March 08, 2011

The Last Hours of Living: Practical Advice for Clinicians: Notifying Others of the Death

MedscapeCME - Linda Emanuel, MD, PhD; Frank D. Ferris, MD; Charles F. von Gunten, MD, PhD; Jamie H. von Roenn, MD

6. Notifying Others of the Death

Spiritual advisors or other interdisciplinary team members may be instrumental in orchestrating events to facilitate the experiences of those present for a death. Those who have not been present may benefit from listening to a recounting of how things went leading up to the death and afterward. Grief reactions beyond cultural norms may suggest a risk for significant ongoing or delayed grief reactions.

When letting people know about the death, follow the guidelines for communicating bad news. Try to avoid breaking unexpected news by telephone, as communicating in person provides much greater opportunity for assessment and support. If additional visitors arrive, spend a few moments to prepare them for what they are likely to see.

Once family members have had the time they need to deal with their acute grief reactions and observe their customs and traditions, then preparations for burial or cremation and a funeral or memorial service(s) can begin. Some family members may find it therapeutic to help bathe and prepare the person's body for transfer to the funeral home or the hospital morgue. For many, such rituals will be their final act of direct caring.

Depending on local regulations and arrangements, some funeral directors will insist on the completed death certificate being present before they pick up the body. All will require a completed death certificate to proceed with any body preparation and registration of the death. To avoid delaying the process, ensure that the clinician who will complete the certificate has ample warning that one will be required.

For many, moving the body is a major confrontation with the reality of the death. Some family members will wish to witness the removal. Others will find it very difficult and will prefer to be elsewhere. Once the body has been removed and family members are settled, professional caregivers can offer to assist them with some of their immediate tasks. They may notify other clinicians and caregivers that the death has occurred so that services can be stopped and equipment removed. Local regulations governing the handling of medications and waste disposal after a death vary. When family members are ready, professional caregivers can let the family know how to reach them, and then leave them to have some privacy together.

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