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Medical Examiner Dialogue - Somali

Author(s): Christine Wilson Owens
Reviewer(s): Mohamed Ali Roble
Date Authored: August 01, 2001
Date Last Reviewed: April 01, 2008

Beliefs about Death

Somalis feel much the same way as other people when there is a death in their community – they grieve, they miss the person, nobody likes death. Death is accepted because it is God's plan, everyone has a time, just as one is born, and lives, they also get taken in death. Death is accepted. Whatever the case of death – whether traumatic or from sickness or from suicide – it is accepted. One Somali man described it: "We believe when your life is created, your words were counted, your food was counted, and your time of death was counted. It is human to create excuses for why a person dies – he was dead because of a car crash, plane crash, he was mentally ill and so he jumped in front of a car and committed suicide. Somalis believe that death and the related situation is out of human control; that death is controlled by God”.

Suicide

Suicide, as with any other form of death, is believed not to be in human control. Suicide is not accepted in Somali culture, it is prohibited. But, it is believed to have been planned. Therefore, it is not in the control of the one who is committing suicide, because it (the death) has been planned by God.

Delivery of News - Instructions for Medical Examiner

There is no difference in the approach the Medical Examiner should take when reporting to family members a suicide versus any other form of death. Nobody wants to hear that someone has died, but the best thing to do is to tell them directly.

When the death of a Somali occurs, go to their home to tell the family, if at all possible. Talk to the elders. Identify eldest contact in the family. Bring a Somali interpreter. Give the information directly to the right person. Ask for Mother or Father, or oldest Brother. Tell them the news directly. The older folks generally react more calmly.

Body Handling Behavior

The body belongs to God. The Spirit has been taken, but the body also belongs to God. Nobody should touch the body other than those who come to wash. This is true for a natural death and for an accident where there may be a mess. In the latter situation, it is important that as much as possible, all pieces of the body be collected together.

The bodies of men and women are dealt with differently. Normally, the woman will be taken care of by the women, meaning they will be washed by the women. Washing happens because of a belief that we came into this world clean, and we go out clean. No men are around when a woman is cleaned. Within 24 hours of death, the body should be cleaned and buried. Very soon after a death, Somali community leaders will be present in the medical examiner's office.

Autopsy

Autopsy is not practiced or accepted in Somali culture. The belief is that when we came into this world, we came in whole, and we should not go out in pieces. There is only one reason to give blood – to save someone's life. But you are not allowed to take other organs. It is a very difficult situation where the law requires an autopsy, such as suicide, shooting, accident or death related to a crime, etc. It is not best for the Medical Examiner to argue that "it is the law". Some people won't care about the law. It is helpful to explain so people understand that the medical examiner is not the authority that made this law, but rather the government did.

The Medical Examiner must present himself as the authority when saying it is necessary for an autopsy to be performed, however it must be done with respect, with friendliness, and with voiced understanding that the culture and religion doesn't permit this practice of autopsy. Relate personally with the community and family, but with a firm and respectful conviction that the autopsy must be done. Offer respect and cultural understanding as negotiation. Also, affirm that the Medical Examiners can do things as quickly as possible, so as to stay within the time frame of 24 hours. (If the community will absolutely not cooperate, the Medical Examiner may say that they can get a court order to demand an autopsy, with the understanding that, for the community, that takes way too much time.)

Conflict and Conflict Resolution concerning American laws vs. traditional practices

For the most part, Somalis will understand that things are not as they would have been in Somalia. There is an understanding that they are living among another culture with its own laws, where the rules are from science not religion. They do understand that there is no way around certain things. There may be huge opposition to that, but the leaders will try to see what the best way to deal with conflict is. They (the religious leaders) will go back to the Quran and find solutions, making sense of the conflicting situation. There is a belief that when you go to another country you live peacefully and obey the laws.

If mistakes are made, or if offenses are made by the Medical Examiner, an apology is merited, but nothing beyond that is required to make amends. Be open to conversation.

Background Information about the Somali Community

The Seattle Somali community numbers close to 20,000. Most of these Somalis came to the US because of war. Roughly 90% of the Somalis here practice the Islamic religion. According to Muslim law, a man can have 4 wives if he can support them well. Consequently, a man may bring wives under the guise of sisters/cousins. Or he may bring all his children and they may petition for their respective mothers. For these reasons, relationship/familial information may be a puzzle and not straight forward. Do not shake hands across gender. Remember that there is diversity within every community. Be conscious of the culture and the religion, and then relate to persons and families individually.

For more information about Somali culture, see the Somali Cultual Profile on EthnoMed:
Somali Cultural Profile