initiative by brake

Sudden bereavement: Viewing the body

Seeing a body immediately  

It should be recognised firstly that some people who are suddenly bereaved have no choice over whether they ever see the body or not, because they see the body at a very early stage due to circumstance.

Some witness the death. For example, people who witness the death of someone close to them in a road crash or a drowning or a sudden medically-caused death.

Other people arrive at the scene of the death just after that death. For example, someone discovers a loved one's suicide, or is alerted by someone else to the death of a loved one nearby that has only just happened.

When recounting this experience later to researchers of sudden bereavement, suddenly bereaved people who witnessed a death or arrived at the scene shortly afterwards said they had an overwhelming desire to be beside the dead person; to hug and touch them and comfort them. They did not want the dead person to be alone and they wanted the dead person to be with someone who loves them. In other words, the bereaved person still felt their dead loved one had a "social identity" and needed nurturing [1]. Often suddenly bereaved people at this time will resist strongly any attempt by professionals or other carers to keep them away from their loved one's body.

The bereaved person's experience of seeing their loved one's body at this time will be different to seeing their loved one's body later. There will be no control at this early stage over whether or not they see any visible injuries or physical damage to their dead loved one's body. There will be no ability to prepare for the situation they find themselves in. In the case of violent disasters, it is often a chaotic, fast moving experience.

Seeing a body later

After a sudden death there are usually opportunities to see the body in a more formal and usually much calmer setting, such as when it is laid out in a mortuary or funeral parlour. There are often many people who were close to the person who died, including children, who may wish to consider seeing the body at this stage, and who did not see the body at the time of the death.

The decision to view a body of a loved one is a big decision. It results in a suddenly bereaved person experiencing something that usually creates a strong memory, central to the experience of the bereavement. This can be a memory viewed positively or negatively, or both. However, the feelings that result from that memory may change over time.

The decision not to view a body is also a big decision. It can result in feelings of regret at not seeing the reality of the death with "my own eyes". Arguably this is something that may be felt more often in cases of sudden death, due to the unexpected and unanticipated nature of the death, and therefore the feeling of unreality often associated with it.

Research by Oxford University published in the British Medical Journal [2] interviewed people suddenly bereaved about their experience of viewing or not viewing the body of their loved one.

It concluded:

• Many people bereaved by a sudden and traumatic death think it is important to see the body of their loved one.

• However, within a family there will be different attitudes; some bereaved relatives may want to view, but others will not, and some will find viewing helpful, but others may find it distressing.

• Seeing a damaged body is inevitably distressing, but in the research was often not regretted. Clinicians should not assume that relatives will be harmed by seeing a bruised or damaged body.

• Those who had mixed feelings or regretted seeing the body felt they had lacked choice or preparation.

• The way that relatives refer to the body can be a strong indication for professionals about whether the person who died retains a social identity for the bereaved.

Therefore, while many suddenly bereaved people may find the experience helpful, it is inadvisable to encourage a suddenly bereaved person to view a body. To enable a bereaved person to make the choice that is best for them, you can help by asking them relevant questions and providing them with relevant information. The below guidance helps you to do this.

Information about the body's appearance

Some people who have been suddenly bereaved may want to view the body of their loved one because they have had a positive experience of viewing a body previously, for example a grandparent who died in old age. If someone dies of old age then their body in death often looks fairly similar to their body in life. However, when someone dies suddenly in childhood or in mid life their body may look very different to how the person looked when alive. This is particularly the case if their death was violent, or they had urgent medical intervention such as a major operation prior to death.

A body may be different in death to life because:

• injuries or surgical procedures have damaged the body. For example, skin has changed colour due to internal bleeding, or the body's facial appearance has changed due to a broken jaw, or cuts, etc.

• a mortician or funeral director has changed a body's appearance through clothing, or hair arrangement, or cosmetics. Such "dressing" of the body may be very different to how the person in life would have done it.

• the body smells different. For example, due to embalming processes, or antiseptics used during an operation.

Maggie says: "I had seen the body of my grandmother so I wasn't worried about seeing my husband's body. I knew that seeing my grandmother's body had helped me come to terms with her death so I thought it would be the same when I saw Gary's body. I just didn't think how different it would be. Gary's body was destroyed by the car crash. When he was in the Intensive Care Unit of the hospital the staff had wired up his broken jaw and not bothered to tell me it was broken because he had so many internal injuries and other broken bones so they felt his jaw was unimportant information; a minor detail. But when he died and I went to see the body I was utterly shocked that his face looked so collapsed. I thought he would look about the same in death as he had when he was on the life support machine. I remember screaming "That's not my husband" and running out. It was horrible. I felt terrible, and I felt I had behaved terribly, with no self control. This left me with feelings of misery and some embarrassment."

As someone helping a bereaved person, it is therefore useful to know what changes have occurred to a body, and, firstly, to tell a bereaved person that there have been changes, then, secondly, ask the bereaved person if they wish to know the details of those changes in order to assist them to make the decision to view a body or not.

Some bereaved people may not want to be told about any changes to the body and may not want to view the body. They may wish to remember the person how they were in life, and not have this memory intruded upon in any way, either by being told what the body looks like or by seeing the body.

Some bereaved people may want to be told the changes, but then choose not to see the body.

Some bereaved people may want to be told the changes and then choose to see the body.

Some bereaved people may want to discover the changes for themselves and not be receptive to being given information second hand.

Information about the environment in which the body is housed

Charlotte arrived to view the body of her sister. She was taken into an empty room with no explanation. With no warning, a curtain was swept back and she found herself within a metre of her sister's body, on a table behind the curtain

Charlotte says: "It was like a magician's trick and a terrible shock. It made me want to run out of there straight away. I burst into tears and only stayed a few minutes. I really regret the way this made me feel and the whole experience."

John went to view the body of his son in a hospital mortuary. He was taken into a small intimate room containing only his son's body. While he was in the room a member of the mortuary staff stood solemnly in the corner. "It was very strange. I had been anticipating this time with my son's body and wanted it to be special and private. Yet this man was in the corner the whole time. I remember it made me feel very self-conscious and left me feeling like he was a prison warden; there to check I didn't do anything silly, such as run off with the body. It didn't give me a good feeling. It was such a vivid experience that I remember every single detail. I remember that the man was wearing a white coat with a small enamel badge on it of a steam engine. I have no idea why; I presume he was a train enthusiast. But I remember thinking "Why are you interfering with my private experience of grief by being there and making me think about steam trains when I want to be thinking about my son?" It made me feel unreasonably angry towards the man at a very difficult time."

Every detail about the viewing experience matters and every detail can be explained to a person who is going to view a body, before they view a body. As someone caring for the suddenly bereaved person, you can help by:

1. Talking to the bereaved person about what they want the experience to be like. Do they have any requests, for example they may want to be left alone, or only see the body at a distance or through glass.

2. Talking to the mortuary staff about what the experience will be like. For example, will it be possible for a bereaved person to touch the body? Sometimes this is not possible for forensic reasons. Will parts of the body be covered because they are too damaged? Are there any parts that the bereaved person is not advised to touch because they are fragile? What will the room look like and will anyone else be there?

Every word matters

Jane was only five when her father died. Her mother told her that "Daddy isn't here anymore. His body is here, but the rest of him had gone away to heaven." Jane, who is now an adult, remembers being shocked when she saw her dad's body because it had a head, arms and legs. She had thought the word "body" meant his torso, so she thought she was only going to see his chest and stomach areas and that his head and limbs had gone up "into the sky to another planet".

If you are giving information to someone who is considering whether to view a body it is important to ensure that your information is understood. This is particularly important to check when talking to children, or people who are communicating in a second language or have hearing difficulties.

Concentration is difficult when suddenly bereaved so important details may need repeating.

One way to ensure your information is understood is to seek consideration through continued conversation and repetition. For example, "I've told you a few things that I'm just going to list again now. I've told you that you won't be able to touch your dad's chest area, and that only his head and hands will be exposed, and that his eyes will be shut and his skin colour will be purple due to internal bleeding. I've told you that a mortician will be present. Do you have any thoughts about what this experience may be like for you if you decide to see him?

Managing the experience

If more than one person wants to view the same body, have conversations with these people about whether they want to do the viewing on their own or together. Sometimes viewing rooms may be small and get crowded easily, reducing the quality of the experience. Children's experiences have to be managed with particular care, ensuring they are accompanied by an adult helper who will assist them appropriately to understand what they are seeing.

It is also important for bereaved people to consider what they are going to do after viewing a body. Will they be able to sit somewhere safe and quiet and have a few minutes to themselves and an offer of a hot drink before facing the world again? What will their plans be for the rest of the day; will it be possible to do something relaxing, with people they trust and know, that doesn't require extensive travel?

Religious rules and rituals

When managing the experience, it is important to be aware of, and consider the implications, of any religious rules or rituals that wish to be followed by a person viewing the body, such as touching and preparing a body through procedures such as washing and wrapping, or only allowing certain people to visit at certain times.

The importance of such rules or rituals to loved ones should be considered sensitively alongside any needs for post-mortem examination by pathologists and forensic scientists. Some families may object to the touching of the body by a non-faith member, but there is no rule for this in Hinduism, Islam or Sikhism in emergency situations. In Islam an invasive post-mortem examination (involving cutting open the body) is forbidden and it may, in some circumstances and in some countries, be possible to agree a non-invasive post mortem examination.

It is important to be receptive to cultural and religious differences and consult with the family to identify their particular needs. Although there are some general rules, it is important not to make assumptions based on a religious or cultural background. However, knowledge of other backgrounds may make communication and understanding easier.

Identification

Often, the police require identification of a body; however sometimes no-one wants to view the body. In this case, some countries allow identification through a photograph, or through glass.

Author note

This paper was prepared by Mary Williams OBE, Chief Executive, Brake with advice on religious rules and rituals by Yunus Dudhwala, Head of Chaplaincy & Bereavement Services, Newham University Hospital NHS Trust, UK

References

[1] and [2]: Viewing the body after bereavement due to a traumatic death: qualitative study in the UK, A Chapple, S Ziebland, 2010, BMJ