Royal Stoke University Hospital - End of life care for Muslim patients R1

End of life care for Muslim patients & Bereavement Support

Spiritual Religious & Pastoral Care & Bereavement Services

This booklet is intended to provide a brief overview of Muslim practices and requirements around end of life care and death.

It offers information regarding the access to appropriate support for patients and relatives and aims to provide a simple reference at a very difficult time.

Emotional Support and Religious Care

Receiving difficult news, facing times of uncertainty and end of life, as well as trying to fulfil the hopes, wishes and beliefs of the patient can be challenging. The Spiritual Religious & Pastoral Care Team are available to provide support. Chaplains and Chaplaincy Volunteers visit the wards regularly, they can be contacted between visits and when urgent via the hospital switchboard. Please ask the nurse to contact the on-call Chaplain for you.

The Spiritual Religious & Pastoral Care Team has other resources that may be of use.

For example:

• A prayer room; ablution facilities; copies of the Quran; prayer mats

• Volunteer Imam’s who lead Jumuah prayers

When death is imminent

Within Islam, death is seen as a natural event and a journey to the hereafter. Muslims are encouraged to prepare for death and manage it in a dignified and sensitive manner. Key points that might be important at this time include:

• Talking with staff about care, treatment and support needs

• The patient and their loved ones should be able to discuss their current needs and preferences and if possible, to talk about arrangements after death in order to make preparations for burial within 24 hours

• Having acknowledged any needs of preparation etc, please work with the staff in order to meet these requirements where reasonable and practicable to do so

Places of care

Hospital staff are trained to care for patients at end of life and many people choose to remain in hospital during their last days, however some people seek to explore other options. The patient and/or their loved ones might want to consider the patient being cared for at home or in a hospice. If this is appropriate and available, the patient and relatives will be offered information regarding home or hospice care. Many hospices provide good quality residential care that can cater for a wide range of communities.

The role of the family and loved ones

Where possible it is preferred by many Muslims that death should occur in the company of their loved ones rather than people they don’t know. At the time of death relatives may wish to consider the following, which is a brief summary of the guidelines of “Tender, love & care” of Muslim patients in their last few hours of life:

• Be calm and quiet to help the patient to relax, reminding him/ her of al Shahada (la Illaha Illa Allah) in very soft gentle tones

• Reciting the Quran or playing a recording of it to the patient

• Space and privacy may be limited on the ward, staff will seek to sensitively support patients and their loved ones. It is not permitted for any of the visitors to create a noisy atmosphere

• Once the patient has passed away, it is recommended that the patient’s most beloved person closes the patient’s eyes gently

• If the patient is a male and has a beard, it is recommended to wrap the beard to the head in the way that the mouth is closed

• It is permitted to kiss the patient’s face very gently by the relatives and friends

• Ghusl-e-Mayyit (washing of the deceased) is recommended to be done before the patient goes to the grave, this can be done either in hospital or at the community mosque, however normally this is done at the mosque

• The direction of the face and body is recommended to be facing towards Mecca (south east in the UK). The patient should be covered with a sheet which is not transparent

• In Islamic belief if there is a legal requirement for the Coroner to carry out a post mortem, Islam has no objections to proceed with this, however if a hospital post mortem is requested by the medics for scientific reasons, permission needs to be obtained from the patient’s family

• Whilst it is Islamic belief for the burial to take place as soon as possible (within 24 hours) if the Coroner requests a post mortem this has to take priority over a 24 hour burial

• The Spiritual Religious & Pastoral Care Team and Bereavement Services can be contacted for support and advice

Please note that staff are required to remove all needles and catheters from the deceased person unless the death is being referred to the Coroner in which case they must be left in place.

What will happen to your relative after you have left the hospital?

Once you leave the hospital your relative will be transferred in a respectful and dignified manner to the hospital mortuary. For as long as your relative is in the care of the hospital you are able to come and view them, although you will need to telephone in advance to make an appointment, please call the mortuary team on 01782 672085.

When a post mortem is not required and the death has been registered, the deceased will be released to your chosen Funeral Director, they will need the Certificate for Burial, provided by the Registrar, in order to collect the deceased from the Mortuary.

If there is a need for a post mortem examination, the deceased will be released to your chosen Funeral Director once the post mortem is complete.

Obtaining a Medical Certificate of Cause of Death

Medical Certificates of Cause of Death are issued from Bereavement Services at the Royal Stoke University Hospital (you will need this before you can make your appointment to register the death formally).

Following the death of your relative please telephone Bereavement Services at the hospital after 9.00am the next working day.

Opening hours are 9.00am to 4.00pm, Monday to Friday (closed weekends and bank holidays). You can contact Bereavement Services on: 01782 676323

However, should the death occur at the weekend the ward staff can contact the Site Manager who may be able to help you to obtain the medical cause of death out of hours.

The following information about the deceased will need to be obtained either by the Bereavement Team or by the site manager:

• Their occupation

• Whether your relative has been receiving an Industrial Pension, Industrial Injuries Benefit or War Pension; including the percentage (If known)

• If your relative was a smoker

• Whether the Burial is to take place in the UK or abroad (a free from infection certificate from the hospital doctor and an Out of England request from the Coroner’s office will be required to fly the deceased to another country)

• Do you have any concerns about the death, that you feel may need to be referred to the Coroner?

• Any recent falls with traumatic head injuries

• Any recent surgery under general anaesthetic

Your answers to these questions, combined with the information contained within the patient’s hospital notes will help us to determine whether or not the death of your relative may need to be referred to the Coroner. A member of Bereavement Services will be able to advise you about this when you call. They will tell you what will happen next. If the deceased is to be buried outside of England the death will need to be reported to the Coroner in order to obtain an Out of England Certificate.

We aim to issue a Medical Certificate of Cause of Death as soon as possible, however this needs to be completed by the medical staff who have cared for your relative in hospital and unfortunately, due to medical emergencies or urgent clinical issues a delay can occasionally occur.

If the doctor can issue a Medical Certificate of Cause of Death you will be advised of this. We aim to have this completed as quickly as possible. We will provide you with the phone number for the relevant Registration Services. The bereavement team will give you a unique certificate number which will enable you to make an appointment to register the death. We will also advise you if the Medical Certificate of Cause of Death has or has not been cleared/agreed with the Coroner.

However in certain circumstances - if the hospital is not able to issue the Medical Certificate as the cause of death is unclear - the death will need to be referred to H.M Coroner for Stoke-on-Trent and North Staffordshire who may decide to:

• Hold a post-mortem examination

• Hold an inquest. In these circumstances the Coroner’s Office will advise you what to do next

• Contact the patient’s usual GP to see if they are willing to issue a Cause of Death Certificate (for cases under 24 hours)

If the death is referred to the Coroner and the Coroner orders a post mortem you will be advised of this and given a telephone number to call in order to make an appointment to attend the Coroner’s Chambers. In certain circumstances it is possible to hold a telephone interview with the Coroner’s Officer.

If you require further information please contact the Coroner’s Chambers on 01782 234793

Coroner’s Post Mortem Examination

The Coroner is an independent judicial officer with the responsibility for the legal investigation of some types of death. In certain circumstances a death has to be reported to the Coroner, for example, if death is:

• Known or suspected to be due to an accident

• Known or suspected to be due to industrial disease

• If the cause of death is unknown

• As a result of surgery

• Where a Doctor has not seen the deceased within the last 14 days of life or last illness

• Where death occurs in suspicious or unusual circumstances

The Coroner may decide to hold a post-mortem examination to try to establish the cause of death and he will arrange for a medically qualified doctor called a Pathologist to conduct the careful examination. Your agreement is not required. Sometimes it is necessary for the Pathologist to take small tissue samples for analysis (to test for infections or for microscopic examination), which may tell us more about the cause of death. However, even the most detailed post mortem investigation will often leave some questions unanswered. It is the Coroner who will make the decision to conduct the post mortem examination but you will be kept fully informed and will be given a telephone number to call in order to speak to one of the Coroner’s Officers. The Coroner’s Officers, sometimes with the assistance of the Police, assist the Coroner in his investigations.

Where a post mortem is requested by His Majesty’s Coroner – he/she will then appoint a Pathologist to undertake the Post Mortem outside of their NHS work and this is not managed by the NHS. Depending on the availability of Pathologists this means that at times a delay may occur before the Post Mortem takes place and we are sorry for any additional distress this may cause. Clearly in such cases it is important for the Post Mortem to take place to allow the Coroner to establish fully the cause of and circumstances surrounding the death and you will be advised by the Coroner’s Officer once this is completed. Funeral arrangements can then be made.

Once the post mortem examination has been completed the Pathologist will report the findings to the Coroner; the Pathologist in these circumstances acts for the Coroner and is independent of the hospital. When the Coroner receives the results of the post mortem examination he/she will make a decision on how to proceed:

• If the death is regarded as due to natural causes then the Coroner will notify the Registrar of the cause of death; you will be able to make an appointment to register the death with the Registrar

• The Coroner may decide to hold an inquest. In these circumstances the Coroner’s Office will advise you what to do

In either case the Coroner will consent to allow funeral arrangements to be made.

If you require further information please contact the Coroner’s Chambers on 01782 234793

8.30am – 5.00pm (Monday-Thursday); 8.30am – 4.30pm (Friday).

Registering a Death

• Once the Medical Certificate of Cause of Death is complete, this will be emailed to the Register Office by the hospital bereavement team

• This is an appointment only service, please call 01782 235260 option C

• When you call to make an appointment, please let the staff know if you have any special requirements, such as disabled access

When can a death be registered?

• Once you have the unique number for the Medical Certificate of Cause of Death you will be able to make your appointment to register the death of your relative with a Registrar.

• A death must be registered within five working days of its occurrence unless the Coroner is involved or the Registrar says this period may be extended

• In exceptional circumstances the Registrars provide a service on a Saturday only between the hours of 9.00am-12.00 noon to register a death, arrange a burial or to register the death when the body is to be flown out of England on the same day (the Coroners paperwork i.e. the “out of England” being in place)

• This service only applies for deaths and burials that have occurred or are to take place within the city boundary

• This out of hour’s service is not a guaranteed, it is dependent on what registrations and ceremonies are planned within that time frame at the Register Office

• Once the death has been successfully registered the Registrar, whilst in the presence of the family, will contact whoever is ‘on call for arranging the burial’ and burial arrangements will commence. The only contact telephone number available on Saturday for same day burial is 01782 234234.

Who can register the death?

The Registrar would prefer that a relative of the deceased registers the death.

If there are no relatives, it is possible for other persons to register the death, such as someone who was present at the death, a senior administrator of the establishment in which the death occurred or the person instructing the Funeral Director.

What information will I need to give to the Registrar?

• The date and place of death

• The full name of the deceased (and maiden name if appropriate)

• The date and place of birth of the deceased (as shown on the birth certificate)

• The deceased’s usual occupation

• Marital status

• The deceased’s usual address

• Whether the deceased was in receipt of a pension from public funds

• The date of birth of the deceased’s spouse, if any

• Either the deceased’s NHS number or medical card. However, please do not delay registering the death if the medical card is not available

The information provided will form an entry in the Death Register.

After registering the death, the Registrar will provide you with

• A green certificate for the Funeral Director to collect the deceased from the mortuary and allowing burial to take place

• A white form to send to the Social Security Office

• A form to use if you wish to apply for D.S.S assistance with paying for the funeral

• Additional Death Certificates (on request), you may need for bank/building society; solicitor; pension/insurance claims

The cost per Death Certificate is £11.00 (subject to change) and is payable by cash, credit/debit card or cheque.

Contacting a Funeral Director

You may contact a Funeral Director of your choice as soon as you feel able to do so.

When a relative dies it is a difficult and stressful experience, remember that Funeral Directors are used to dealing with people who have been recently bereaved. They will be able and willing to assist you in preparing for the funeral and in beginning to come to terms with the death of your relative.

Most funeral directors are members of one of two trade associations: the National Association of Funeral Directors (NAFD) and the National Society of Allied and Independent Funeral Directors (SAIF). Both have codes of practice which require the provision of a price list on request and will not exceed any written estimate given to you without your permission.

You can find details of a local Independent Funeral Director, or service provider, by contacting the National Association of Funeral Directors, telephone 0121 711 1343, or visit www.nafd.org.uk. Alternatively you can contact the National Society of Allied & Independent Funeral Directors, telephone 0345 230 6777, or visit www.saif.org.uk.

Help with Funeral Expenses from the Social Fund

If the next of kin or the informant who may be responsible for arranging the funeral is on low income they may be able to receive help from the Social Fund to pay towards the funeral costs.

How to Apply

To apply for assistance from the Social Fund, the next of kin or the informant who may be responsible for arranging the funeral will need to complete application form SF200. This can be obtained from the Job Centres Plus (part of the Department for Works & Pensions) by calling:- 0800 731 0469, Mon-Fri, 8am6pm or can be down loaded from the website www.direct.gov.uk.

The hospital is not responsible for any shortfalls following a claim from the Social Fund. It is the responsibility of the next of kin or the informant, who is arranging the funeral, to pay the shortfall, or to choose a funeral service which is covered by the benefits they claim if they are unable to make a contribution themselves.

Coping with Bereavement, Advice and Support

The loss of a loved one is one of the most difficult and painful experiences you will face in life. It is not unusual for people who are grieving to experience powerful emotions, or to feel disorientated by the bereavement they have suffered and the subsequent grief which they experience.

People often find the help of family and friends to be sufficient following the death of a loved one; however, some people find it helpful to talk to someone outside the family about how they are feeling. Your local General Practitioner may be able to help.

There are also various organisations that can advise and support the needs of people who are experiencing bereavement, please contact Bereavement Services or the Spiritual Religious and Pastoral Care Team.

Organ and Tissue Donation

There are different schools of thought in Islam regarding this sensitive issue. There is a significant opinion amongst Muslim Jurists that organ donation is allowed as it is done to preserve life. Anyone wishing to be an organ donor would be well advised to obtain a donor card and inform their family.

Whether or not organs and/or tissue can be transplanted depends on how and where your loved one died.

If the death has been referred to the Coroner, the Coroner must agree to the donation as removal could affect the Coroners investigations.

If you have any questions about organ and/or tissue donation and want to find out whether it is in keeping with your beliefs, please speak to the Spiritual Religious and Pastoral Care Team. Further information can be obtained on www.organdonation.nhs. uk/helping-you-to-decide/your-faith-and-beliefs/islam or by calling the Organ Donor line: 0300 123 23 23. Minicom number, if hard of hearing: 0845 730 0106. To use text chat please SMS 07860 034343. Lines open 24 hours.

Useful Addresses

Registration of Deaths Office

Civic Centre

Glebe Street

Stoke-on-Trent, ST4 1HH

Tel: 01782 235260

Spiritual Religious and Pastoral Care Team

Main Building, Lower Ground 2, Royal Stoke University Hospital

Newcastle Road,

Stoke-on-Trent, ST4 6QG

Tel: 01782 676400

Bereavement Services

Main Building

Royal Stoke University Hospital

Newcastle Road, Stoke on Trent, ST4 6QG

Tel: 01782 676323

Carmountside Cemetery & Crematorium

Leek Road, Milton, Stoke on Trent, ST2 7AB

Tel: 01782 235050

City Centre Mosque –Stoke-on-Trent

Regent Road, Hanley, Stoke-on-Trent, ST1 3AY

Tel: 01782 204092

info@citycentralmosque.org

Royal Stoke University Hospital

Newcastle Road, Stoke on Trent, ST4 6QG

Tel: 01782 715444 (24 hours, main switchboard).

Cashier’s Office

Main Building, Level 1, Royal Stoke University Hospital

Newcastle Road, Stoke-on-Trent, ST4 6QG

Tel: 01782 676310

PALS (Patient and Advice Liaison Service)

Main Building, Royal Stoke University Hospital

Newcastle Road, Stoke on Trent, ST4 6QG

Tel: 01782 676455

H.M. Coroner

The City Coroners Chambers, 547 Hartshill Road, Stoke-on-Trent

Tel: 01782 234793

Longton Mosque

Gillani Noor Masjid

2 Chaplin Rd, Stoke-on-Trent

Tel: 01782 335606

Please contact the various departments and organisations for opening times. Details correct at time of print

Royal Stoke University Hospital

End of life care for Muslim patients & Bereavement Support

Review Date: April 2025

Publication Date: April 2023