When someone dies, either at a home, hospital, nursing home, on the street, or by accident, doctor needs to pronounce dead in Japan. It is said that over 90% in the metropolitan area, people die in the hospital or in the nursing home. In rural areas, such as a small island, where hospital beds are in shortage, people die at home.
In Japan, when pronounced dead, whether the medical system performs extended life measures by usage of AED, CPR, etc, when heart beat stops and the blood pressure is zero, doctor will pronounce dead and will sign the death certificate. This certificate is a government paper, which in many cases, can be redeemed at the municipal office but lately with many forgeries, some city office will not pass it out unless you are a doctor of medicine (I need to verify with the vicinity city offices around my town). I used to have a copy in my bag since some doctors did NOT carry with them and would need to hand out at that point.
After pronouncement of death, at the hospital, the medical staff will ask the survived family to leave the room for a while, after calming down from grief. The staff will have to “process” the means of body fluids not flowing back. They will stuff cotton in the mouth, ears, nose, anus, (for women–vagina) to stop the leakage. Then the families could meet again.
Meanwhile, the doctor or the staff will ask the survived family to call the undertaker to pick up the deceased to take back to home or the parlor, or anywhere other than the hospital. There is a morgue in the large hospitals but it’s a temporary space for the family to greet the hearse, away from the public. Unless the hospital is a hospice, where only the people in are known with very little remaining life, no hospitals want to see a hearse coming in. Thus the morgue is usually in the back alleys, where laundry and rubbish are taken out. There’s not much of a dignity in Japanese large hospitals once pronounced dead.
Doctor will fill out the death certificate on one side. The rest is for the survived family to fill out. But since the family usually have never seen such a paper work, it’s the job of the undertaker to fill out the form. The undertaker will have to find out who is the immediate survived family member and who is to be designated as the person reporting paper works (although paper works are handled by the undertaker). Doctor only fills out the time and the cause of death. AND they cannot write, “stop of heart beat and respiration” since it’s too obvious. Some moron doctors still do. There is always a reason for the “stop”.
At the hospital, while waiting for the hearse, family will perform a ritual of “Matsugo no Mizu”, where they wet the lips of the deceased. This ritual was formerly to quench thirst of the dying. But since it’s hard for the family to be at the immediate place while someone is dying since many die at the hospital, at the unknown time, the ritual became as giving water after the death. This ritual may take place in the room or in the morgue, while waiting for the hearse to pick up.
Then the hearse will take the deceased to their home or to another morgue at the funeral palor.