles with their personal values and identities throughout their careers [21, 22]. Rather than viewing professionalism as the maintenance of rigid boundaries, our findings suggest that professionalism may involve the capacity to navigate and reflect on such boundary crossings in context. That is, participants' experiences suggest that caring for a dying family member did not suspend professional identity but reshaped it, as physician and family identities became increasingly integrated. This was reflected in participants' descriptions of redefining the best care (Theme 3), where contextual understanding and relational knowledge were treated as clinical resources rather than sources of bias. Educational approaches that encourage reflective practice and discussion of emotionally and ethically complex experiences, including caring for family members, may prepare physicians for real‐world practice. Although the tension between professional and familial identities is likely not unique to family physicians, our findings suggest that the way these identities were negotiated may reflect the distinctive orientation of family medicine. Family physicians are trained to integrate biomedical, psychological, family, and community perspectives and to provide longitudinal, relationship‐centered care. This professional orientation may explain why participants viewed intimate knowledge of family context not simply as a source of bias but as a clinical resource for tailoring care.

The ethics of care argues that ethical decisions arise from relationships, interdependence, and responsiveness to others rather than solely from abstract principles or universal rules [23, 24]. Participants' descriptions of leading decision‐making within family contexts (Theme 2) illustrate that their decisions were guided less by abstract principles than by relationships, responsibilities, and the lived realities of those involved. Taking the lead in decision‐making was not only an expression of expertise but also a relational act aimed at protecting others from burden. At the same time, participants remained attentive to patients' values, even when these conflicted with biomedical recommendations. They even recognized that their caregiving also served their own emotional needs, revealing the mutuality inherent in care. Rather than signaling compromised professionalism, this underscores that such care is fundamentally relational, shaped by interdependence rather than detachment.

Participants also described their physician identity as both shielding and opening (Theme 4). A biomedical stance could function as armor, creating distance from the immediacy of loss. This same involvement also enabled moments of closeness, meaning, and even fulfillment. These accounts resist a simple framing of harm or benefit. Instead, they point to the ambivalence of caring for a dying family member, an experience that is simultaneously burdensome and meaningful.

Taken together, these findings suggest that current approaches, which emphasize avoiding physician involvement in family care, may be overly reductive. In practice, such involvement is often a response to gaps in care, relational obligations, and contextual realities [25]. The question may not be whether physicians should care for family members [26], but how they can do so well. Supporting shared decision‐making, involving other professionals, and creating space for reflection may be more constructive than prohibition [22].

Together, the four themes describe a coherent trajectory rather than four independent experiences. Participants first negotiated becoming involved in care, then assumed responsibility for decision‐making, gradually redefined what constituted good care by integrating physician and family identities, and finally reflected on the emotional consequences of inhabiting those dual roles. This progression highlights that caring for a dying family member is best understood as an evolving process of identity negotiation rather than a series of isolated ethical dilemmas.

4.1. Limitation

This study has some limitations. First, the small, purposively selected sample and the Japanese healthcare context may limit the transferability of the findings to other settings. Second, because all participants were family physicians, the findings may reflect the professional values of family medicine, such as continuity and relationship‐centered care, and may not fully represent the experiences of physicians from other specialties. Third, we included one comparative case involving a medical student who cared for a dying family member before establishing a professional identity as a family physician. Although this case enriched our interpretation of physician identity, it differed from the experiences of the other participants. Finally, the first author's personal experience may have influenced data collection and interpretation. To enhance analytic rigor, we employed reflexive practice throughout the study and regularly discussed emerging interpretations with the second author, who provided an independent perspective.

5. Conclusions

Family physicians caring for dying family members navigate a dynamic interplay between professional and familial identities. This study shows that this duality is not only a source of conflict but also a resource for delivering context‐sensitive, meaningful care. Recognizing and supporting this complexity may help physicians better address the realities of end‐of‐life care within families.

Author Contributions

Junki Mizumoto: conceptualization, methodology, software, data curation, formal analysis, investigation, funding acquisition, writing – original draft, visualization, project administration, resources. Hirohisa Fujikawa: data curation, validation, formal analysis, supervision, writing – review and editing.

Funding

This work was supported by JSPS KAKENHI Grant Number 24K23757.

Ethics Statement

This study was approved by the Ethical Committee of Ehime Seikyo Hospital (No. 51‐2‐2025‐005).

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

File S1: Interview guide.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.