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“Sensitive incineration” – definition please?

Wednesday, 13 July 2016

incineration of clinical waste

Guest post by Tim Morris from the ICCM

“Sensitive incineration of Pre-Term Babies”

Is this a valid option for bereaved parents alongside burial and cremation? Believe me, it has been accepted in some quarters. If you are a bereaved parent or of a sensitive disposition, I apologise for any cold technical and legal terms used however they are in use, I mean no offence.

The Institute of Cemetery and Crematorium Management has opposed the option of ‘sensitive incineration’ as an option for the disposal of pre-term babies, on the grounds that such a thing does not exist.

When the Human Tissue Authority (HTA) consulted on the disposal of pregnancy remains following pregnancy loss or termination in March 2015, the ICCM made its position very clear. Is adding the word ‘sensitive’ an attempt to make the disposal of babies as clinical waste sound acceptable? The (re)introduction of incineration was a surprise when the HTA Guidance was published, as the year prior to this, 2014, the then Health Minister had branded the practice ‘totally unacceptable’ and ordered it to cease – see here.

Scotland, ahead of the game at present in matters of burial and cremation and the disposal of the dead, banned the sending of lost babies to incineration plants in 2012.

Well done Scotland.

Having attended various events and gatherings, and more recently speaking at the Child Funeral Charity seminar just a week ago, I have taken the opportunity to ask those gathered if they could describe sensitive incineration. To date nobody has, not even the HTA and organisations that have supported it.

Whist it could be understood and accepted that some women might not want any recognition for their baby, whether miscarried or aborted, the suggestion that it would be their wish to have no record of nor recognition for their baby does not follow. There will always be a record at the hospital or clinic on medical files, and the hospital or clinic would need to retain a signed consent form, plus the record of waste transfer to the incinerator (in the form of a waste transfer note required under waste management legislation) is yet another record in the chain of events. In other words an audit trail.

If the final act takes place at a crematorium or cemetery, a hospital or clinic record will be maintained albeit the name of the mother being substituted with a case number in order to maintain confidentiality required under the Abortion Act if the mother so desires. No record of the mother would be held at the cemetery or crematorium, hence confidentiality maintained. Whilst there might be audit trails in respect of incineration, burial and cremation the overriding fact is that parents are not revealed and confidentiality is maintained. Recognition of a lost baby could only be given or not by parents.

Anyway, an attempt at a description of sensitive incineration comes via the HTA Guidance that suggests that these babies should be placed in a container and not with other clinical waste, and that a minister of religion could accompany the container (yellow plastic bag??) on its journey and to its end.

It also suggests that these babies are incinerated separately from other clinical waste. Is this possible in a commercial, continuous, industrial process? Could someone explain? The ash, even if it could be separated from the ash produced from the burning of other waste, would surely not be respectfully scattered in a pleasant area of grounds but will be dumped in a landfill site.

I really feel for those hospital staff that might be required to attempt to describe sensitive incineration alongside descriptions of burial and cremation. Perhaps some might refuse? Perhaps some bereaved parents will be shocked into making complaint? Time will tell. Perhaps hospital managers should visit both crematorium and incineration plant and draft a truly accurate description of the process observed at each in an attempt to help their staff?

Note Clause 5.3 in the Royal College of Nursing Guidance

The MoJ published its response to its consultation on review of the cremation regulations on 7th July, just last week. The review was required as it was evident that action was required in light of the Baby and Infant Cremation Investigation Reports, the Commission report in Scotland, and the Emstrey report in England. It was music to our ears as the Institute had long since campaigned to bring the cremation of fetuses into regulation. The first Institute policy statement issued in 1985, (yes 1985!) entitled ‘Fetal Remains, an IBCA policy statement’ was basically an attempt to cease sending pre-term babies to waste incinerators (Note that IBCA is the former title of the Institute). At that time, all babies born prior to 28 weeks (now 24 weeks) gestation and showing no signs of life, were consigned to the incinerator. Only stillborn babies had recognition and were either buried or cremated. Various legal and ethical arguments for and against cremation of pre-term babies were aired at that time, including the fact that fetuses have no legal status and that an attempt was being made to turn crematoria into waste disposal sites. Whilst fetuses still have no legal status today and the vast majority of crematoria will cremate them, the fact that cremation is technically unlawful has been avoided by government in England and Wales until now.

Good for Scotland and Lord Bonomy for recommending the regulations of the cremation of fetuses in 2014 in his Report of the Infant Cremation Commission, the Scottish Parliament bringing the regulation of Baby and infant cremations into a new Burial and Cremation (Scotland) Act 2016 and hence leading England and Wales along the same path.

There is a big difference though. Incineration is banned in Scotland yet condoned in England and Wales.

The Institute stuck to its aim and reviewed and revised its policy and guidance on the Sensitive Disposal of Fetal remains over the years and numbers of burials and cremations slowly increased so perhaps incineration decreased.

Not surprisingly the MoJ response includes ‘definition of ashes’ in its list of items to be dealt with, as this was the fundamental issue in at least three of the inquiry etc. reports. The response also speaks of an inspector of crematoria and statutory forms and register, the latter two items being the masterstroke of Lord Bonomy in bringing the cremation of fetuses into regulation. At last.

The only part of the MoJ that was not music to our ears was reference to ‘sensitive incineration’. The mention of sensitive incineration mirrors the view of the (HTA) that it should be an option for bereaved parents alongside burial and cremation. I don’t recall that this option was discussed in the MoJ consultation. The spectre of sensitive incineration exists and has been reinforced.

So back to basics:

Can anyone describe the sensitive incineration of babies?

Why is sensitive incineration being given a push?

Are the words of the Minister ‘totally unacceptable’ made in 2014 being ignored?

The Institute’s description of sensitive incineration is ‘disposal at a waste incinerator that conducts a continuous, industrial process in accordance with waste management legislation’. Any advance on this or perhaps a more ‘sensitive’ description?

Has the word ‘sensitive has been highjacked?

Finally, are we are supposed to be a sensitive and caring society? Seems that Scotland has the lead on this as well.

7 comments on ““Sensitive incineration” – definition please?

  1. Wednesday 13th July 2016 at 11:07 pm

    Dwelt on your last paragraph Ken.

    Every person working at cemeteries and crematoria knows that many mothers who lost stillborn babies in the 60′, 70’s and early 80s attempt to find their lost baby many years after. In those days it was the norm for mothers that had suffered a stillbirth to be told to go home, have more children and the hospital will look after the burial. Remember that during this era foetuses were not buried in cemeteries nor cremated at crematoria. The majority of mothers would go home and have healthy children who grew up and eventually flew the nest. This is when some mothers look back to find the one they lost. Most of these stillborn babies were buried in public graves, no record kept of which cemetery and hence a difficult search to locate the place of burial. I do think that the actions of hospitals at that time were well meaning in attempting to remove a burden however with hindsight, a wonderful thing, we realise that this was misguided and stored up problems for bereaved parents in the future.

    if sensitive incineration is not described accurately to bereaved parents at a time after their loss when they are able to make a considered decision when potentially a wrong decision could be made, will we see some parents looking back in years to come only to be horrified at what had happened? Might some suffer guilt alongside their delayed feelings of loss and grief? Will we see flowers being tied to the gates of the incineration plant? Is this potentially another scandal? Dare I say Alderhay? Was Alderhay the reason that government formed the Retained Organs Commission that later became the Human Tissue Authority? Someone correct me if I’m wrong.

    In 2001 the report of the Select Committee Inquiry into Cemeteries included a conclusion that ‘good bereavement services are vital to the health of the nation’.
    Can someone remind me of Gladstone’s (I think) words that suggest that the sensitivities of a nation can be judged by the way it treats its dead?

    At least those mothers that lost stillborn babies in the 60’s etc. can find a grave and have a focal point. The latter day mothers whose babies are incinerated will not. How ‘sensitive’.

    • Michael Jarvis

      Thursday 14th July 2016 at 9:39 am

      “Show me the manner in which a nation cares for its dead and I will measure with mathematical exactness the tender mercies of its people, their respect for the laws of the land, and their loyalty to high ideals.”

      But who said it? It’s attributed to Gladstone by some, but doesn’t seem to have appeared in print until several years after his death. Many people have made arguments which dispute the attribution on stylistic grounds.

      • Thursday 14th July 2016 at 10:33 am

        Thank you Michael for the full quote. It does say a lot, whoever actually said it.
        Thanks again,
        Tim

  2. Ken West

    Wednesday 13th July 2016 at 4:05 pm

    Lucy, you did so well in following through on this cremation and obtaining what you wanted. All crematoria can recover ashes given the right conditions.

    As to your final point. Even if crematoria adopted the right practice, the incinerators will continue if the HTA or hospitals stay in their present mindset. If the reason why they take this approach is because they see it as the cheapest option, then it suggests that they will ask medical staff to talk up the process when informing the parent. That means that parents will not be told the truth and nor will they consider any other alternative options, or the fact that the ashes themselves are such an issue.

    What upsets me is that so many parents who do not, or cannot, take any interest in the process just after the loss, will change their mind in the future. When that happens, their opportunity to find any ashes, and grieve, will be lost.

    • Thursday 14th July 2016 at 9:29 am

      It was so important to the family that they have the ashes returned to them and no Oxfordshire crematorium would guarantee it, I had to travel further afield.

      I was so glad I found Feltham. They were absolutely amazing and even made me coffee while I waited.
      The whole process was explained to me and they do have a smaller cremator which meant I could tell the family with absolute certainty they would have ashes returned to them.
      If I had used a crematorium in Oxfordshire, I wouldn’t have been able to give that assurance.

      Where the parents don’t feel they can be a part of any arrangements, could the hospital arrange a cremation service (Feltham and others generally don’t make any charge for) and have the ashes scattered or placed in a memorial garden? That way the cremation is recorded and there is a focal point at which the family may visit should they wish in years to come.

      Incineration however sensitive or not surely shouldn’t be used in this instance when there is another option available.
      As already suggested, is this just a future scandal and outrage waiting to happen?

  3. Ken West

    Wednesday 13th July 2016 at 3:49 pm

    Well done Tim, as this sums up a complex issue and shows how it has gone on for so long now, despite all your work.

    It would be good to see a response from the faceless person who coined the term ‘sensitive incineration’, but somehow I don’t think this will happen

  4. Wednesday 13th July 2016 at 12:20 pm

    Really interesting article.

    I wouldn’t want to be the person responsible offering “sensitive incineration.” Not only is it a bloody awful term but totally unnecessary.

    The crematoriums in Oxfordshire flat our refused to guarantee ashes when I arranged a premature baby funeral three years ago.
    I called and checked this year when asked to undertake another one.

    In both cases, all I asked was that the parents pay (cost price) for the coffin and I drove to Feltham Crematorium who do guarantee there are ashes to be returned.
    In fact, the crematorium is so fantastic that they let me wait in their staff room and drive back to Oxford with the ashes with me.

    I think a lot of parents feel a traditional grave isn’t for them and when told they will probably not get any ashes back, it is a risk they are willing to take.

    If crematoriums actually wanted to cremate a foetus or baby and retrieve ashes, I have been assured that it can be done. They just chose not to.
    If crematorium’s adopted this practice, incinerators wouldn’t be necessary.

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