By Ron Hamel, Ph.D., Senior Director, Ethics, Catholic Health Association of the United States

Over the past several years, and even more of late, many CHA members, as well as non-members, have inquired about the disposition of fetal remains. Interestingly, the current fourth edition of the Ethical and Religious Directives for Catholic Health Care Services (ERDs) does not address the issue. Nor was any guidance offered by the third edition that came out in 1995. In spite of this lack of guidance from the ERDs, many systems and facilities in Catholic health care have developed policies, quite possibly informed by earlier versions of the ERDs and by discussions of the matter by various medical moralists. What assistance do these sources provide?

The 1971 edition of the ERDs simply states that a fetus may be cremated "in a manner consonant with the dignity of the deceased human body" if there is a reasonable cause for not burying it (Directive 43). The 1956 edition of the ERDs notes that "the normal manner of disposing of a dead fetus, regardless of the degree of maturity, is suitable burial" (Directive 60). It does permit cremation if there is a serious reason such as sanitation. The 1949 edition of the ERDs also permits cremation for a serious reason, but aside from such reasons, state that "every fetus, regardless of the degree of maturity it has reached, must be suitably buried in a cemetery" (Part IV, no. 3).

Medical moralists writing in the mid-1950s echo the ERDs. Charles McFadden, for example, writes that "it is advisable to bury a fetus in a cemetery, and not on hospital grounds."¹ Cremation should only be resorted to in order to prevent the spread of a contagious disease. Edwin Healey takes a more permissive approach. He observes that, as a general rule, if the parents of the fetus are Catholic, the fetus should be buried. However, it might be cremated for serious reasons. Healy pastorally cites as reasons for allowing cremation the avoidance of contagion, inability to afford burial, legal formalities for burial causing considerable inconvenience, or if burial would reveal the sin of an unmarried mother.² Other medical moralists writing at this time seem not to address the issue.

Some additional insight might be gained from the Canadian and Australian ethical and religious health care directives. There are two relevant statements in the Canadian Health Ethics Guide. The first says that "all embryos and fetuses, including those that are malformed, deserve the same respect owed to any human being" (60). And the second notes that hospitals should have a policy in place "to ensure that all aborted embryos and fetuses, and the remains of miscarriages and stillbirths, are buried or cremated in a respectful manner and place" (63).³ Much the same advice is found in two statements in the Code of Ethical Standards for Catholic Health and Aged Services in Australia. One says that "when embryos and fetuses die, they should be given the same respect as is due to every human being who dies" (6.13). The second deals with pastoral care of the parents, baptism of a live but miscarried fetus, and underscores the need for procedures to be in place "to assist with the proper disposal of the body or remains in ways respectful of the dignity of human life and in keeping with the parents' wishes" ( 2.25).⁴

Two other sources of guidance are found in the Congregation for the Doctrine of the Faith's Donum Vitae and the Code of Canon Law. The former speaks of the respect that is to be given to embryos and fetuses: "The corpses of human embryos and fetuses, whether they have been deliberately aborted or not, must be respected just as the remains of other human beings."⁵ The Code of Canon Law speaks to the method of disposition: "The Church earnestly recommends that the pious custom of burying the bodies of the deceased be observed; nevertheless, the Church does not prohibit cremation unless it was chosen for reasons contrary to Christian doctrine."⁶

What, then, can be learned from these sources about the proper disposition of fetal remains? First, it is quite clear that the remains of embryos and fetuses must be treated with respect, just as the remains of all human beings. What we would not do to the remains of more developed human beings should not be done to the remains of embryos and fetuses. Above all, such remains are not to be considered as "medical waste" or treated in the same way as medical waste. Second, the remains of embryos and fetuses should either be buried or cremated in a respectful manner and place. Cremated remains should normally either be buried or entombed. Third, hospitals should have a policy in place for the proper (i.e., respectful) disposition of fetal remains, and, to the extent possible, in a manner consistent with the parents' wishes.

Of course, the actual disposition of fetal remains is only one dimension of the issue. Also of great importance is the pastoral care of the parents who have experienced a tragic loss. As part of this care, parents should normally be the ones to arrange for the disposition of the remains of their fetus. If, for some reason, the parents are not able to do this, the hospital should then arrange for disposition, carefully informing the family of the hospital's procedures and ensuring that the family is comfortable with them. Needless to say, pastoral care personnel should be involved to support the parents in their grief and to lead them in prayer if they so wish, or to assist them if they would like to ritualize their loss in some way.

What follows on Page 10 is a portion of an extensive policy and procedures about how to deal with fetal demise due to miscarriage or stillbirth. This particular portion is limited to the disposition of fetal remains. The first part of the policy is for fetuses at 20 weeks gestation or more and the second is for fetuses less than 20 weeks gestation. This policy is meant to be illustrative.

NOTES

1. Charles J. McFadden, Medical Ethics (Philadelphia: F.A. Davis, 1967), 242.
2. Edwin Healey, Medical Ethics (Chicago: Loyola University Press, 1956), 389.
3. The Catholic Health Association of Canada, Health Ethics Guide, (Ottawa: Catholic Health Association of Canada, 2000), 42.
4. The Catholic Health Association of Australia, Code of Ethical Standards for Catholic Health and Aged Services in Australia (Australian Capital Territory: The Catholic Health Association of Australia, 2001).
5. Congregation for the Doctrine of the Faith, Donum Vitae, 1987, Part I, para. 4. www.vatican.va/roman_curia/congregations/cfaith/documents/ rc_con_cfaith_doc_19870222_respect-for-human-life_en.html.
6. Code of Canon Law, Book IV, Part II, Title III, Canon 1176, para. 3. www.vatican.va/archive/ENG1104/ P4A.HTM.

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