Post mortem photos and ethical issues.

  1. for last several years our nicu bereavement team has done post mortem photos, with or without the parents present or approval. a few weeks later when we send home the infant loss kit (molds if they come out, hair, footprints, book, etc) we would send the pictures too. we've never had a problem with this until just recently a parent complained because she/he apparently didn't like us doing the pictures (i don't know the reason, i haven't asked yet). so now all post mortem pics in the entire hospital are on hold (pediatric hospital).
    i'm on the nusing ethics forum and will be using this as a topic in a couple of months so i'm doing a little research. any input would be appreciated.
    thanks.

    addition 1/1/07 - i think i spoke to too soon. i do believe that we would take the pictures but wouldn't send them without first asking. you all have given me some good ideas. i have to speak to the nursing ethics group in a couple of months and will bring up some of these suggestions. i have heard of "lay me down to sleep". i know there is a photographer in town who has volunteered her services although i don't know if she is with an organization also. i didn't mention that i am a semi-pro photographer and am part of an organization called "the american child photograhers charity guild" acpcg.com . i had to sign a conflict of interest statement at the hospital. i don't really want to advertise down there anywhere because i don't have time to drive 20 miles to work everyday to do photos.
    Last edit by kcangel on Jan 1, '07 : Reason: update my thinking
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  2. 14 Comments

  3. by   BittyBabyGrower
    We do the pictures, but we have a bereavement counselor or hospice nurse that calls and talks to the family and brings up the fact that we have pictures if they would like them, we never just send them to the family. The other items we give to the family before they leave if they wish, otherwise the forementioned people tell them what we have and ask if they would like it sent to them or brought over.

    That being said, we always have our families filll out a form that has questions on it about religion, practices, etc. Some, such as the Mennonites/Amish, will not consent to pictures. You need to find out why this mom was against it. I don't think just sending pictures without warning is a good idea....some families will think this is "gross" or "wrong" and will not want pictures of their dead child, others will embrace it. We keep all pictures for one year and let them know if they change their mind, they are welcome to them. We have a digital camera for use on our floor and we will take pictures for the family while the child is still "alive".
  4. by   ginger58
    My first thought is any photo of a patient has to consented to, so in this case, that would be the parent. But I know in our NICU we took looks of photos of the live babies without consent.
    I guess in terms of post mortem photos I would want parents' consent. When the baby dies ask them if they would like any photos.
  5. by   ?burntout
    I'm on both sides of this fence as both a RTS team member and a bereaved parent.

    When my son died, we were asked if we wanted pictures but we did not sign any forms. We were given his memory box right before we left the hospital and someone from the bereavement team called us about his pictures-did we want them, etc. The photos and the negatives were mailed seperately and I had to sign for them both times.

    Now that I work with RTS, we try to take pictures when we can. We do let the family know that we did take pictures and we ask them do they want them. If they don't, we keep them on file. If we do, we will mail them to the family after asking again if they would like their pictures.
  6. by   caliotter3
    I agree with everyone who stated that the family should be asked first before sending photos. They should never, just be sent automatically. And in today's lawsuit society, signed releases to even do the photos in the first place should be obtained.
  7. by   kcstudentnurse06
    I work in mother baby and when we have an IUFD, we ask the parents if they would like photos. We also have photographers that participate in "Now I Lay Me Down To Sleep" which is a group that volunteers their services to families that have lost a child. They come to the hospital and take professional photos. It is really amazing what they can do. You can see samples of their work at Now I lay Me Down To Sleep - ~Infant Bereavement Photography~

    I forgot to mention, that we have a digital camera and printer, so if the family wants pictures, we give them to them before they are discharged.
  8. by   babynurselsa
    We always let the family know that we would be taking pictures and that they would be available to them.
    I never had a family request that we not take the pictures. Some would say they did not want them, but many later called and requestd them.
    We never sent the pictures out without making sure they were welcome and that the family knew they were coming.
    This could be a rude shock out of the blue.
  9. by   2curlygirls
    We take pics while babe is alive (if possible) and after he/she passes. Put the camera in the memory box. Parents can develop if they want to.

    Once we had twins. One was going to be removed from support. The nurse thought it would be nice to put the twins together for a photo. Mom was horrified! Why would we want a dying baby next to a living one? Was her thought. They were from a different culture and didn't think death photos were appropriate.

    Things to keep in mind. Some people prefer memories to photos.
  10. by   dawngloves
    We take the pictures, but do not develope them without a signed consent. The parents have the option of consenting later. I think it would be heartbreaking for a parent to decided months later that they wanted pictures of their baby and it would be too late. But we also tell parents that the film will deteriorate and two years down the road it may be too late. They can have us hold developed pictures until they are ready. We have pictures that go back years in deep storage.
  11. by   traumaRUs
    Wow - I guess I never considered this. I know working in the ER for many years, we had many deaths of children from neonate through teens. We did a memory box if possible with a lock of hair and hand/foot/finger print if possible. We offered this to families. However, we never took pictures - no camera and somehow just never seemed appropriate. I see that in L&D and NICU this would be different.
  12. by   meg335
    Quote from kcangel
    For last several years our NICU bereavement team has done post mortem photos, with or without the parents present or approval. A few weeks later when we send home the infant loss kit (molds if they come out, hair, footprints, book, etc) we would send the pictures too. We've never had a problem with this until just recently a parent complained because she/he apparently didn't like us doing the pictures (I don't know the reason, I haven't asked yet). So now all post mortem pics in the entire hospital are on hold (pediatric hospital).
    I'm on the nusing ethics forum and will be using this as a topic in a couple of months so I'm doing a little research. Any input would be appreciated.
    Thanks.

    I am pre-nursing, but I was a bereavement specialist in a hospital for two years. I also am the VP of the MISS Foundation, which is an organization that provides services to families in crisis after the death of a child. I also travel around the country doing inservices for hospitals on this and other topics related to caring for families who experience the death of a child. I would be happy to assist you if you would like to contact me privately with specific questions and can point you towards research that could be helpful.

    In general, however, what I suggest is that parents be included in all of these decisions. There may be some cultural issues with picture taking. Sometimes the parents will initially refuse, but it can be revisited - gently - as the news of their child's death begins to sink in. Since these may be the only pictures the family have holding their child, I would always try to include them in the process. I would never mail pictures to a family. They may have no one there to support them when the "surprise" comes in the mail. We went to digital equipment and I was able to take pictures and print them before they left the hospital. I also know that in our ER and those in many of the hospitals I have taught in, staff was not allowed to take hand or footprints if it was a coroner's case. In fact, sometimes our ME would not allow us to even take a lock of hair. It is worth checking with your county coroner's office.

    In general, pictures and mementos are treasures to families. I have facilitated parent support groups for many years and more often than not, parents bring their pictures and share them with us and with other parents. Many also make memory books. Hope this helps....
  13. by   nd deb
    I looked at the website of the photos. It was so sad but some of them were really beautiful photos. There is one one there with the mom and baby skin to skin and with the mom, dad and baby skin to skin.

    I recently lost my 2 yr unexpectly to AML in Aug. They asked us if we wanted photos and we were at first a bit mortified by it but we did allow them to take some. About a wk or so later we were glad that they did. At first we were worried that the pics would bother us but they aren't too bad. It actually makes you remember what he looked like. The last photos we had of him were taken around 2 wks before he died. We did comment to the picu that they should ask every parent if it is ok to take them and they have the option of having later if they decide they want them.
  14. by   ElvishDNP
    I looked through the Now I Lay Me Down To Sleep website....wow. The pictures are absolutely stunning, at least the ones I could see through the tears running down my face. I work mother/baby so we do have a few IUFDs a month. I try to encourage families to take pictures with their babies, as I think that (for most, anyway) it helps heal. This is a great thread.

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