The Hospital's Quiet Transfer: Death's Quiet Journey

When a person dies in a hospital, the hospital staff will handle the official declaration of death, which is the first step to obtaining a death certificate. The body is then taken to the hospital morgue, where it is kept until the family's chosen funeral director collects it. The funeral home staff will then undress and dress the body, clean it, and remove any jewellery. The hospital will keep the deceased's belongings safe until they are collected by the person administering the estate.

The role of the coroner

A coroner is a government or judicial official who is empowered to conduct or order an inquiry into the manner or cause of death. The coroner's role is to determine the cause of any sudden, unexpected, or unnatural death, especially those that occurred abroad or under the control of a central authority. The coroner may also investigate or confirm the identity of an unknown person who has been found dead within their jurisdiction.

Coroners have a team of officers who carry out investigations on their behalf. These officers often have a nursing or paramedical background and perform scene investigations, which include evidence collection, scene interviews, and examination of the body and circumstances. The coroner must then correlate these findings with the clinical history, criminal, psychological, and family medical history.

In some cases, the coroner may decide that a post-mortem examination or an inquest is appropriate. An inquest must be held when a person dies in the custody of legal authorities, such as in police cells or prison. The coroner is responsible for issuing a death certificate, a legal document stating the cause and manner of death.

The coroner must also notify the next of kin and maintain constant contact with the family to advise them of the investigation and autopsy results and to provide any needed assistance. They also make referrals to specific groups, such as suicide survivor groups, as the situation dictates.

It is important to note that the qualifications and duties of a coroner vary between jurisdictions. While some coroners are trained in medicine, law enforcement, or forensic science, others may consult with physicians or pathologists due to the absence of medical expertise.

The involvement of funeral directors

When a person dies in a hospital, the hospital staff will be sympathetic and available to answer any questions. The hospital will care for the deceased until plans have been made with the chosen funeral director. Funeral directors are pillars of the community and are there to serve the families of the deceased. They are responsible for transferring the deceased to funeral homes from hospitals, coroner's offices, and nursing homes. They also assist with cremations, the dressing and casketing of the deceased, and ensuring funeral services run smoothly.

Funeral directors also perform a variety of tasks to assist the family of the deceased. They can help ease the concerns of families and answer any questions or address any concerns they may have. Funeral directors can also take the body to their chapel of rest until the funeral takes place.

Funeral directors are also responsible for removing any lines, drains, tubes, and implanted devices, such as pacemakers, from the deceased. These devices and attachments are left in place by mortuary staff and are to be removed by the funeral director after collecting the deceased.

In some cases, the family of the deceased may wish to see their loved one while they are still in the hospital's care. Some hospitals provide private and comfortable family rooms for this purpose. The family can make an appointment to visit their loved one before they are transferred to the care of the funeral directors.

Organ donation

When a person dies in a hospital, hospital staff will be sympathetic and answer any questions the family might have. The hospital will care for the deceased until plans have been made with the chosen funeral director. The doctor will advise if the death requires the attention of the coroner. If the deceased's wish was to donate their body to medical science, they would have needed to register for this before death with a body donation programme.

If organ donation is a possibility, the NHS organ donor register is checked, and the next of kin is consulted. The next of kin is encouraged to support the deceased's decision, and if no decision was recorded, they will be asked to make one. If the deceased is registered as an organ donor, the hospital will inform the local Organ Procurement Organization (OPO). The OPO will then decide if the deceased is a possible donor, and if so, they will travel to the hospital. The OPO will require legal consent, which can be given by checking the state or national registry. If the deceased is not registered, the OPO may ask the next of kin for approval. Once approval is given, the OPO will conduct a medical evaluation, after which they will contact the Organ Procurement and Transplantation Network (OPTN).

The surgical team will then remove the donor's organs and tissues, closing all cuts afterward. The donor's body will be left in a fit condition for the funeral procedure of their or their family's choice. An open casket funeral is possible after organ donation. The team will preserve the organs and deliver them to the recipient's transplant hospital. The recipient should be waiting at the hospital when the organ arrives, and surgery will take place as soon as possible. The OPO will follow up with the donor's family, letting them know which organs were transplanted while keeping the recipient's name confidential.

Religious and cultural customs

In Islam, family members may also wish to close the eyes of the deceased immediately after death, and it is appreciated if arrangements can be made for the patient to be turned onto their right side, facing Mecca. In the immediate moments before death, reciting prayers and hymns and being with family, relatives, or religious figures can bring comfort to Muslims.

In some African American communities, it is believed that the soul will not go to heaven if the body is cremated, and jazz funerals with brass bands and dancing are common in New Orleans. In Jamaica, funerals are often held 2-3 weeks after death to allow for preparations and the arrival of family from abroad.

In Haiti, Catholic and West African burial rituals are combined, with a priest from each religion conducting the ceremony. This is followed by a "nine-night" celebration, where villagers come together for prayer, music, singing, food, and gatherings, and it is believed that the soul departs to its destination on the ninth night.

In Vietnam, Buddhism influences the belief that a person's life is predetermined, and prolonging life is futile. Families may request a monk to pray at the bedside to guide the person into the next life.

In the Samoan, Vietnamese, and Asian Indian cultures, there is a belief that dying away from home can lead to disturbances of the spirits, and some may feel there are too many disturbing spirits in hospitals. In Korean culture, dying at home is encouraged.

In some cultures, such as Filipino, it is customary to protect dying family members from knowing their prognosis, as sharing this information is considered disrespectful or a cause for the person to lose hope.

Funeral customs also vary between religions. Buddhists may practise cremation, water burial, or inhumation depending on local customs. Orthodox Jews are opposed to cremation, while some more liberal groups permit it. Roman Catholicism and Orthodox Churches favour burial over cremation due to the belief in the physical resurrection of the body.

Cultural competence is an important aspect of nursing care, and nurses are encouraged to learn about the cultural and religious practices of their patients to provide respectful and appropriate care.

The emotional impact on families

Experiencing the death of a loved one in a hospital setting can have a profound emotional impact on families. The death of a relative is often associated with loss and can trigger a range of emotions, including anger, guilt, sadness, and helplessness. The way families process these emotions varies, and while some may express anger towards hospital staff, others may direct their anger inwards, experiencing guilt and self-blame.

The emotional impact can be particularly acute when the death is sudden and unexpected. In such cases, relatives may struggle to accept the reality of their loss and may find it challenging to cope with the news. The shock and sensitivity that accompany unexpected deaths can heighten the risk of a violent grief reaction if families perceive a lack of compassion or kindness from the healthcare team.

The process of breaking the news of a death in a hospital setting can be highly stressful for treating doctors and clinicians. The manner in which the news is delivered can significantly influence the family's grief reaction. Clinicians are advised to employ special skills and follow step-by-step guidelines when communicating with bereaved families. This includes preparing relatives for the news, using simple language, and facilitating the family's grief reaction and their viewing of the deceased.

The death of a patient in a hospital can also elicit emotional responses from medical professionals, including doctors and nurses. Studies have shown that doctors experience moderate to strong emotional impacts, with women and those who cared for the patient for longer reporting stronger reactions. Nurses, who often have more frequent and prolonged contact with patients, may develop strong bonds and experience emotions such as compassion, sadness, and helplessness upon a patient's death.

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