Standards for mortuary services: guidance published by the Scottish Ministers, Police Scotland and the Crown Office and Procurator Fiscal Service

Standard 2: Dignified and respectful care of the deceased

Standard statement

Each organisation's mortuary service is respectful of the deceased's wishes, spiritual, faith and cultural values, beliefs, identity, dignity, privacy and confidentiality.

Rationale

Care of the deceased is seen as an aspect of clinical care.

The personal, spiritual, faith and cultural values, beliefs and identity of the deceased are to be respected if known and followed where possible.^{[32, 33]}

In those deaths that involve the police (COPFS cases), although the personal, spiritual, faith and cultural values, beliefs and identity of the deceased will be considered, it may not always be possible to act on them as legal requirements and forensic practice will take precedence.

Where known, the deceased's wishes are taken into account by the mortuary services and discussed with the bereaved. Some people are fearful that their wishes, spiritual, faith, culture, beliefs and identity will not be respected in death. Where the wishes left by the deceased do not align with the wishes of the bereaved, the mortuary service, operating within its organisation's procedures and requirements, will discuss and work with the bereaved to identify and agree a solution.

It is important the bereaved have confidence that the deceased will be treated with kindness, dignity and respect at all times. Evidence suggests that this can be a comfort to the bereaved, especially at the time of viewing.^{[34, 35]}

When a person dies, experience indicates that the personal effects worn by the deceased when they died can be of very significant importance to the bereaved. Treating personal effects with care and keeping clear records of the deceased's personal effects is of utmost importance.

Criteria

2.1 The deceased will be treated with kindness and dignity at all times, including during transportation and when being presented for viewing. This will be in line with professional standards^{[11, 36]} and organisational requirements.

Ensuring the security of the deceased from illegal and unauthorised access will be given utmost importance and will be in line with the security arrangements set out in Scottish Health Planning Note 16-01 Mortuary and Post-Mortem Facilities: design and briefing guidance^[9].

2.2 The dignity, privacy and confidentiality of the deceased will be respected in all cases. If known, the wishes, spiritual, faith and cultural values, beliefs and identity of the deceased will be taken into account and followed where possible.^[32]

2.3 The deceased's clothing, belongings and personal effects received into the mortuary will be handled with sensitivity and returned, taking into account the following:

• in those deaths that do not involve the police, the personal effects of the deceased will be cared for and returned respectfully in consultation with the nearest relative
• in some cases of deaths in the community, clothing may not be returned to the nearest relative for reasons of infection control^{[24, 37]}
• in those deaths that involve the police (COPFS cases), legal procedures, including the need to secure evidence, will take precedence. In these cases, an accurate record of the personal effects and their location should be kept so that when no longer required for evidence they will be returned in line with COPFS standards
• in all cases where belongings cannot be returned, a full explanation will be given to the people who are bereaved
• in those deaths in the community that do not involve the police, where the deceased is accommodated in the mortuary while awaiting medical certification of cause of death, the handling of personal effects will be the responsibility of the funeral directors unless requested otherwise, and
• a record of all clothing, belongings and personal effects of the deceased will be produced and retained for a minimum of two years or in line with the organisation's records management policy.

2.4 Each organisation is responsible for ensuring that all information regarding the deceased, including identification, is as accurate and complete as possible during handover between services, for example, during transportation of the deceased.

2.5 Organisations ensure that when caring for and transporting the deceased:

• standard operating procedures for care and treatment of the deceased are in place
• standard infection control precautions are given high priority and followed at all times, ensuring the safety of all people who may come in contact with the deceased^[24]
• other precautions for particular circumstances, such as exposure to radiation or chemicals, should also be followed in line with HSE and Scottish public health guidance^[24]
• a coding and records system is in place to facilitate traceability of the deceased, ensuring correct care and a robust audit trail
• partner agencies should agree and set a minimum retention period for records
• the bereaved's permission should be obtained for any 'cosmetic' procedures, adjustments or other invasive procedures prior to release of the deceased. Where the deceased's wishes are known, these should be taken into account and discussed with the nearest relative and the bereaved
• a procedure is in place to discuss with the nearest relative and the bereaved any condition that may cause them distress, for example, when viewing or preparing the deceased for burial or cremation
• the deceased is considerately, respectfully and thoughtfully prepared for both viewing and release, and
• patient confidentiality is respected in line with law and guidance.^{[21, 23, 38-40]}

What does the standard mean for people in the care of mortuary services?

• All people will be confident that personal information will be kept confidential after they die except in those circumstances when disclosure is in line with law and guidance.
• All people will be confident that when they die, where it is known and possible, they will be treated as they would wish to be.

What does the standard mean for staff?

• Mortuary staff are trained in, and have information on, faith, spiritual and cultural practices, beliefs and transgender identities, to confidently, sensitively and appropriately care for the deceased.
• Mortuary staff check for recorded information on the deceased as a matter of routine and respect the requirement for maintaining patient confidentiality.
• Mortuary staff will always care for the deceased in a respectful and dignified manner, which is also appropriate for viewing and release.

What does the standard mean for organisations?

• Each organisation needs to discharge its duties under the Equality Act 2010.^[32]
• Mortuary staff have access to training and are supported to understand their responsibilities under appropriate legislation.
• Each organisation has a range of standard operating procedures to underpin care and consistency within the service.

Practical examples of evidence of achievement (NOTE: this list is not exhaustive)

• Records show that the deceased's personal effects are returned to people who are bereaved wherever possible in accordance with guidance and standards.
• Records show the deceased's personal, spiritual, faith and cultural values, beliefs and identity have been respected wherever possible and where this has not been possible, an explanation is recorded.
• Records show that each organisation has undertaken a security risk assessment in line with Health Facilities Scotland Scottish Health Planning Note 16-01 Mortuary and Post-Mortem Facilities: design and briefing guidance^[9] and taken appropriate action where required.
• Feedback shows that transgender people have been prepared in an appropriate, sensitive and respectful way.
• Examples of feedback from people who have been bereaved, where persons of faith and belief groups were prepared in line with their faith.
• Feedback from people who have been bereaved has been sought and acted on appropriately.
• Feedback from funeral directors has been sought and acted on appropriately.
• Records of transport of the deceased, correct identification and relevant clinical information (including hazards).
• A system is in place to track the deceased from admission to the mortuary to release for burial or cremation. For example, the use of three methods of identification and records such as the CHI number, post-mortem number, name, date of birth and death.
• Risk assessments include how to mitigate the identified risks. This includes actions that need to be taken, specifically who is responsible for each action, deadlines for completing actions and confirmation that actions have been completed.
• A care after death policy.^{[16, 17]}
• Evidence of dignity and respect for the deceased would be in line with the care after death policy and would include:
  • being clean and appropriately clothed or shrouded
  • the mouth and eyes closed
  • a block placed under the head throughout the stay in the mortuary, and
  • medical devices, for example, cannulas removed where this is possible.
• Standing operating procedures on:
  • identification of the deceased
  • procedures for releasing the deceased
  • receiving and preparing the deceased to leave
  • transportation of the deceased
  • personal effects
  • record retention, and
  • infection control.