7 FAM 200 APPENDIX C
DEATH OF CHILDREN, STILLBIRTHS, and MISCARRIAGES
(CT:CON-804; 04-30-2018)
(Office of Origin: CA/OCS)
7 FAM 210 appendix c INTRODUCTION
(CT:CON-156; 02-07-2007)
a. One of the most difficult situations a consular
officer may encounter in assisting U.S. citizens abroad is the death of a
child. This appendix provides guidance to help you aid families.
b. A child's death is often viewed as particularly tragic.
Unlike an adult's death, a child's death is often felt to be especially
unnatural or unfair. The following thoughts are common when dealing with the
death of a child:
|
Children aren't supposed to die. It's not natural.
The child never had an opportunity to experience a full
life.
The child was innocent and didn't deserve to die.
The child was helpless to intervene or change the
outcome. (This thought may be particularly strong if child abuse is
suspected.)
|
c. This appendix also includes guidance on assisting
families who suffer a miscarriage or stillbirth abroad.
7 FAM 220 appendix C GRIEVING FAMILIES
(CT:CON-431; 01-08-2013)
a. Most consular officers have no formal training in
coping with pediatric deaths. Being unprepared for these intense experiences
can negatively affect consular officers and the quality of assistance provided
to families.
b. After the death of a child, families commonly have
very strong crisis and grief reactions.
(1) Crisis: Crisis involves powerful and often
uncontrollable emotions. Individuals in crisis may need assistance in handling
their emotions. Recruiting other family members, clergy, friends, and others
to support an individual in crisis is often helpful.
(a) Consular officers should repeatedly recommend
specific actions for the safety of the person in crisis (e.g., "Dont
drive. Let me call a friend to take you home.)
(b) Because individuals in crisis often behave
illogically or have impaired decision-making abilities, responsibilities to
dependents may be forgotten. Therefore, it is wise to inquire about other
children or elderly family members who may require assistance.
(2) Grief: Grief is a natural reaction to the death
of a child. The grief process begins with understanding that the child's death
is real. 7 FAM 200 Appendix B provides guidance about grief and bereavement.
Confer with Locally Employed Staff or other local resources, including as
appropriate the Regional Psychiatrist, to ensure cultural sensitivity.
(a) Host country practices may differ from those of the
United States regarding bereavement (see 7 FAM 200 Appendix B).
(b) The attending physician may allow (not force) family
members to see or hold their dead child. However, the family should be
prepared for what will be seen and possibly misunderstood without prior
explanation (e.g., endotracheal tubes, chest tubes, other resuscitation
equipment) when they enter the resuscitation area. Occasionally, offering the
family the opportunity to take with them a memento (e.g., a lock of hair) helps.
(c) Suffering is a natural part of grief. Consular
officers should expect and accept a wide range of emotions of families
suffering from the loss. As appropriate, consular officers may wish to provide
families information on local psychologists or other counseling services. If
the family members are in the United States, victim assistance specialists in
CA/OCS/L (ASK-OCS-L@state.gov.) may assist in connecting the family to local
grief and bereavement specialists.
(d) Families often feel guilty. If possible, reassure
families that they did not contribute (either by acts of commission or
omission) to the child's death. This may best be done by attending physicians
and other medical staff, clergy, or social workers. Reassuring families that
they did everything they could is important.
(e) Do not give false hope while respecting the family
members religious beliefs or lack thereof.
(f) It is extremely helpful for consular officers to
remain with families as they deal with local officials. An understanding of
local medical examiner, police, funeral home, and hospital policies and
procedures is necessary to provide a road map to survivors.
(g) Families should not be placed in the position of
consoling the health professional or consular officer.
(h) Violent reactions from survivors are rare. However,
be aware of this possibility and protect yourself. As with a potentially
violent psychiatric patient, do not allow your access to the room exit to
become blocked. If possible, arrange for others to accompany you.
(i) Often, family members already suspect that their
loved one is dead. When interacting with the family after death, consider the
following suggestions:
|
When talking to families
Use the child's name when speaking with family members.
Speak in short sentences; use plain language (avoid
medical jargon).
Avoid euphemisms for death (e.g., "gone to a better
place"); use culturally sensitive appropriate words such as passed
away or died.
Try to make eye contact and speak to all family members,
not just the most vocal ones.
Look for nonverbal communication from family members.
Be aware of your body language. Try to sit. Touching an arm or shoulder can
be appropriate.
If expressions of anger are directed at you or health
professionals, try to accept them without fighting back. The family member
may just be venting. If family members have gross misconceptions, attempts
at education are reasonable. If resistance is encountered, it is probably
wise to return to the subject at another time and place.
Do not "hit and run." If you say something
hard, remain with family members long enough for them to absorb it
emotionally.
Try to be comfortable with silence. Sometimes doing
nothing is actually doing something. Your presence alone can help family
members.
Accept the family's discomfort. You can support family
members in their pain, but removal of the pain is not within your abilities
as a consular officer.
Do not attempt to find a silver lining in discussing the
death.
Deeply religious families may find great solace in
prayer, religious observance, or a philosophical conversation. Consular
officers may attend such services if invited by the family, and may assist in
directing the family to religious organizations in the host country, preferably
in the familys denomination.
|
(3) Victim Assistance: If the childs death was the
result of a crime; 7
FAM 230 ,7 FAM 1900, and the consular victims of crime resource notebook
available on the CA/OCS Intranet (Specific Types of Crimes) provides guidance:
Guidelines for Victim Assistance in Homicide Cases; Homicide Background
Reading; Homicide Case Referrals. If the death occurred as a result of an act
of terrorism; 7 FAM 1800 provides guidance. Deaths resulting from violence can
be even more difficult than a death due to disease or accident.
(4) Organ Donation: Families may inquire about the
possibility of organ donation. The host country may not have a tradition of
organ donation, particularly of children. Consular officers should assist
families in talking to local authorities about this subject. The generosity of
one family whose child was killed in Italy prompted a marked increase in organ
donation.
|
See:
The Nicholas Green Foundation
NOTE: This is a very compassionate, but emotional Web site.
|
7 FAM 230 appendix C STRESS ON CONSULAR
OFFICERS ASSISTING FAMILIES WHO HAVE LOST A CHILD
(CT:CON-454; 04-15-2013)
a. Because a child's death may be viewed as especially
tragic, consular officers may have strong feelings of nonspecific sadness and loss.
In the aftermath of a pediatric death, you may have feelings that make it
difficult to maintain composure. Natural psychological defenses are
unconsciously summoned to assist you in maintaining composure. While
maintaining a professional demeanor, you should also avoid appearing to be
remote, distant, or cold.
b. Consular officers with children may be especially
vulnerable to an emotional response to a child's death. If their children are
nearly the same age as the deceased, consular officers may realize suddenly,
perhaps for the very first time, the possibility of losing their own children.
Consular officers with children may also identify closely with the parents'
loss. This is also true for consular officers who do not have children of
their own, but have nieces or nephews or friends with children.
c. Consular officers need not be embarrassed if a
pediatric death produces strong feelings within them. It is uncommon for a
person to be totally dispassionate in the circumstances of a child's death. Do
not hesitate to seek assistance from family, friends, clergy, and other
professionals in helping to manage your own feelings. (See 7 FAM 1800 Appendix
A, Managing Stress and Consular Crisis
Work.)
d. If consular officers feel angry because the death is
due to abuse or neglect, it may be helpful to remember the limits of the
consular role. Others (i.e., police, courts, juries) have the responsibility
to conduct an investigation, adjudicate, and assign guilt. Directing anger at
the situation, but not at any individual, can avoid the possibility of causing
great harm by placing guilt on the wrong person.
7 FAM 240 APPENDIX C REFERENCE AND
RESOURCES FOR PARENTS WHO HAVE LOST A CHILD
(CT:CON-156; 02-07-2007)
a. Consular officers should be familiar with resources
in the host country for families in these tragic circumstances.
|
For example:
BBC Coping With Grief Childhood Death
U.K. Child Death Helpline
|
b. The following are selected on-line material that may
be useful. Do not provide such referrals in your initial conversations with
surviving family members.
|
See:
The Death of a Child the Grief of the Parents A Lifetime
Journey
National Funeral Directors Association Discussing Death
With a Child
Hospice Talking to Children About Death
National Center for Grieving Children and Families
American Cancer Society Discussing Death With a Dying
Child
American Heart Association Coping With the Death of a
Child
Pregnancy Loss and Infant Death Alliance
Death of an Infant, Child, Grandchild
Compassionate Friends
American SIDS Institute (Sudden Infant Death Syndrome)
MEDLINE PLUS SIDS
Parents of Murdered Children
|
7 FAM 250 APPENDIX C STILLBIRTHS AND
MISCARRIAGES
(CT:CON-431; 01-08-2013)
a. Posts may be called upon to assist U.S. citizen
families abroad when birth results in stillborn infants, miscarriages, or when
infants die shortly after birth. Different countries have different standards
regarding this distinction, which can determine the host country policy on the
issuance of a birth or death certificate and release of remains to the family.
b. Report of Death: In the case of a stillborn child,
the consular officer may issue a report of death, provided local authorities
have issued a death certificate or the attending physician provides a statement
regarding the stillbirth, and the parents submit required evidence of their own
identity and citizenship. The remarks section of the report of death should
reflect the circumstances. Reports of Death are not generally issued for a
miscarriage, but if it is a late term miscarriage which would be considered a
stillbirth in the United States and the family asks for such a document,
consular officers should e-mail ASK-OCS-L@state.gov., which will provide
immediate guidance. (See 7 FAM 270.)
c. Report of Birth or Stillbirth: 7 FAM 1470
provides guidance regarding issuance of Reports of Birth and Reports of
Stillbirth.
d. Consular Mortuary Certificate - Disposition of
Remains: Posts should assist parents wishing to bring the remains to the
United States. A consular mortuary certificate should be modified
accordingly. CA/OCS is aware that some countries use terms such as medical
waste to describe a miscarriage. Do not use such terminology in any consular
documentation or in any conversations with families. If no local death
certificate is issued (due to host country interpretation of the definition of
miscarriage v. stillbirth), posts may assist families in communication with
local authorities to obtain release of remains on a humanitarian basis. Host
country authorities should be asked to execute some certification as to the
contents of the hermetically sealed container and the fact that no communicable
disease is involved. (See 7 FAM 250.)
e. Bereavement Assistance: If the family is residing
in the host country, you may direct them to local resources for bereavement
assistance.
|
For example:
International Stillbirth Alliance
Compassionate Friends Stillbirth
SANDS Stillbirth and Neonatal Death Society U.K.
SANDS Australia
The MISS Foundation
Missing Angels Foundation Legislative Reference Site
Bereavement and Childbirth in Ireland
|