Chapter 1

Funeral Rule

(funeral industry practices trade regulation rule) 1) enacted 1984 2) revised 1994 -applies to ALL states

What does embalming make possible?

- Temporary preservation and sanitation of the deceased body renders the body inoffensive by slowing postmortem changes - Seeing the body allows the family and friends to accept the finality of death, - Allows time to organize ceremony and ritual with the body present - Time for friends and relatives to gather for funeral ceremonies and if desired view the deceased remains - Moving the deceased to a distant location for final disposition if desired -Viewing restores a favorable body image by removing the adverse effects of disease, trauma, or postmortem changes - Preservation for anatomical study and research by medical institutions -a slow breakdown of the body over time; desiccation rather than putrefaction

body donation, organ donation

- the embalmer needs to maintain a neutral position and follow the directions of the family wishing to donate organs or tissue of a deceased family member -some medical institutions permit embalming with restrictions, or a preparation without embalming for a viewing, if desired by family and friends

judicious counsel

- the embalmer should advise the family concerning their expectations for a visitation and viewing - representations concerning embalming an restoration should be full and factual, including invasive procedures -need for available photos to aid in embalming and feature setting, cosmetic and hair dressing preferences - misrepresentations are unethical and unprofessional and should be avoided at all times, need to give realistic expectations

what federal agencies regulate the funeral profession?

-CDC -EPA -FTC -OSHA -TSA

What types of death require notifying the coroner or medical examiner?

-accidental deaths - homicidal deaths -suicidal deaths -abortions -sudden deaths

human nature of embalming

-american denial and defiance toward death and dying -dead human body represents a psychological and ethical paradox for people as we are attracted and repulsed by the dead -burial of the human body is oldest of religious customs practiced 60,000 BC by Homo sapiens neanderthalensis

Don't do it bitch

-do not talk shit about another professional -it is unethical for an embalmer to willfully entice the employees of another firm with the purpose of unduly hurting that firm or professional

proper care of the deceased and documentation

-embalmer should deliver and document quality care of the deceased body -embalming procedures must be documented on embalming report for future reference -embalming report must be completed for each body -record of clothing and other items received -written permission to embalm or a record of expressed permission obtained -permission still needs to be obtained for minimum care treatments for identification of or viewing the body

ethical practice

-ethics is the science of rectitude and duty -its subject is morality and its sphere virtuous conduct

consequences of the act

-in the downfall of powerful regimes it can be seen that the lack of proper care for the dead was commonplace -there are ethical, moral and sociological consequences to neglecting care of the dead

protection of the body

-never leave prep room door open -never let photos of the deceased be taken or viewed

Embalming Authorization Form

-provides permission for embalming the body and indemnification of the funeral home -it expands who may assist in the embalming: mortuary students/mortuary interns -provides for employment of a trade embalmer -allows the body to be embalmed at the funeral home or at a separate embalming facility -allows restorative treatments -protects funeral home if the body has been misidentified

handling the remains of the deceased human body

-removal must be accomplished with same degree of care as a patient being transported -all equipment must be clean (cots, sheets, pillows, pouches) -remains protected by wrap or appropriate covering -universal procedures should be followed for any removal

health protection and sanitation

-safe sheltering of human remains -keeping the prep room sanitary -restrict entry to anyone not authorized to be there

ethical model

-the supreme ethic if the funeral profession is reverence for the dead -the ethical question of what should be done with the dead becomes a tricky one

religious impact on embalming

-two references to embalming in the old testament -new testament contains references to Judeo-Christian tradition to care reverently for the dead

psychosocial model

-within attachments between people are deep links -patterns of recognition become very powerful -usually unaware of how strong these are until separated from death or physical or emotional distance -through this process familiarity with characteristics of the significant other is imprinted in our minds

legal considerations

1. Authorization to embalming -verbal permission -Written permission 2. Authorization for procedures other than embalming 3. The text has many sample forms

Ethical performance standards

1. Being entrusted with a family's deceased loved one is not something that should be taken lightly. 2. Be sure to carefully and thoroughly read the Ethics section of the text.

Different forms that must be filled out for legal reasons?

1. Embalming Authorization Form 2. Authorization for Restorative and Cosmetic Care form 3. authorization for minimum care services form 4. Minimum care authorization when embalming is declined form 5. authorization to prepare donation cases for viewing form 6. Green Funeral Release and Indemnification form 7. identification of the remains of the descendent form 8. Viewing when not advised against by the funeral home form 9. Attention Funeral Director Form 10. Decedent Care Report

Preventative measures

1. Not represent that a deceased person is required to be embalmed for: 1) direct cremation 2) immediate burial 3) a closed casket funeral without viewing or visitation when refrigeration is available and when state or local law does not require embalming 2) place a disclosure on the general price list in immediate conjunction with the price shown for the embalming

Professional Conduct

1. Show respect/reverence for the dead 2. Maintain high standards in all areas of embalming (e.g. facilities, equipment, education, etc.) 3. Limit access to the preparation room -Licensed funeral service professionals and registered trainees -Those authorized by the family -Those authorized by state law 4. Identify and secure preparation room 5. Maintain high moral standards -Keep body covered as practical -No use of recording technology/photographing without permission -No inappropriate comments -Maintain confidentiality at all times (1) No discussion of any details of the deceased (2) No social media, etc.

preservation

1. Stabilize body proteins 2. Destruction of most enzymes that act upon the body after death (autolysis) -Autolytic enzymes -Microbial/bacterial enzymes

Legislative intent for embalming

1. Two primary state regulatory boards 2. Federal Trade Commission (FTC)

Social and psychological performance standards

1. Universal convictions 2. Rituals and ceremonies

Four classifications of embalming

1. Vascular (Arterial) embalming 2. Cavity embalming -This process is sometimes referred to as "cavity treatment" and is necessary to reach those spaces that cannot be treated via arterial injection (e.g. inside the stomach.) -There are two phases: aspiration and cavity fluid injection 3. Hypodermic embalming 4. Surface embalming

sudden deaths

1. alcoholism 2. sudden death on street, at home, in a public place, at place of employment 3. deaths in unknown circumstances whenever there is no witness or when little or no information can be elicited concerning the deceased 4. deaths that follow injuries sustained in the work place 5. all stillborn infants where there is suspicion of illegal interference 6. death of persons after visiting attending physician within 2 weeks prior to death 7. all sudden deaths occurring within 24 hours of admission to a hospital

accidental deaths

1. anesthetic accident (death on the operating table) 2. blows or other forms of mechanical violence 3. burns or scalds 4. crushed beneath falling objects 5. cutting or stabbing 6. drowning (actual or suspected) 7. electric shock 8. explosion 9. exposure 10. firearms 11. fractures of bones, not pathological 12. hanging 13. falls 14. carbon monoxide poisoning 15. heat exhaustion 16. insolation (sun stroke) 17. poisoning 18. strangulation 19. suffocation 20. vehicular accidents

Four functions of embalming?

1. disinfection 2. preservation 3. restoration 4. sanitation

When a state issues an embalming license to a qualified practitioner, it is declaring the following:

1. embalming is a practice affecting the public safety and welfare and is subject to regulation and control in the public interest 2. the preparation, care, and final disposition of a deceased human body should be attended with appropriate observance and understanding, in addition to having due regard and respect for the reverent care of the human body and for those bereaved and the overall spiritual dignity of human kind 3. as a matter of public interest, the practice of embalming merits and receives the confidence of the public in that only qualified persons be authorized to embalm in their state of practice 4. the state codes should be liberally constructed to best carry out these subjects and purposes

Acts considered deceptive under FTC Funeral Rule

1. represent that state or local law requires that a deceased person be embalmed when such is not the case 2. rail to disclose that embalming is not a requirement by law except in certain special cases

Three cases for which an embalming fee may be charged

1. state or local law or regulation requires embalming in the particular circumstances, regardless of any funeral choice which the family might make 2. Prior approval form embalming from a family member or other authorized person 3. the funeral provider is unable to contact a family member or other authorized person after using due diligence, has no reason to believe the family does not want the embalming performed, and obtains a subsequent approval for embalming already performed -must disclose that a fee will be charged if the family selects a funeral requiring embalming such as a viewing

four divisions of OSHA that affect the funeral home:

1. the general rule 2. the hazard communication standard 3. the Formaldehyde rule 4. the bloodborne pathogen rule

autopsy

An examination of the body after death usually with such dissection as will expose the vital organs for determining the cause of death -funeral director needs to remain neutral as a family may resist demands of an autopsy by corner or medical examiner -sudden or traumatic deaths can have legal ramifications and may be necessary for insurance benefits

authorization for minimum care services form

Authorizes minimum care when embalming is not requested. It gives the funeral facility permission to perform certain tasks to prepare the body for identification, viewing, or immediate cremation.

EPA

Environmental Protection Agency

An embalming report form (or decedent care report) should be completed for ALL bodies that enter into the funeral home's care

Even those bodies that are not embalmed (e.g. cremation case that is being prepared for an identification viewing) should be assigned an embalming report form so that the condition of the body when it is received can be documented as well as any procedures (e.g. bathing, setting of features, etc.) that are performed on the body

terminal disinfection

Final cleaning of the body, instruments, work area, etc.

Green Funeral Release and Indemnification form

Gives direction for disposition of the dead human body when a green burial (natural burial) is requested.

OSHA

Occupational Safety and Health Administration

concurrent disinfection

Occurs during the embalming process

restoration

The goal is to restore the deceased to an "acceptable appearance."

An embalmer should always complete an embalming report at the conclusion of the case.

This vital document can protect the embalmer (and the funeral home) in a lawsuit should a family have any issues with the embalming/presentation of their loved one. Without an embalming report, the embalmer has no legal recourse and it will be nearly impossible to defend their performance in a court of law.

sanitation

Though not a direct result, sanitation may aid in disinfecting the body. If you create a clean environment free of biohazards, you will remove the environment in which the microbes thrive; thus indirectly kill the microbes.

embalming

a chemical method of bringing about a temporary preservation of the dead -the chemical treatment of the dead human body to reduce the presence and growth of microorganisms, to temporarily inhibit organic decomp, and to restore the dead human body to an acceptable physical appearance

coroner

a public official who investigates by inquest any death not due to natural causes

funeral

a social function that reflects the reality of our capacity to form deep attachments and the most human need to grieve and mourn our dead

confidentiality

all confidences from family members bust be ensured by the embalmer and funeral director

universal convictions

all cultures place an importance on death practices and the community viewing the body, commemorate their dead -reverence for the dead binds all of humanity together

What is a common occurrence in people experiencing complicated bereavement?

an inability to recall a clear mental image of the body in death

Minimum care authorization when embalming is declined form

authorizes minimum care of the body. provides a detailed description of "minimum care" that can be performed

abortions

criminal or self-induced

Important concepts in embalming:

disinfection, preservation, and restoration

Decedent Care Report

documentation of body conditions and subsequent treatments when sheltering, or preparing a body for visual identification prior to cremation; or for a body received from another facility -MUST be completed for EACH deceased human body brought into a funeral or embalming facility. A copy of the report must accompany the body being shipped or transported to another funeral facility

What is the embalming disclosure?

except in certain special cases, embalming is not required by law. Embalming may be necessary, however, if you select certain funeral arrangements such a funeral with viewing. If you do not want embalming, you usually have the right to choose an arrangement that does not require you to pay for it such as direct cremation or immediate burial

leave-taking

farewell or departure, families need time to view the body in order to do this

Authorization for Restorative and Cosmetic Care form

gives necessary permission when extensive or operative restoration work may be necessary in the preparation of the body

body image

in funeral service this mental photograph individuals have of others as a result of imprinting

Where does grieving begin?

in the bereaved psyche by sensory (visual and tactile) confrontation with the dead person's retained body image

homicidal deaths

including those that involve child abuse

it is critical that the funeral service practitioner appreciates the complex processes behind these human attachments and separations

it is these psychological processes on which the ethic of reverence for the dead is based and which necessitate the need for funeralization. Without human attachments there would be no funerals

identification

must make sure the body in question has been properly identified

What should never happen morally

never let logic dismiss importance of a body as dead flesh, always let emotion tell us it is a human being -avoid traps of rationalization and denial

primary obligation of the embalmer

quality control int he removal, transportation, preparation, care and security of the remains -an embalmer by each act of service contributes to family satisfaction, serves the public, and contributes immeasurably to the future success of any firm

if an embalmer notices any suspicious cause of death they should:

report it to the coroner or medical examiner

What is a basic ethical axion of the funeral service profession?

reverence for the dead -preparation of human remains is an ethical fulfillment of this -charged with the maintenance of this moral and ethical responsibility

how long has embalming been prevalent in the american death industry?

since the second half of the nineteenth century

in home removal

soiled bedding should be removed, and make up the bed so everything looks nice and orderly -be prompt in responding to home call, hospice, nursing home or hospital call

observing laws

the embalmer must be sure they obverse all legal and regulatory requirements for federal, state or local government

preparation of remains should be viewed as:

the right of the deceased person to be cleansed, sanitized, groomed, restored and embalmed with dignity

don't be a dick

to any extent possible embalmers should attempt to accommodate families who are unable to pay for embalming but may still wish for a viewing -think of it as the family's right to check the embalmer's performance

practical model of embalming

to fully implement the ethical, psychological and sociological values of funeralization people need time (to organize, think and make decisions about the funeral) -embalming slows the process to allow for more time -renders the body inoffensive and makes it presentable -offers extended transport -modern embalming reflects tech of the age

what is the embalmers ultimate purpose?

to make the body presentable for viewing, and through the technical work of the embalmer, the realization of the finality of death takes place practically and tastefully

authorization to prepare donation cases for viewing form

used when a funeral facility prepares a body where organs/ tissues have been donated

Viewing when not advised against by the funeral home form

used when the funeral home advises against viewing the body but the family does want to view. note that a description of the body is given

What is the best way for the bereaved to overcome any death denial feelings?

viewing and touching the body -refusing to see the body is an act of denying the death, and must be recognized as such

The American Way of Death

written by Jessica Mitford in 1963

American Society of Embalmers Best Practice Embalming Tenets

1. treat all deceased human remains with thoughtful care, maintain dignity, and show respect at all times 2. Be knowledgeable of and in compliance with all regulatory authorities (federal, state, and local) that govern the preparation and disposition of a deceased human remains 3. Prioritize the use of excellent communications among all funeral professionals involved with the decedent and family 4. All documents, photographs, and personal information about the deceased must be kept in strict confidence and under secure storage 5. Respect and comply, without comment, with the wishes of the family or the deceased requesting organ/tissue donor, hospital or forensic autopsy, or full body donation to science 6. Professional conduct with ensure that embalmers will not knowingly allow non-licensed embalmers (exception students) to practice embalming and that they will not participate in derogatory public comments about other embalmers 7. purse ongoing and continuing education opportunities 8. practice thorough and complete preservation of the entire remains 9. document all remains entering the funeral facility on a preparation care form 10. be knowledgeable of multiple methods of treating all types of embalming cases, regardless of their condition 11. protect yourself from any potential hazard, infectious, chemical and physical 12. the establishment ownership and the embalming practitioner must agree to have available all necessary supplies, chemicals, dry goods, and equipment to prepare every type of embalming case 13. the preparation room and adjoining facilities must be maintained in a clean and sanitary condition

Attention Funeral Director Form

A form for bodies being shipped to another funeral facility -describes condition of the body at shipping location and requests notification of any problems encountered by the receiving funeral facility -accompanied by Decedent Care Report

medical examiner

A physician who investigates suspicious or unexplained deaths, can perform an autopsy

primary disinfection

Topical disinfection of the body prior to beginning the embalming process

identification of the remains of the descendent form

Verifies the identification of a decedent -states who is making identification -states that body was viewed and identified -states that next of kin refuses to identify the remains but authorizes final disposition without positive identification -indemnifies the funeral facility if the body is incorrectly identified