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SWGMDI’s NOK Services and Communication Committee

Principles for Communicating with 

Next of Kin during Medicolegal Death Investigations 

When a death requiring a medicolegal death investigation occurs, families will have many 

questions and concerns as they assimilate and accept information about the death of their loved 

one. Families of individuals who died in situations requiring an investigation experience 

additional challenges and emotions not faced by families following “normal or anticipated” 

deaths. Sudden deaths exacerbate the experience of grief and loss- regardless of the manner of 

death. The investigation generally delays and often affects mourning rituals, and thus has the 

potential to create uncertainty, additional frustration and psychological stress. 

How medicolegal professionals communicate with families in the aftermath of a death will have 

a direct impact on their ability to cope, their view of the medicolegal system, and their 

willingness to cooperate with the investigation and future proceedings. 

Medical Examiners’ and Coroners’ offices vary widely with regard to capacity, resources, and 

statutory mandates. The principles included here can be adapted by any office in their approach 

to interacting with Next of Kin (NOK) in any manner of death whether it is: natural, accidental, 

suicide, homicide or undetermined. 

Principle 1: No two individuals grieve alike. Sensitivity and respect for cultural, religious 

and individual preferences should be pursued and accommodated to the extent that the 

investigation allows. 

 Do not assume that ALL NOK will prefer communication in the same way. 

 Understand that the detailed experience the NOK has with medicolegal professionals 

during this traumatic time will become part of their personal and family history forever. 

Principle 2: Medical Examiners, Forensic Pathologists, Coroners, Medicolegal death 

investigators and all other Medicolegal Professionals who have the potential to interact 

with NOK should receive training appropriate to their duties. This training should include 

but not be limited to: death notification, interacting with people in crisis and trauma, grief 

education and the management and return of personal effects.

 Additional local resources for possible trainers, in addition to the above mentioned MDI 

professionals, who may support these training needs include: victim assistance programs, 
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mental health providers who are involved in trauma intervention, bereavement programs, 

hospice programs, and various organizations dealing with sudden death. 

 Specific topics for training content include, but are not limited to, the basics of effective 

crisis intervention, communication basics with individuals in crisis (verbal and nonverbal), understanding the basics of grief and loss, and responding to angry 

reactions/managing hostile situations. 

 Recognize that guilt can be a major factor for the NOK in many causes and manners of 

deaths. 

 Appendix A covers some well-intentioned but potentially hurtful statements that 

medicolegal professionals should be sensitive to avoid. 

Principle 3: Provide information in multiple formats (verbally, brochure and website) on 

the basic death investigation process, including why it is necessary and required. Keep the 

language as simple as possible. Anticipate questions in advance. If a significant segment 

of your population is non-English speaking, offering similar brochures in commonly 

spoken languages for your area is appropriate. Access to non-family translators, including 

sign language for deaf families, should be available. 

 Grieving families have difficulty processing information verbally and remembering 

details. Information may need to be repeated. Provide important information in writing, 

including but not limited to: 

o A point of contact and their contact information for follow up questions. 

o Why a death investigation is recommended/required 

 Include information about organ/tissue retention (when/where, how, why) 

o What to expect during the death investigation process and time expectations 

o How/when the final cause of death will be communicated 

o How to obtain reports and/or records involving their loved one and the 

appropriate contact information (e.g., autopsy report, death certificate) 

o Resource List (e.g., for financial assistance, coping with their loss/grief) 

 List Local and National Resources 

 See Appendix C: Abbreviated Listing of National Advocacy/Family 

Support Programs 

 Note: Do not promote any specific faith-based group 

o Include statutory requirements for investigating sudden deaths 

o How to obtain personal affects 

o See Appendix B: Frequently Asked Questions. 

 Provide information in multiple formats as soon as possible (i.e., at scene, during 

interview...) 

 See Appendix D for the following brochure examples/templates 

o Miami-Dade County Medical Examiner Department 
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 English and Spanish 

o The Sudden Unexplained Death In Childhood (SUDC) Program 

o Clark County Office of the Coroner/Medical Examiner 

Principle 4: Prepare NOK for the condition of the remains. 

 Many people expect to receive an intact body and may not be prepared for 

decomposition, severe damage, or fragmentation. 

 It is important for Medical Examiner/Coroner personnel to take responsibility for 

addressing the viewability of their loved one with the NOK. Taking time to prepare the 

NOK for what will be/will not be viewable will allow them to craft realistic expectations. 

o The funeral home chosen by the family may be an additional resource in fostering 

this communication to NOK. In cases of trauma, some reconstruction may be 

possible by funeral home professionals. The extent of reconstruction possible 

may be difficult to assess by many medical examiners/coroners. The medical 

examiner/coroner may direct the family to work with the funeral home to 

optimally set expectations. 

Principle 5: When possible and requested by NOK, medicolegal professionals should 

consider allowing the NOK to view the decedent prior to transportation. Separate policies 

should be created to handle requests to view the decedent after transportation to morgue. 

Considerations may include: 

 The condition of remains- Is it appropriate for NOK the view the decedent? Most 

traumatic deaths are best viewed after some funeral home preparation. This is 

particularly true with head trauma or traumatic injury in children, where family members 

may want to hold or touch their loved one. It is very difficult (at times impossible) to 

stop blood or other fluids (including brain tissue) from flowing from a body with 

significant head trauma prior to funeral home preparation. The family may also be 

unprepared for dislocation / fractures of long bones or other significant traumatic defects. 

These can readily be ameliorated with simple preparation by funeral home professionals 

and avoid additional emotional trauma to the family. 

 Maintaining Integrity of the Investigation- Determine if allowing the family to view or 

have contact with the decedent legitimately jeopardizes the integrity of the investigation. 

Ensure the integrity of the investigation while remaining sensitive to the needs of NOK. 

o Ex: If trace evidence is not being collected, then compromising trace evidence is 

not sound rationale for preventing NOK to view the decedent. 

 Environment that is safe and conducive to viewing- Due to the emotional crisis that 

sudden deaths create, creating an environment that is safe and conducive for viewing by 

the NOK can vary due to the location itself. NOK should be assessed for their ability to 

follow the directions of MDI professionals in viewing the decedent to ensure the integrity 
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of the investigation (i.e., “you can see your loved one, but cannot touch them” or “you 

can hold your baby, but for safety, you need to stay sitting in this chair while you do so”, 

etc.) 

 Supporting the grief process- Allowing the NOK, when they request to view the decedent 

immediately after death, allows them to begin to face the reality of the death and promote 

healthy grieving. It also allows them the opportunity for goodbye rituals that contribute to 

a healthy grieving process. This is especially important in child deaths, where parents are 

faced with the unanticipated and unnatural order of death by surviving their own children 

and the tremendous disbelief that ensues. 

o Allowing the NOK, when they desire it, to be with the deceased for even a short 

time, and even with supervision, can be a lasting benefit to them that can reduce 

additional trauma, maladaptive coping behaviors and more complicated grief. 

 There may be cultural or religious rituals and ceremonies important to NOK that 

traditionally should be performed as soon as possible following death. Accommodation 

of these practices should be a goal while maintaining case investigation integrity. 

Families should be aware and counseled on the need/rationale for investigation protocols; 

families should also be heard and cultural/ritual ceremonies accommodated to the extent 

possible in an individual case. 

If the decedent has already been transported to the morgue, a request to view the decedent 

by NOK may create hardships on the medicolegal office. It may interrupt and delay the 

medicolegal investigation process, and offices are often not set up to easily accommodate this 

request. 

 However, if viewing is a policy or available practice in a particular jurisdiction, or 

utilized on a specific case, consider the following: 

o When feasible, a small and private room should be set aside for families. The 

room should be furnished comfortably and can be equipped with a closed circuit 

monitor for viewing. 

o Brochures and other literature explaining the benefits of the autopsy process, legal 

issues, and grief assistance resources can be available in the room. 

o The areas of the body to be seen or touched may be limited. 

o Time should be allowed afterwards for families to ask questions.

 Encourage families to postpone viewing remains until it can be done at the funeral home. 

However, staff should not assume NOK will agree to delay viewing the remains; each 

family’s request should be considered individually and with cultural sensitivity. 
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SWGMDI’s NOK Services and Communication Committee

Principle 6: Provide NOK with reasonable expectations 

Initially the NOK can be informed that an “investigation” will be conducted. However, on some 

cases, what that investigation will specifically entail (i.e., external, toxicology, autopsy) may not 

be known initially. 

 Convey what is known and not known, including timeframes (if known), what may 

occur, how they will find out and who they can contact if they have questions. 

Principle 7: Avoid direct visual identification of remains by NOK whenever possible. 

Although a forensic or contextual identification is preferred; there are some cases when a 

visual identification may be necessary. It is not uncommon for NOK to assume they must 

identify the decedent or directly observe the body to do so. This misconception can be 

avoided by explaining the medical examiner’s or coroner’s protocols for identification. 

 Information should be provided to the NOK about how the identification was accomplished.

 When necessary, consider showing the NOK a photograph at a neutral or separate location. 

 NOK can also play a role in obtaining information useful in the identification process (e.g. 

dental records, medical records, etc.), so consideration should be given to discussing the need 

for such information and how it will be used.

 Be aware of what can and cannot be legally communicated to NOK among decedents whose 

identities have not yet been confirmed, especially those involving victims of crime.

 Refer to SWGMDI Decedent Identification Committee for additional information about this 

topic 

Principle 8: Provide information on resources available to the NOK to assist them in their 

grief early in investigation. 

 Develop and maintain resource networks with local and national advocacy/family support 

programs, to include crime victims’ assistance, bereavement counseling and support 

groups, crime victims’ compensation and burial assistance, COD specific organizations 

and community crisis intervention programs. 

 The individual(s) in the medical examiner’s or coroner’s office who interacts most with 

NOK should liaise with these organizations and maintain a resource file, including 

brochures or applications for these programs. Some programs may provide volunteer 

support on-site on a regular or as needed basis.

 Refer to Appendix C for an introductory listing of national advocacy/family support 

programs. Many of these national organizations will have local chapters or may act as 

clearinghouse to refer to known local resources.
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SWGMDI’s NOK Services and Communication Committee

Principle 9: Ensure that families understand their rights to access the final autopsy report, 

that they understand how to obtain the autopsy report, and that the reports are provided 

in the most meaningful and compassionate manner. 

 NOK should be informed how to obtain a copy of the autopsy report and to whom they 

should address questions about the contents of the report. 

o Unsolicited mailing to NOK of autopsy reports/cause of death information/final 

death certificate is highly discouraged. 

o Autopsy reports are best understood when explained by the pathologist or another 

medical expert. 

o NOK may also ask for photographs, and a policy should be developed to handle 

such requests if statutory requirements do not already exist. 

Principle 10: Inform NOK regarding issues related to public information and the media. 

 Inform the NOK what is considered public record in your jurisdiction 

o Autopsy reports? Photographs? 

o If appropriate, explain what an open records request is. 

o Include how they might affect what is released by an open records request (i.e., 

court orders or other means to stop release). Consider effects of special 

populations or poorer populations who may not have access to legal counsel in 

this regard. 

 Inform the NOK of media relations issues before made public 

o If press release is generated or information released to media- communicate 

information to NOK beforehand. 

Principle 11: Recognize and respect that families have a right and need to understand how 

and why their loved one died. The worst news can be delivered with sensitivity and 

compassion. The method of communicating the final COD to the NOK should be 

communicated early on in the investigation. If the NOK has a specific preference for this 

method (i.e., scheduled call vs. unanticipated call, letter, or meeting etc.), considerations 

should be given to attempt to comply with their wishes. 

Most people will visualize the death and surrounding circumstances and create a narrative in an 

attempt to make sense of it. What families imagine is often worse than the reality. Even when 

the facts are terrible, the majority of people can eventually accommodate or come to terms with 

them. 

 Family members who lack information on how their loved one died tend to experience 

maladaptive coping behaviors and more complicated grief. Families undergoing a 

“pending investigation” are at great risk for additional stress and anxiety as they live with 

a constant sense of uncertainty. Communicating timelines and a direct liaison to the 
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SWGMDI’s NOK Services and Communication Committee

office for these families are especially important to deal with their ongoing need to try to 

understand the death, and their prolonged anticipation of the investigation findings. 

 Delivering the Final Cause of Death (FCOD) and Manner of Death (MOD) to the NOK: 

When the FCOD an MOD are NOT already known to the NOK due to the circumstances 

of death, they should be delivered to the NOK via the established point of contact at the 

office, or by a staff member most appropriate to answer the NOK’s questions and 

respond to their anticipated concerns. 

o How? - In a manner that has been outlined to the NOK early on in the 

investigation. 

 A form letter or phone call via the NOK’s point of contact stating the 

FCOD/MOD is available and who they can contact via phone or to set up 

meeting to discuss is appropriate and usually adequate. 

 An additional option is to have the autopsy report sent to a personal 

physician. NOK could then review the report with their doctor, who 

would also be prepared to help the family members cope with distress and 

answer their questions. However, all personal physicians may not be able 

to decipher all autopsy information or answer all the family’s questions 

and therefore the pathologist should be available to the family or personal 

physician in this instance. 

o When? – As soon as possible after the FCOD/MOD is determined. 

o Exception: Unless the NOK has communicated they do not want to be informed 

of the FCOD, or if the initial COD/MOD has been communicated and is already 

known to NOK. 

 NOK should be given the option to meet or communicate with the pathologist to improve 

their understanding of the final cause of death. 

 Inform the family when a situation exists where the cause and manner cannot be released 

(i.e., homicide of child) 

 The pathologist should communicate in their reports and during any conference with 

NOK and/or their personal physician: 

o If the FCOD/MOD or autopsy findings have any potential health implications for 

surviving family members 

o What the limitations of the investigation and autopsy include to ensure optimal 

medical care and follow-up of surviving family members (and/or during 

subsequent pregnancies). 

 What known disorders were NOT ruled out (in an unexplained death)? Ex: 

Cardiogenetic arrhythmias 

*Best Practice*: Offering a Post Autopsy Family Conference 

o Early on in the investigation, the NOK is offered the option of a “Post Autopsy 

Family Conference” with the pathologist of record to discuss the FCOD/MOD 
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SWGMDI’s NOK Services and Communication Committee

when it is determined. The conference also serves to address any concerns or 

questions of the NOK. Upon determination, the NOK is contacted with the 

FCOD/MOD and again offered the service of the post autopsy family conference. 

o The NOK’s timelines will vary for those who choose this service. Some will 

want the conference to be held ASAP, others may wait several months or perhaps 

around a significant date (ex: anniversary of death). 

o During the conference, the Pathologist will lead the conference but additional 

staff can be present as appropriate to support the NOK’s understanding and 

coping of the information provided (i.e., Coroner, Death Investigator, Primary 

Care Physician, Social Worker or counselor who has been supporting the family). 

The conference is held in person or via telephone when necessary or preferred by 

NOK. 

o Conferences can be very effective in relaying accurate information about the 

FCOD/MOD in an understandable way to the NOK. They are also extremely 

helpful in allaying feelings of guilt by the NOK and responding to their specific 

concerns that may/may not be specifically addressed in the autopsy report. The 

benefits of dealing with these concerns directly with the pathologist can be 

immeasurable to the NOK. 

 “Did they suffer?” 

 “If I had found them sooner, could they have been saved?” 

 “She had a little cough and I think if I would have taken her to the Doctor 

I could have prevented this. I know the cough killed her.” 

o References: 

 Hirsch CS. Talking to the Family After an Autopsy. Arch Pathol Lab Med

1984; 108 :513-14 

 Valdez-Dapena M., The Postautopsy Conference With Families. Arch 

Pathol Lab Med Vol 108 June 1984 

Principle 12: Ensure that families receive personal effects in a sensitive and timely 

manner. 

 Ensure that families know how to retrieve their loved one’s personal effects, whether it is 

from the medical examiner or coroner, law enforcement, military officials, funeral home 

or hospital. 

 Ensure that families understand if some personal effects are held for legal reasons or 

evidence and the expected timeframe / processes needed to return these to the families. 

Provide the family with an office or individual contact for personal effects that are 

retained for evidentiary reasons. 

 Specific contact information should be provided to NOK to streamline the personal 

effects retrieval process. 
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SWGMDI’s NOK Services and Communication Committee

 Maintain a list of local companies that clean and decontaminate personal effects 

following death. 

Principle 13: Ensure that families ALWAYS have a single point of contact at the 

medicolegal office and that questions/calls are responded to in an efficient manner. 

 In the event that NOK requests for communication are excessive and/or repetitive to 

information provided, consider utilizing local or national resources to assist the family in 

their grief and cope with the investigation process. See Appendix C for some resources. 
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SWGMDI’s NOK Services and Communication Committee

References:

Hirsch CS. Talking to the Family After an Autopsy. Arch Pathol Lab Med 1984; 108:513-14 

Baker A, Crandall L. To Hold or Not To Hold. Forensic Science Med Pathol Nov 2009 

Valdez-Dapena M., The Postautopsy Conference With Families. Arch Pathol Lab Med Vol 108 

June 1984 

Adelson L. The Forensic Pathologist “Family Physician” to the Bereaved. JAMA 1977; 237: 

1585-8 

Vanezis P, Leadbetter S. Next of Kin Clinics: a new role for the pathologist. J Clin Pathol

1999;52: 723-724 

Drayton J., Ellis P., Purcell T., Letter to Editor: Next of kin clinics. J Clin Pathol 1999 
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SWGMDI’s NOK Services and Communication Committee

Appendix A: “WHAT NOT TO SAY...” 

Avoid well-intentioned but potentially hurtful statements by NOT saying: 

‐ “I know how you feel...” 

‐ “This will help you get closure...” 

o Although the process may eventually provide the family with information that 

helps them cope with their loss, insinuating that it will “help them get closure” 

is inappropriate and insensitive to many. 

‐ “I know what you’re going through...” 

oThere is no such thing as true empathy. No two losses are alike. 

‐ “It could have been worse...” 

‐ “It is God’s will...” 

o Do not bring up religion unless they bring it up first. (Hirsch 1984) 

‐ “Sometimes it’s hard to understand the bigger plan for us...” 

‐ “ You will be ok” 

‐ “They are in a better place” 

‐ Never refer to the decedent as “the body” 

‐ When describing autopsy procedures, use plain language 

oBut be careful to avoid insensitive analogies (Ex: “Microscopic studies are when 

we chop up an organ and look at it under the microscope.”) 

What TO Say: 

I am so sorry for your loss. 

I am here to help. 

I have some resources that might be of help. They have been helpful to others. 

Remember: 

Be Truthful. Don’t Ever Lie. 

Be Sensitive. 

Be Yourself. 
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SWGMDI’s NOK Services and Communication Committee

Appendix B: FREQUENTLY ASKED QUESTIONS 

1. Where is my loved one? 

2. Can I see him/her? 

3. Do I need to identify him/her? How will they be identified? 

4. What do I do now? 

a. Include information on final dispositions i.e. embalming, cremation, funeral home 

b. Advise family that they need to provide the ME/C office with information on their choice 

of final disposition in order to release their loved one (ie., such as name of funeral home). 

c. Do no promote, endorse or recommend any specific funeral home as to avoid conflict of 

interest, or accusation of directing business 

5. Why is the ME/C involved? 

a. ME/C legal requirements 

1. Homicide, suicide, accidental, traumatic, abuse, suspicious, unattended, in custody, 

overdose, abortion, medical facility death within 24 hours, surgical death. 

2. Manner of Death 

a. Homicide 

b. Suicide 

c. Accident 

d. Natural 

e. Undetermined 

6. Is an autopsy always performed and is there a charge? 

7. Can I refuse an autopsy? 

8. Why are autopsies performed and who performs them? 

9. What are the benefits of an autopsy? 

a. Death Certificate 

b. Cause of Death 

c. Hereditary medical condition 

10. How do I recover personal effects and clothing collected by ME/C? 

11. When will he/she be released? 

12. Who has the responsibility of making arrangements? 

13. Who can I contact with questions? 
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SWGMDI’s NOK Services and Communication Committee

14. How do I learn the COD/MOD? 

15. If the identification of my loved one is pending, what information can be shared with me? 

16. What does it mean for case to be “pending”? 
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SWGMDI’s NOK Services and Communication Committee

Appendix C:  Abbreviated Listing of National Advocacy/Family Support Programs

and Resources

Compassionate Friends, Inc.

www.compassionatefriends.org

877‐969‐0010

CJ Foundation for SIDS

www.cjsids.org

888‐8CJ‐SIDS

The Dougy Center for Grieving Children

www.dougy.org

866‐775‐5683

(Materials tailored to children and adolescents, will refer to local support resources)

First Candle

www.firstcandle.org

800‐221‐7437

Mothers Against Drunk Driving (MADD)

www.madd.org

800‐GET‐MADD

National Organization of Parents of Murdered Children, Inc

www.pomc.com

888‐818‐POMC

National Center for Victims of Crime

www.ncvc.org

202‐467‐8700

National Organization for Victim Assistance

www.trynova.org

800‐TRY‐NOVA

SADS Foundation

www.sads.org

800‐STOP‐SAD

Sudden Unexplained Death In Childhood Program

www.sudc.org

800‐620‐7823

Tragedy Assistance Program for Survivors (TAPS) – (for military families)

www.taps.org

800‐959‐8277
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SWGMDI’s NOK Services and Communication Committee

Publication: “Serving Survivors of Homicide Victims During Cold Case Investigations: A Guide for Developing a Law

Enforcment Protocol”

www.sheriffs.org/coldcaseguide

Appendix D: BROCHURE EXAMPLES AND TEMPLATES

Miami‐Dade County Medical Examiner Department FAQ brochure (page 1)
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Miami‐Dade County Medical Examiner Department FAQ brochure (page 2)
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Miami Dade County “Who will help me when a loved one dies” brochure (page 1)
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Miami Dade County “Who will help me when a loved one dies” brochure (page 2)
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SWGMDI’s NOK Services and Communication Committee

The SUDC Program’s “Help for families when an infant or child dies” brochure (page 1)

* Go to www.sudc.org if you would like request this complimentary personalized brochure be created

for your office.
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SUDC Program’s “Help for families when an infant or child dies” brochure (page 2)
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Clark County Office of the Coroner/Medical Examiner Information Guide (Page 1)
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Clark County Office of the Coroner/Medical Examiner Information Guide (Page 2)