One almost inevitable responsibility and privilege for pastors is to walk with church family through bereavement. I’ve been starting to put together some materials helping church leaders to think through and prepare for pastoring church members through bereavement.
I write having been both sides, having both pastored church members when they came to the point of dying – and their family members through that time – as well as having experienced bereavement myself and appreciated the support of our church family.
Normally, if an older person dies, then things may be reasonably straight forward: there is a known cause of death and a doctor is able to sign off and give the cause of death as well as time. It is then a matter of going to the registrar’s office to get the death certificate. However, this doesn’t always happen.
With both my mum and my father-in-law, for different reasons, the matter went to the coroner. In my father-in-law’s case, this was because he died suddenly at home and the cause of death had to be determined, whereas in mum’s case she had died in hospital following surgery. In the first case, things were processed fairly quickly after an autopsy. It is worth knowing that autopsies are not always necessary once a case goes to the coroner. Additionally, families should be prepared for questions including what they wish to happen to any remains such as organs that have been removed from the body.
Because my father-in-law died at home, the ambulance team arranged for the police to attend too. This could feel quite scary to some. It’s important to know that this is routine. The police are acting on behalf of the coroner at that stage and ensuring that enough information is gathered to enable a swift establishing of cause of death. They are not there because there is a question of suspicion or criminality.
In mum’s case, we also expected things to be straight forward at first. It seemed like it was just a matter of process. We had known for the week leading up to her death that her death was a real possibility; we knew she was struggling with a severe infection and we had spoken to an ICU doctor who had made it clear that he did not expect her to survive being brought off of mechanical ventilation. We did not feel as though we were one of those families with big unanswered questions to resolve. We weren’t trying to make sense of things. One of the strange things was that at times it felt as though we were being treated as though that was the assumption, even at the inquest.
However, as it turned out, things were not so straight forward. An investigation was opened, which is where the coroner wants to pursue things further but at this stage would prefer not to move to a full inquest with all the emotional implications for a family. At this stage, the family are asked to provide a statement themselves giving background to the deceased, their own observations and any questions they might have. The coroner, or their representative will write to those who have been involved in the person’s care leading up to death. This might include their GP, medical staff involved in treatment, surgery and after care and of course the doctor responsible for signing off on the death.
In mum’s case, after this investigation was complete, the coroner decided that they still were not in a position to confirm the cause of death and decided to open an inquest. It then took more than a year before the inquest was heard in the coroner’s court. Some times it can be quicker than this but I understand it can also take longer.
Practically, even with a coroner’s process happening, things can still move forward smoothly as they will issue an interim certificate of death and this will enable you to update pensions, the Inland Revenue, etc., using the Tell Us Once service. The interim death certificate will also be accepted by most other organisations including solicitors, banks etc. Once the coroner has released the body you can also hold a funeral. It may take a little longer than usual though.
If the case goes to inquest, then you will be assigned a coroner’s court officer who will be your first point of contact. They will liaise with everyone to try and find a convenient date for all. They will often prefer this to summoning people to appear on a given date. This may prove frustrating as they attempt to get all diaries aligned. Releasing medical staff will be the most challenging.
Additionally, the coroner will review all of the evidence and information before the inquest and may determine that they still need to investigate further so that the hearing can be completed satisfactorily on the day. It may also be that a different coroner picks up the case that week and has a slightly different perspective. In mum’s case, this meant that the hearing was postponed at the last minute as a different coroner decided that they needed to call a different set of witnesses and gather information from them first.
There is a voluntary service that offers support to families on the day. You are entitled to attend the hearing and you will be given the opportunity to ask questions yourself. This is likely to be an emotionally taxing time as you re-hear and relive the events leading up to a loved one’s death. Coroner’s courts tend to have a bit more of an informal feel than you might expect from courts and are sensitive to families’ needs. At the same time, it is still a court with procedures and protocols. I was not able to attend in person but a live link was set up for me to join.
The coroner’s job is to confirm the identity of the deceased, ensure there is a record of the facts of the death and to the best of their ability determine the cause of their death. It is crucial to be aware of the very narrow scope of their remit. They are not there to apportion blame, though the outcome may support further legal action. They are also not really there to ensure that lessons are learnt, although that can be an incidental outcome.
Given that limited scope, families may find it helpful to pursue other courses of action if they want to either get big questions answered or to ensure that lessons are learnt. Sometimes, hospitals will offer an opportunity for the family to come in and talk with the medical team responsible for their loved one’s care. We took up this offer and found it hugely beneficial. I got the impression that the medical team did too and there were things they picked on to help them learn lessons. It is again helpful to approach such meetings in the spirit offered. If you turn up “lawyered up” they will get nervous and lawyer up too. This type of meeting doesn’t work if there has been a break down in trust.
At the inquest, the coroner will seek to determine the cause of death and this may include natural causes, accidental death, suicide or unlawful killing. They may sometimes give an open verdict where it is genuinely not possible to reach a conclusion or offer a longer “narrative verdict” where instead of giving one cause of death, they tell the narrative of the events leading up to the death. This is used where the cause is complex. It was this type of verdict that was given for mum.
Pastorally, I think there are some important ways that we can help and support families. First, simply helping people to know the process enables them to understand what is happening and guards against surprises. Secondly, I think it is fair to say that the grieving process is likely to be extended and amplified. This may be further exacerbated because if the death was traumatic then the bereaved may well be suffering from PTSD. We noticed when visiting mum that there were posters on the wall advising that many people who had been with relatives in ICU later suffered PTSD-like affects. I know that even visiting the hospital afterwards can be very painful.
Here are a couple of ways in which bereavement might be amplified and prolonged. First, there’s the denial stage. This is a normal part of grieving as we come to terms with loss. Bereaved people talk about calling out to a loved one when they arrive home or looking and waiting for them to come down the garden path. It is a lot harder to move through this stage when there hasn’t been closure. You know that you left your loved one’s body at the hospital or saw it taken away but the death certificate says “interim”. It’s not the real thing. Perhaps there was a mistake and if so, maybe they didn’t need to die or even haven’t really died. Maybe the coroner will come back and tell you that it’s all been a big bad mistake and mum is coming home soon. It’s all irrational of course, you know that deep down, but we are not dealing with our rational thoughts at that stage.
Secondly, grief often involves feelings of anger and blame. The anger may or may not be justified. It is possible that someone did get something wrong, often we do not know. However, anything that involves investigation opens up the possibility of blame being identified, even if it isn’t the coroner’s job to apportion t. Perhaps we will “get to the bottom of things.” So, it is worth noting, that extending and amplifying the grieving time is not necessarily a bad thing because there will be many occasions when this form of closure is crucial.
However, anger can be further provoked by the frustrations of the process. This is especially so if things aren’t running smoothly and when you are dealing with the barriers to good communication that bureaucracy creates. It’s important to remember that this is what it is and isn’t necessarily evidence that someone is trying to hide something.
Thirdly as well as blaming others, bereavement often involves a sense of guilt. Again, this can be heightened by an inquest process. I think where there have been difficult decisions about treatment and end of life, that this can be acutely so and not always helped by how those decisions are worked through and communicated. The recounting of events, the listening to evidence and, frankly, just the waiting can cause you to question yourself. Reassurance is crucial. The best thing we can do pastorally is simply to be there for the family. It means a lot to know that you are not alone and haven’t been forgotten about when it feels as though everyone has moved on with their lives. Having people to listen, send an encouraging message and most of all to pray matters through
Faithroots 