After death what to do next & the body

• If the deceased has not been seen and treated by a registered medical practitioner within 28 days before death.
• Where the cause of death is unknown (whether sudden or not).
• Death occurred within 24 hours of admittance to hospital.
• Any death which may have been caused by anaesthetic, diagnostic or therapeutic procedure.
• Due to possible negligence, misconduct or malpractice.
• The death of persons in defined vulnerable groups.
• Suicide.
• Any maternal death that occurs during or following pregnancy (up to six weeks after birth) or that might be reasonably related to pregnancy.
• Any death of a child in care.
• Any infant death, such as from Sudden Infant Death Syndrome.
• Certain stillbirths.
• If the deceased was in a mental health facility, in prison or in Garda or military custody.
• Any death due to accident at work, occupational disease or poisoning.
• Any accident caused by any vehicle, aeroplane, train or boat.
• Where there are suspicious circumstances, violence or misadventure.
• Where a body is to be removed from the State.
• In certain circumstances where a body is to be cremated.
• Where a body is unidentified.
• Where a body or human remains is “discovered”.

When a death is due to natural causes, and the attending doctor can certify the cause of death, a post-mortem examination is not needed. When the cause of death is unknown, and in certain other circumstances, the Coroner is obliged by law to order a post-mortem. A post-mortem is an examination of a patient after death. The procedure is carried out by a specially trained doctor, known as a pathologist, assisted by a mortician, a specialist technician. It is performed to establish the cause of death and/or to examine the effects of treatment. Unless the post-mortem examination is directed by the Coroner your consent must be obtained before any investigations are carried out.

1. CORONER’S POST-MORTEM: The Coroner is an independent official with legal responsibility for the medical-legal investigation of certain deaths including those of a sudden, unexplained, unnatural or violent nature. In some circumstances this enquiry may necessitate a post-mortem examination. If the Coroner directs that a post-mortem examination take place the question of obtaining consent from the next-of-kin does not arise.

2. CONSENT POST-MORTEM: If a Coroner’s post-mortem examination is not required, the doctors may ask you to

agree to a post-mortem examination on your relative. Consent post-mortem examinations can be:

Full – This involves a detailed examination of all the internal organs including the brain, heart, lungs, liver, kidneys, intestines, blood vessels and small glands.

Limited You may be uncomfortable with the idea of a full postmortem. You may then be asked to agree to a limited postmortem examination. This could involve examination only of those organs directly involved in your relative’s illness. A limited post-mortem examination may only lead to an incomplete or partial assessment. It may fail to identify the cause of death and any medical conditions which affected multiple organs.

Post-mortem examinations provide valuable information on why your relative died (the cause of death). They can provide vital information for future treatment and research. As a relative you may like to know about aspects of your relative’s illness that could affect your own health. Some illnesses are hereditary and these can be identified during a post-mortem examination. It may also reveal co-existing conditions including inheritable problems whose early recognition may benefit other family members. It may also contribute to the development of new treatments for future patients with similar problems.

The benefits of a post-mortem extend beyond providing information to individual families. The data obtained from postmortem examinations is important for assessing and improving medical care and research into the nature, causes and prevention of disease. It also assists the education of doctors and medical students, and public health planning, by providing accurate mortality (death) and morbidity (illness) statistics.

A post-mortem examination typically takes two to three hours. So it may not delay any funeral at all or only change the timings slights.

Typically the post-mortem report takes at least six weeks to complete, but in complex cases the final report may take longer.

In the case of a body leaving the jurisdiction of the Coroner (being taken to another country for burial) a rapid provisional report can be sought as a matter of priority from the Coroner.

A post mortem normally  involves retention of tissues (small pieces of an organ) and fluids and may, in exceptional cases, involve retention of organs for detailed laboratory examination. Retention is done to determine and verify the cause of death. If you do not wish organs, or any tissues, to be retained, it is important that you inform the medical team when permission to carry out a consent post-mortem examination is granted. It is important that you record what you agree to on a special consent form. You will be given a copy of this form. You may prefer to agree to the pathologist carrying out the post-mortem and keeping what is necessary without going into specific details.

A post-mortem examination does not involve disfigurement of the body, which may be viewed afterwards in the same manner as if no post-mortem had been performed.

Is an ancient ritual providing an opportunity for people to offer a final mark of respect for the deceased person. Historically it was carried out by family members and whilst this is still the case in some religions it may be something that family want to be involved in when the understand the details.

The aims of last offices are to prepare the deceased for the mortuary (a funeral home or morgue), whilst respecting their cultural beliefs. But also to comply with legislation, in particular where the Coroner is involved as well as minimise any risk of cross-infection to relative, health care worker or persons who may need to handle the deceased

The body of the deceased can be left for up to an hour as a mark of respect before some of the following steps are performed

• Removal of jewellery.
• Straightening the limbs.
• Removal of mechanical equipment (e.g. pacemaker or pump)
• Washing the body.
• Mouth cleaned and the face shaved.
• Covering of Wounds, including pressure sores with a waterproof dressing.
• Eyelids are closed.
• The jaw is often supported with a pillow or cervical collar.
• The bladder is drained by applying pressure on the lower abdomen. Orifices are blocked only if leakage of body fluid is evident.
• Labelling the body.
• Dressing the body in clothes or a shroud.

Funeral directors want to protect families from the reality of a decaying body hence their preference for embalming the body. When informed of the subtle and entirely natural changes to a body many family members can cope  fine with these as in most cases they’ll have seen changes to the body in the months and days prior to death. 

Dead bodies, after initial washing with antiseptic soap, do not present the enormous contamination risks we fear. As time passes the eyes sink back, the skin changes colour and texture, but often there is a relaxing of the features that may have been tensed in the previous months of worry and pain.

In Ireland some Funeral Directors have refrigeration, so similarly if planning to keep the body at home the room needs to be kept as cold as possible and the body cool. The body can be cooled with

• Cool blanket which may be possible to hire from your Funeral Director
• Dry-ice
• ~ 25 large plastic cooling blocks of me type used for picnics.
  • These are used to keep the trunk cool as this is the main source of bacteria in the body.

It is also Crucial to avoid flies laying their eggs in the mouth and nose. These should be kept firmly and completely covered.

1. For the mouth the funeral director will most likely stitch is closed. Alternatively a simple plastic collars or scarf will keep the mouth closed.
2. The nose should be plugged with balls of cotton wool when unattended.

Note: It takes forty-eight hours for the eggs to gestate into maggots. But the coffin will also most likely be closed when a viewing is not taking place and if something does happen your Funeral Director will be experienced in this regard.

Reducing odours is also advisable

The modern embalming process involves 

1. Using a Trocar to access the various fluids in the abdomen. Suctioning the abdomen before ~1Ltr of cavity fluid is inserted into the cavity.
2. The removal of the blood and the use of ~6-24 Ltrs of a combination of embalming fluids (most of which are formaldehyde based). This is done via incision into one or more arteries. 

The embalming process uses toxic chemicals, so it should take place in a suitably equipped facility (ventilation & protective equiptment) to protect the Health & Safety of the embalmer. In Ireland many funeral directors embalm as a matter of routine and the numbers could be as high as 95% of all deaths in Ireland. 

It has the effect of pinking and plumping up the body as well as slowing the natural process of decay. Being bodily fluids then both blood and other fluids are poured into the main drains. Most embalmers and funeral directors believe that it gives a better result to families when they visit the deceased or when they are viewed in an open coffin.

Restoration can be done at the time of embalming. The results can be of immense comfort to families, even allowing for an open coffin in situations which would not have been thought possible.