• Choose a category
• All
• Classic-Fiction

By Root 1477 0

(Neuberger 2004) and needs to remembered when administering Last Offices in order to avoid presumptions. While those who have settled in a society where there is a dominant faith or culture other than their own might appear to increasingly adopt that dominant culture, they may choose to retain their different practices at times of birth, marriage or death (Neuberger 1999). Approaches to death and dying also reveal as much of the attitude of society as a whole as they do about individuals within that society (Field et al. 1997).

Practices relating to Last Offices will vary depending on the patient’s cultural background and religious practices (Nearney 1998). The following sections provide a guide to cultural and religious variations in attitudes to death and how individuals may wish to be treated. The information that follows is not designed to be a ‘factfile’ (Gilliat-Ray 2001, Gunaratnam 1997, Smaje and Field 1997) of information on culture and religion that seeks to give concrete information. Such a ‘factfile’ would not be appropriate as we need to be aware that whilst death and death-related beliefs, rituals and traditions can vary widely between specific cultural groups, within any given religious or cultural group there may be varying degrees of observance of these issues (Green and Green 2006), from orthodox to agnostic and atheist. Categorizing individuals into groups with clearly defined norms can lead to a lack of understanding of the complexities of religious and cultural practice and can depersonalize care for individuals and their families (Neuberger 1999, Smaje and Field 1997).

Last Offices for an expected death may be very different to those given to a patient who has died suddenly or unexpectedly (Docherty 2000) or in a critical care setting, so these issues will be dealt with later in this chapter. In certain cases the patient’s death may need to be referred to the coroner or medical examiner for further investigation and possible postmortem (DH 2003c). If those caring for the deceased are unsure about this then the person in charge of the patient’s care should be consulted before Last Offices are commenced.

Prior to the patient’s death, whenever possible it is good practice to ascertain if the patient wishes to donate organs or tissue following their death. For further information on this, visit www.nhsorgandonor.net.com

Preprocedural considerations

Before undertaking Last Offices several other events must take place.

Confirmation of death

Death should be confirmed or verified by appropriate healthcare staff. At present, confirmation of death is usually done by a medical doctor but can be undertaken by nurses in certain healthcare settings, if death is expected and local policy permits this (RCN 1996). Unexpected deaths must be confirmed by a medical doctor (and usually a senior medical doctor). Confirmation of death must be recorded in the medical and nursing notes (and care pathway documentation if necessary).

A registered medical doctor who has attended the deceased person during their last illness is required to give a medical certificate of the cause of death (Home Office 1971). The certificate requires the doctor to state on which date they last saw the deceased alive and whether or not they have seen the body after death (this may mean that the certificate is completed by a different doctor from the one who confirmed death). Out-of-hours medical examiners can now certify death where there is a cultural/religious requirement to bury, cremate or repatriate patients quickly (DH 2008). Medical examiners can also certify for reportable deaths where a postmortem is not deemed necessary (DH 2008). The medical examiner (ME) is a primary care trust-appointed but independent health professional who determines the need for coroner referral. For those who need a quick burial within 24 hours, this remains at the discretion of the local births and deaths registrar in each council and depends on the individual opening hours and on-call facilities. Local hospital policy should outline procedures for out-of-hours