“Sensitive incineration” – definition please?

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 7^th 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.