On being a doctor and caregiver: Tertiary preventive (palliative) care during crisis times in Iran

Objective: This personal reflection, as a doctor, public health professional, and gerontologist, on the dying of my father with terminal cancer, provides insight into the gaps in tertiary preventive care (palliation at the end of life) during Covid-19 period in Iran. Methods: The reflection is based on the author's lived experience as a family caregiver during the final months of her father's life during Covid-19 time in Iran. Results: This narrative situates challenges within Iran's fragmented health system, where palliative care is neither routinely integrated nor systematically funded-exacerbated by sanctions and pandemic-related disruptions. Despite these gaps, Iran offers relatively accessible and affordable essential health services for much of its population. It explores how structural barriers limited access to palliative services and calls for 'dying preparedness' as a public health priority. This narrative discusses that the collaborative efforts of families and health care professionals need to be systematically integrated into health care system. Conclusions: The paper argues that system-level preparedness for end-of-life care is essential to honor patient wishes, reduce caregiver burden. This preparedness supports families through unavoidable deaths-particularly in low- and middle-income countries with no formal hospice infrastructure.