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When Death Occurs

by Elizabeth L. Cobbs, MD, Karen Blackstone, MD; Joanne Lynn, MD, MA, MS

Death must be pronounced in an official and timely way by an authorized person (such as a doctor or nurse), and the cause and circumstances of death must be certified. Fulfilling these requirements varies substantially in different parts of the United States. If a person plans to die at home, the family should know ahead of time what to expect and what to do. When a person has hospice care, the hospice nurse typically explains the protocol. If police or other public officials must be called, the family should know this and the officials should be notified in advance that the person is dying at home. Hospice and home care programs often have routines for notifying officials that spare the family uncomfortable encounters. If no hospice or home care agency is involved, the family should contact the medical examiner or funeral home director, preferably before death occurs, to learn what to expect. A death certificate is necessary for making insurance claims, getting access to financial accounts, conveying property titled to the deceased, and settling the estate, so the family often needs at least a few dozen copies.

The family may be reluctant to ask for or approve an autopsy, which, if requested, is often not paid for by insurance. Although it does not help the deceased, an autopsy may help advance knowledge about the diseases contributing to death and can help family members clear up any uncertainties about what caused death. After the autopsy, the body can be prepared by the funeral home or family for burial or cremation. Incisions made during the autopsy are hidden by clothing. Decisions about autopsy are usually best made before death because that is usually a less stressful time than immediately after death.

Prearranging and even prepaying for funeral services can be very helpful to the family, as can knowing the dying person’s preferences for the handling of the body after death. The options can range from burial to cremation to donating the body to research. Many families have a funeral or some gathering to honor the memory of the loved one. Some choose to have a funeral service soon after the person has died, whereas others choose to have a planned memorial service a few weeks or even months later.

Getting on with life after a loved one has died depends on the nature of the relationship with the deceased, the age of the deceased, experiences near the time of the loved one’s death, and the emotional and financial resources available. Also, the family often needs to examine whether they did what was expected of them and to seek reassurance. Having a talk with the doctor a few weeks after the death can help answer lingering questions. Most people who have lost a close family member experience at least 6 months of grief, which can involve disbelief, anger, depression, loneliness, disorientation, and yearning. Grief abates with time, but a sense of loss persists. People do not “get over” a death as much as they make sense of it and go on with life.