“Why do we do what we do? Does it matter to the decedent? They know how they died. We’re there for the family, the criminal justice system, the medical system, and the public health system.”
Dr. Gregory Schmunk, former president of the National Association of Medical Examiners
Death-scene investigators are among the first professionals to come face to face with families and caregivers as they realize their child has died. Investigators and their medicolegal colleagues play a critical role in survivors’ long-term coping.
Autopsy and investigation laws, protocol, and training vary by jurisdiction, but here are a few ways medicolegal professionals can facilitate a compassionate death investigation:
1. Understand that every interaction is a hallmark memory. Death investigators may encounter several deaths in a day or month. But for families, the death of a child is a singular event. Every interaction with death investigators and associated staff has the potential to create lasting memories, both loving and painful. Recognize the importance of every interaction and its potential to support long-term family coping.
2. Approach investigations with compassion and seek every opportunity to reduce harm. Always remember that you are meeting parents and families on what is likely the worst day of their lives. Calmly help parents learn what to expect from a death investigation, make sure a chaplain or faith leader is on the way if needed, and answer questions as thoroughly and honestly as possible. Gentle and compassionate care should be taken when death investigations require family interactions or the replaying of events, especially in the hours and days following a death when confusion and grief “volumes” are high.
3. Allow families to say goodbye. Parents report bitter and debilitating regret when they are prevented from saying goodbye to their child. Allowing families to spend time with their child’s body is an important way to honor the parent and the relationship they fostered. Limited ability to view their child (due to office hours or other constraints) can result in parental feelings that their child is no longer their own, and that they have been annexed by a system in which they have no control. While many jurisdictions are moving toward fingerprint identification or photos of the deceased, the research is clear: Parents need the ability to physically say goodbye to their child.
4. Refer to resources and support. Whenever possible, share support resources with families. Many experts state that families are not ready or eager for mental health support for six to nine months following a death, particularly for violent deaths. Providing a list of resources or providers to a family in the weeks or months that follow an investigation may be helpful. Check for national programs and services if none are available locally.
5. Notify families when the autopsy report is ready. Receiving an autopsy report is a painful experience for the family. Some are eager to understand the specific cause or manner of death, while others may decide to leave the report unopened for decades. Notifying families that a report is available or has been mailed is an important and compassionate step toward preventing unexpected information. Consider labeling any envelope clearly so that the family understands an autopsy is inside.
6. Provide organ donation opportunity respectfully. Not every parent will be open to organ donation. Some will be highly resistant and untrusting. Take care not to push too hard, as that can create an overwhelming aversion. Research shows that organ donation, and by extension helping another family, can be a meaningful and positive experience for bereaved families. Donor organs are especially scarce for children because the size of an organ matters; there are relatively few size-matched deaths of younger children to provide enough livers, hearts, and lungs to meet the demand. The Gift of Life Donor Program works closely with medical examiners and coroners nationwide to ensure successful outcomes for all organ and tissue donations, while simultaneously supporting the forensic needs of investigators. That collaboration is important in honoring the decision of a family to donate and is considered a best practice, by the National Association of Medical Examiners.
7. Recognize that culture matters. Connect with a network of community leaders who can support parents’ various religious and cultural needs. As an investigation unfolds, there are numerous moments when families can be further traumatized and when their efforts to honor their child are not respected. For example, many families want to set up shrines and have rites performed with the child’s body.
8. Seek self-care. Given the circumstances of responding to fatal emergencies, many professionals can be at risk of developing post-traumatic stress. Understand that scenes themselves can pose a health risk and seek self-care in the aftermath. Many forms of support may be required to cope with the continual exposure to stress, death and trauma. Taking care of yourself is fundamental to serving yourself and your community.