What to do when someone dies
Dying in a hospital or rest home
Much as we all want to die peacefully in our own beds, the fact is that the majority of people in NZ die in hospital or in a rest home. One source puts this figure as high as 80%. When someone dies, their death must be certified by a doctor who is qualified to fill out and sign a Medical Certifcate of Cause of Death form (MCCD). Normally this will be done by the doctor who was attending the person prior to their death. If a doctor cannot certify the death, the Coroner must be called in - see below.
When a person dies, their body starts to decompose immediately. A simple video which explains what this entails can be viewed here. If the person died in hospital they will be taken to the mortuary, where they will be refrigerated (not frozen) and the decomposition process will be slowed, but not halted. The person can normally stay in the mortuary free of charge for up to two weeks, but once the MCCD has been signed (or the body has been released by the Coroner, if one was involved) the body can be taken home by the family or friends.
If a person dies in a rest home or hospice then one of their doctors will sign the MCCD. The person will usually need to be taken away the same day, either by you or a funeral director.
Dying at home
When someone dies at home, unless there are suspicious circumstances, or the death is completely unexpected, it is not an emergency, so there is no need to call an ambulance or the police. In the case of an anticipated death, for instance of an aged parent or a friend or sibling with a terminal disease, the person's doctor will need to sign the MCCD, but this does not need to happen immediately. I have heard of one signoff happening on a Monday when the person died late on a Friday, because the person's doctor was going away that weekend - so you can take your time. The only thing which does need to happen immediately is cooling of the body as much and as soon as possible, so as to slow down decomposition.
When someone dies in the middle of the night, there is no need to let anyone else know immediately. Once you pick up the phone, other people get involved and things will start to happen. But until you do that, you can take the time to just be with your person - a relatively short and precious window of opportunity. Whoever is holding vigil with them can just be present, put the jug on, take some steps to cool the body, reminisce and generally take the time to adjust to this new and unalterable fact of life. You will more than likely be exhausted anyway so have a breather before the mayhem starts.
After-death care: embalming and infection risk
The notion of having to embalm a body because it is "unsanitary", or in order to protect public health or shield others from contagion or contamination is just nonsense. According to a NZ government publication, "The Infectious Hazards of Dead Bodies", living people pose a greater risk of transmitting infection than dead ones. The main benefit of embalming is that it halts body decomposition, disguises the visible signs of decay, improves presentation and gives a family more time to arrange a funeral. However embalming is not necessary if the person's body is in good condition and is only going to be kept at home for a short period.
If a person has died of a disease classified as "communicable" (which includes such things as tuberculosis, Hepatitis and HIV), the certifying doctor can require the body to be transported in a sealed, closed casket, and buried or cremated within 48 hours. But even in this unusual situation, you do not need a funeral director to carry out the specific handling procedures which are required - you can do it yourself. However if a person has died from old age or a non-nfectious cause (cancer, COPD etc) there is no greater risk of infection than there would be from contact with the body fluids or bodily waste of any other person.
After-death care: cleaning, dressing and keeping the body cool
It is perfectly safe and legal to keep a body at home for a few days. However it is important to keep the body cool until it can be cremated or buried. All bodies are different, and the speed of decomposition will vary significantly depending on several factors. Temperature is important but advanced disease, medications, sudden death and body size can all affect the rate at which a body will decompose. Yes some protective precautions (eg wearing gloves) should be taken when touching or handling a dead body, as it contains bacteria and viruses just like a live person does, but it is no more infectious than it would have been when the person was alive - in fact it is probably less so as the body is not breathing, and many pathogens are killed by the decay process. The microorganisms involved in the decay process are not themselves disease-causing.
A useful guide on the steps that can be taken to care for a body at home can be viewed here. Please note this is an American document and their advice on preparation for cremation does not apply here in NZ. Frozen hot water bottles, techni-ice sheets or even ordinary ice in bags from the supermarket, wrapped in towels to catch the condensation, will cool the body down and should allow it to be kept at home for several days, although even so there will be changes in appearance, and some bloating may still occur. Another American document which has more detail on ways to keep a body cool can be viewed here. Again, not everything it says translates to the NZ environment, but the basic principles are helpful.
When does a coroner need to be involved?
A coroner is called in if a person's death cannot be certified - that is, because the death was unexpected, or if the cause of death cannot be determined. All deaths occurring in violent or unnatural circumstances, during medical procedures, or while a person is in the care or custody of the state, are reported to the Coroner. Unexpected deaths are reported by police or ambulance officers who are called to attend, and at that point state mechanisms take over. Coroners have a legal duty to enquire into all deaths reported to them, investigate the circumstances and if necessary, carry out post-mortems and inquests.
If the Coroner requires an investigation, the body will be collected by a funeral director, which is paid for by the state. Until the investigation is completed, the family cannot control what happens to the body. Coroners generally try to authorise the release of a body within 24 hours of a post-mortem examination taking place, and although planning can begin, a burial or cremation cannot proceed before then.
For more information about coronial services, click here.
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