Archive: 2014

There is no legal definition of ashes.

Perhaps you prefer to call them ‘cremated remains’. Or ‘tangible remains’. Or even ‘total recoverable remains’. Selecting just one term and assigning an exact definition to it was one of the jobs Lord Bonomy set himself in his report. The fact that there remains no legal definition has resulted in confused and misleading guidance to the parents of babies who have died.

Does it really matter what you call them? Yes, it does. It comes down to what you think ashes are.

Are they what remains of a dead human after cremation?

Or are they the remains of a dead human + coffin + anything that was placed in the coffin after they have been cremated?

On the one hand, the Federation of Burial and Cremation Authorities offers this directive to those who advise the parents of children who have died:

“In cases where bereaved parents desire the cremation of an infant or of fetal remains, they should be warned that there are occasions when no tangible remains are left after the cremation process has been completed. This is due to the cartilaginous nature of the bone structure.”

The inference of this directive is that ‘tangible remains’ are the remains of the body. The ash from the coffin and anything in it don’t count.

On the other hand, the Institute of Cemetery and Crematorium Management defines ashes as both the remains of the body + coffin + anything in it. It all counts.

When this clash of definitions was pointed out to Tim Morris, chief exec of the ICCM, in 2013, he responded: “I have only heard about this distinction in the last few months.” Yup, the two representative authorities have been reading from different hymn sheets.

Everyone agrees that cremation is complete when the last flame has flickered and died. No one is suggesting that metal parts which survive cremation should be considered ashes.

And common sense tells us that the FBCA directive is nonsense. How on earth could you possibly tell skeletal remains apart from coffin ash? Only a fool would try to separate them.

Bonomy takes the view that everything that remains at the end of a cremation is ashes. His opinion is reinforced by the “widespread perception among the public” that this is so, “and that if that is not the perception among crematoria staff, then it should be.”

He identifies the conflicting perception of “representatives and staff of Cremation Authorities and Funeral Directors” who believe that “’ashes’ are what remains of the cremated baby.”

In doing so, he gets to the root cause of the misleading advice given to the public: the misguided “understanding that the bones are not sufficiently developed to produce remains led crematoria to convey to Funeral Directors, clergy and healthcare staff that there would not be, or were unlikely to be, ashes following the cremation of a baby” – because coffin ash doesn’t count.

This ‘understanding’, let us be clear, seems to have resulted from ignorance that skeletal remains can be recovered from a baby of 17 weeks’ gestation. So it is with ill-concealed understatement that Bonomy concludes:  “The extent to which that information was accepted without question by healthcare staff, as illustrated in the MIR, is surprising.^”

Bonomy wants cremation law in Scotland to define ashes as: “all that is left within the cremator at the conclusion of the cremation process and following the extraction of all metal.”

But as he points out, crematoria in Scotland comprise but 10% of the UK total. We clearly need a clarification of the law in England, Wales and Northern Ireland, too. The sooner the better.

The Bonomy report lays bare the reasons why some crematoria have been able and willing to recover ashes from infant cremations and others haven’t. Given the enduring and agonising distress and uncertainty this has caused to an uncountable number of parents, it can only be a matter of time before the media give it the treatment it deserves. The BBC has already been extremely active in Scotland and at Emstrey crematorium, Shrewsbury.

The inconsistencies of practice highlighted by Bonomy are of the gravest possible concern. Some crematoria have recovered ashes in 100% of cases, others in none: 0%. The science shows that a foetus as young as 17 weeks’ gestation will, if cremated gently, yield ash. This being so, and given the extreme sensitivity of the matter to the parents of babies who have died:

Why on earth has best practice not been applied in all crematoria in the UK?

How is it that some crematorium managers and technicians seem to have lost all sense of duty to the bereaved?

Bonomy’s recommendations are comprehensive. If applied, they will make the future a better place. If you haven’t read them, you really ought to because no one escapes criticism; everyone has something important to learn. Here are some of the most important. The bold is mine.

In legislating, devising policy, drafting information and guidance documents, and making arrangements for and conducting baby cremations, the baby and the interests of the family should be the central focus of attention. Parents and families should be given time and space to reach the correct decision for them.

“Ashes” should be defined as “all that is left in the cremator at the end of the cremation process and following the removal of any metal”.

All Cremation Authorities at whose crematoria ashes are not always recovered should liaise with a crematorium or crematoria where ashes are recovered more regularly to share their experiences and information about their respective practices. 

As an urgent interim measure, the ICCM and the Federation of Burial and Cremation Authorities (FBCA) should form a joint working group … to consider the various practices and techniques currently employed in baby and infant cremation in full-scale cremators with a view to identifying those practices which best promote the prospect of recovery of ashes inclusive of baby remains and compiling guidance for cremator operators. 

The ICCM and FBCA should review their respective technical training programmes.

The power of the ICCM and the FBCA to put things right is limited. No one has to join either body. Perhaps in consideration of this, Bonomy (explosively) proposes “an independent Inspector to monitor working practices and standards at crematoria, provide feedback to Cremation Authorities on how they are performing and to report to the Scottish Ministers as required.” A national inspectorate. It makes you wonder why we don’t already have one. That would really shake things up. 

Bonomy concludes with a recommendation whose humanity shames all those who have been complicit in the shoddiness that has caused so much grief and will cause much more as the full story comes out. He asks the Scottish government to “consider whether there should be a national memorial dedicated to the babies whose ashes were mishandled or mismanaged.”

Here at the GFG we have sought responses from people of influence in the industry. We have asked the ICCM and the FBCA to respond to the following questions:

1.  I am not aware of any published figures regarding success rates for the recovery of ashes resulting from the cremation of ‘babies and infants’ (Bonomy) by crematoria in England, Wales and Northern Ireland. Have the figures been collated?

2.  If not, we are aware that in Scotland, until very recently ashes had not been recovered and returned in any of Aberdeen’s baby cremations since 2008, while in Inverness 100% were returned. In Fife, ashes were recovered in 45 out of 87 cremations of stillborn babies and those aged up to one year. Would you expect to see, or are you aware of, similar disparities in baby ash recovery rates between crematoria in the rest of the UK?

3.  Bonomy recommends that the “ICCM and FBCA should review their respective technical training programmes”. Has [your organisation] fallen short in its training provision to operators of crematorium equipment and subsequent sharing of best practice?

Tomorrow we shall publish an account by Ken West. On Wednesday we shall publish a response by Tim Morris, chief exec of the ICCM. We shall follow that with a response from the FBCA if we get one.

By Dr Clive T Chamberlain:

The cremation culture and equipment used in the UK is not the only way to dispose of human remains, although cremation in the rest of Europe is similar – driven as it is by a commonality of environmental regulation. The cremators used, and the legislation which controls their use are mostly (but not all) the same, but funeral practices do differ.

The most common cremator type in Germany has a different construction. It is called the ‘Ėtage’ or ‘Durchfall’ oven, and the chambers of the cremator are stacked vertically. The coffin is charged into the top chamber. When partly burned, the remains fall into the next lower chamber, and then finally into the third or ‘ashing’ chamber from which the completed cremated remains are retrieved. This type of cremator tends to be more energy-efficient (after coming up to normal working conditions), and is very suitable for continuous operation.

Differences in practice centre on the relationship of when the cremation takes place as opposed to when the farewell ceremonies take place, and this influences a number of details of practice.

Some countries (for example Scandinavia and German-speaking countries) have farewell ceremonies soon after death but the coffin is stored for cremation at a later date – sometimes several weeks after the farewell ceremony. Consequently, the cremation is almost a ‘production line’ operation, carried out separately from family participation. This enables the actual cremation process to be planned in an orderly manner and it also enables extended periods of operation to be used (even 24 hour operation), with more efficient use of energy and facilities.

It is not uncommon for a single cremator to carry out as many as 5,000 cremations in a year (for example in Moscow) compared to an average a few hundred per cremator per year in the UK – in the same make of cremator! There are tantalising savings of energy and greatly reduced wear of the cremator construction – there being no repeated start-up and shutdown of the unit each day. The crematorium is still operated in a most dignified and tasteful way and cremated remains are returned to families.

The remainder of Europe tends to carry out cremations as in the UK, and the family is present at the farewell ceremony at the crematorium, with cremation immediately thereafter or within the same day. There is one noticeable difference in that is common for the whole process to include family meals or refreshments in elegant and purpose-designed facilities, (whilst the cremation is taking place in the crematorium building), finishing with the presentation of the cremated remains to the family to be taken away. A solemn, dignified and effective way, which is held to assist and promote closure for the family.

There are a wider range of practices used throughout Asia with big differences according to the ethnicity of the populations. Environmental protection is an ever-growing need in Asia and modern crematoria are moving towards close regulation, with advanced cremators and emission abatement systems.

The practice in Japan is quite different, and there are more than 1,200 crematoria throughout the country. The cremator is constructed differently, and the base is removable, so it can be moved in and out of the cremator on wheels. Coffins are inserted into the cremator on ‘chariots’ on which they burn. After the completion of cremation the remains, still on the vehicle, are removed, allowed to cool and then placed in a room set aside for families who then select pieces of bone of the deceased for retention.

The Bonomy report is published today in Scotland. Its 64 recommendations will address cremation practice in that country and, by extension, throughout Britain. They will impact the NHS, funeral directors and cremation authorities, especially the ICCM and the FBCA.

Shockwaves are expected.

Lord Bonomy’s brief was to “examine the policies, practice and legislation related to the cremation of infants in Scotland and provide recommendations for the future which will ensure that no-one in Scotland ever again has to suffer the distresses that were highlighted by the Mortonhall Investigation Report.”

Reminder: from 1967 until 2011 parents of babies who had died antenatally or perinatally in Edinburgh were informed, on the authority of Mortonhall crematorium, that there would be no ashes after cremation. Hundreds of families were affected.

This is not just a Scottish problem. For a medley of muddled reasons there seems to be no mandated practice nationwide for the cremation of infant remains nor any general awareness that ashes can be recovered from foetuses as young as 17 weeks. As a result, there are probably vastly varying outcomes from crematoria everywhere. Here’s just one (Scottish) example. Until very recently ashes had not been returned in any of Aberdeen’s baby cremations since 2008, while in Inverness 100% were returned. In Fife, ashes were recovered in 45 out of 87 cremations of stillborn babies and those aged up to one year.

What would the picture look like if we had figures for the whole of the UK?

George Bell, manager in charge of Mortonhall for 30 years until 2011, has distanced himself from criticism and blamed funeral directors for giving the wrong advice to parents:

“I feel for them and apologise if [parents] have been given wrong advice which led them to choose cremation and not have the option of burial …  I tried my best to make sure that the message got out that there might not be the opportunity of recovering ashes after the cremation and we provided alternatives but unfortunately relied on frontline professionals. I must emphasise the crematorium staff didn’t make funeral arrangements.”

Bell also blames politicians:

“Sadly there’s no legal status for non-viable foetuses and as an industry we have worked hard to try and raise standards but to raise standards we need the legislation to go with that. I think the industry needs clear legislation as to what the procedures are. There’s no legal definition as to what ashes are – I think this needs to be addressed.”

The record shows that there is no agreement among cremation authorities about what ashes are, either:

“The FBCA (Federation of Burial and Cremation Authorities) consider that ashes consist of cremulated bone to the exclusion of any other source of ash obtained from the burned coffin, clothing or soft toys cremated along with the baby. The ICCM (Institute of Cemetery and Crematorium Management) considers ashes to include all ashes from the cremation, both cremulated bone as well as ash from
items which were mementos or part of the fabric of the baby’s last resting place. Tim Morris, Chief Executive of the ICCM, was interviewed on camera about this distinction by Mark Daly of the BBC in a broadcast in April 2013 when he indicated that: “I have only heard about this distinction in the last few months.” “[Source]

Things have subsequently gone from bad to worse in Aberdeen, where it is now alleged that babies were cremated together with adults — playing to the direst public misgivings about what really goes on in crematoria.

In England only one case has been reported so far but you wonder how many others might have been and may yet be. The culprit is Emstrey crematorium in Shrewsbury where only 1 in 30 sets of ashes have been given to babies’ families since 2004. The fact that it is run by Co-operative Funeralcare is at best semi-relevant. The verdict of a former Emstrey manager, Ken West, is devastating:

“I see absolutely no reason why cremated remains were not produced. The issue for me is they were not captured. They were either in the flue system or workers didn’t take the trouble to check whether there were any ashes before introducing the next cremation. So it’s very possible those babies’ ashes got mixed in with the next cremation.”

On this blog Ken West has written:

“I was a cremator operator in the 1960′s and ashes were always returned for baby or infant cremations … At no time have I ever accepted that no ashes exist. Had I accepted that then I would have considered cremation unacceptable and advised burial as the better option.”

If it has been demonstrated that ashes can always be retrieved, why does the ICCM continue to advise: “The hospital must inform parent(s) that ashes may not be recovered from cremation.”? And why does the FBCA advise: “In cases where bereaved parents desire the cremation of an infant or of foetal remains, they should be warned that there are occasions when no tangible remains are left after the cremation process has been completed.”

Elish Angiolini’s Mortonhall Investigation report expresses impatience with this muddled thinking: “The existence or otherwise of ashes following the cremation of foetal remains ought to be a matter of fact; either there is some residue from the human tissue or there is not.”

The FBCA states that there may be no tangible remains left after cremation because of “the cartilaginous nature of the bone structure.”  This sounds scientific, but is it? Compare it with this:

Experimental research has been undertaken to quantify the percentage of bone (bone ash or calcined bone) remaining in human skeletons following cremation. Trotter and Hixon (1974) studied skeletons from an early foetal period through to old age. This included 124 male and female foetuses of American Caucasoid and Negroid ancestry, which ranged in age from 16 to 44 weeks gestational age. It was possible to record the ash in even the youngest and lightest skeletons, the lightest being a white male of 16 weeks gestation which weighed 3.4 g pre-cremation. [Source 2.8]

Note: the above research is all of forty years old.

Compare the FBCA statement also with this. In a photograph of the cremated remains of a 17-week-old foetus at Seafield crematorium:

Bones [are] identifiable on the image include the femur, humerus, mandible, ilium (pelvic bone), the pars lateralis and possibly basilaris of the occipital bone (skull), radius, ulna, clavicle and a minimum number of 12 ribs. It is likely that the fibula is also present but it is difficult to distinguish clearly. [Source 2.8]

Given the extraordinary sensitivity of this issue, the recommendations of the Bonomy report are going to make for very interesting reading. We can’t give you a link because we are without an internet connection today. We believe this will take you to it.