Clients are usually pronounced dead by a doctor; however, some senior nurses may undertake this task as part of their expanded role if the death was expected and there are no suspicious circumstances. The procedure is usually performed when relatives are present though on occasions circumstances may prevent this.
Nurses and others may recognize classic signs, which are:
• no evidence of pulse, respirations or blood pressure
• pupils fixed and dilated.
Post-mortems may only be carried out with written consent of relatives unless the death occurs in suspicious circumstances or occurred without prior medical intervention. In these cases permission – whilst desirable – is not required in law. A booklet produced by the Royal College of Pathologists (2000), Examination of the Body after Death, offers useful information about post-mortem examination for relatives, and copies are readily available from http://www.rcpath.org.uk.
If a post-mortem is to be carried out, under no circumstances should any tubes, catheters or other invasive equipment be removed from the body. If unsure then you must check with the medical officer or senior nurse before performing Last Offices and adhere strictly to their guidance.
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