Burial for a foetus

In recent years there has been a noticeable change in the attitudes of society and parents in particular with regard to the proper way of disposing of foetuses born before their time.

It is becoming more and more evident that in proportion to the reduction of fertility, there is a correspondingly increased reaction to the loss of a cherished pregnancy. While in the past parents were only too happy to leave the disposal of miscarried foetuses to the authorities, now they seem to wish to take control of the situation and give them a proper burial in an effort to do "the right thing".

In these situations it is important for parents to come to terms with the tragedy of foetal loss. A grieving period whose length is often proportional to the degree of maturity of foetus is crucial to enable parents to adjust to a new life which invariably feels empty and depressive.

It is difficult to decide precisely at what stage of maturity should a foetus be given full burial rights. The law is not of much help in this situation. There is nothing in Maltese law regarding burial nor about an "act of death" for foetuses, although there is an indication that a limit of 180 days (or about 25 weeks) should be considered in regard to viability of a foetus. Moreover, it states that an "act of birth" shall only be drawn up where the foetus shall have completely assumed the human form (Civil Code, article 283). This is, of course, a very subjective definition and liable to misinterpretation.

The need to set guidelines as to when a foetus should be given burial rights is understandable from a purely pragmatic and bureaucratic point of view but makes no sense from either a biological or a moral point of view which make no distinction between foetuses of various gestational ages. From the very moment of fertilisation the foetus is a human being.

Herein lies a fundamental dilemma: Should all foetuses be given burial rights, or only those who have reached a certain degree of maturity? Should a foetus just a few days old or a few weeks old also be thus treated? Such propositions, while logical, would lead to impossible practical considerations. It is possible that a compromise would be reached where a foetus becomes increasingly worthy of such treatment when it starts to assume recognisable human features, which occurs as early as the seventh week of pregnancy, although such a dividing line would be purely arbitrary, as mentioned already.

Every effort should be made to help the parents come to terms with their grief, and they should be allowed to dispose of their foetus in a proper manner (not "where and when they wanted", as George Gatt, president of Sands is reported to have said - The Times, March 30).

One might conjure visions of preserved foetuses standing on the mantelpiece as part of a perpetual process of remembrance - this should not be encouraged any more than encouraging the practice of keeping one's dead husband in the bedroom for longer than is proper.

It is also worthwhile to keep in mind the paranoia generated some time ago in the UK when it was discovered that foetuses were kept for a prolonged period. There was a time when most teaching hospitals had "museums" of pathological specimens which included foetuses with abnormalities. For reasons good or bad, this practice has all but disappeared.

But what was particularly pernicious about the UK experience was the overkill generated, ensuring that every specimen taken from a foetus for pathological examination, including paper-thin sections of tissues, had to be given full burial rights, which often resulted in several burial ceremonies for the same foetus!

In relation to the need of examination of the foetus for evidence of pathological abnormalities, it is suggested that the same procedure be undertaken for adults, namely, that the next of kin (that is, the parents) should be approached and asked for permission to do the necessary examinations and/or take tissue for specific purposes, including research.

No examination of tissue from the foetus should be allowed unless the required permission is obtained in advance. This is the current practice here.

It is often the case that most problems arise because of lack of communication between the health care staff and the woman concerned. It should be normal practice to have open discussions about methods of disposal, to ensure that the wishes of the family are taken into consideration, and that disposal of foetal remains is not seen as a clandestine procedure which is considered to be degrading to the dignity of the foetus.