HEALTH: SECOND OPINION

THIS COLUMN is not breakfast reading, dealing as it does with the treatment of bodies after death. Until quite recently most people died in their own homes; the body was then washed, sealed and dressed for the relatives to see it before the funeral. This traditional laying- out may still be carried out by relatives for people who die at home. People dying in hospital have the "last offices" performed by nursing staff. The body is then prepared by undertakers so that people may pay their last respects.

Two-thirds of all deaths now occur in hospitals, and changes in attitudes are causing problems for families who wish to follow the custom of viewing the dead. Concern about infectious diseases such as meningitis, hepatitis and Aids has led to some hospital staff treating all bodies as potentially hazardous, and some hospitals have stopped carrying out the last offices. The result is that funeral directors are receiving more bodies sealed in plastic body bags in a condition that makes preparation for viewing difficult and unpleasant.

A survey of funeral directors, doctors and others concerned with the care of bodies recently appeared in Communicable Disease Report (1995; review 5: 69-73). Three-quarters of the funeral directors said that they would not permit hygienic preparation of bodies known to be infected with hepatitis or HIV viruses, but they were often not told the cause of death or if there was any risk of infection.

Fewer than 1 per cent of the 600,000 deaths each year in Britain are due to infectious diseases, but this still means several thousand potentially infectious bodies that need to be prepared for funerals using methods that maintain respect for the dead while not exposing funeral staff to the risk of infection. The funeral directors in the survey agreed that viewing of the body by relatives was acceptable practice even when the cause of death was known to be an infectious illness, but that the relatives should be instructed not to touch the body.

In some countries embalming, in which preservative liquids are injected into the body, is customary. Embalming prevents the natural process of decomposition and is thought to reduce the risk of infection for those handling the body. In the US some embalmers are prepared to treat bodies of people who have died from virus illnesses such as Aids. Here, where embalming is less usual, the British Insti-tute of Embalmers recommends its members to avoid cases known to have been infected with hepatitis or HIV viruses.

The vast majority of bodies pose no risk of infection, and hospitals that apply precautions in all cases are likely to cause unnecessary distress. The Communicable Disease Report calls for better communication to ensure that funeral directors know which small number of bodies presents any real risk of infection. Hospitals that place all bodies in bags are denying families the chance to carry out the mourning rituals to which they are accustomed - and which are an important part of psychological adjustment to bereavement.