Report of the National Committee on Infant Cremation 2014-15

7. Updated Guidance on The Cremation of Pregnancy Losses

In 2012, the Scottish Government Chief Medical Officer and Chief Nursing Officer issued revised Guidance to the NHS in Scotland, notifying them that incineration of pregnancy losses (ie losses that occurred before 24 weeks' gestation) was no longer acceptable, and that shared cremation was now the minimum standard. All fourteen territorial Health Boards confirmed in 2013 that they were meeting that new minimum standard.

The Bonomy Report commended this new Guidance and, as a result of its in-depth work, was able to identify and highlight small but significant areas where the Guidance could be improved or made more accurate. Several recommendations were made relating to this Guidance, including legislative ones which are now contained within the Burial and Cremation (Scotland) Bill.

An early piece of work for the National Committee, largely via its Shared Cremations Sub-Group, was to ensure this Guidance was updated to reflect the Bonomy recommendations. The revised version was submitted to Scotland's Chief Medical Officer and Chief Nursing Officer, and was subsequently issued to all NHS Health Boards in June 2015.

It is worth noting that one of the changes introduced, a requirement to discuss all available burial and cremation options with the individual who had experienced the loss, caused concern to some medical professionals working most closely in this area, who felt this may cause additional distress to their patients. Although the Bonomy recommendation is based on sound principles of ensuring informed consent / authorisation, and despite the option for the patient to decline all discussion, there is a continuing view that actively discussing all options may still be a step too far in some instances, particularly in the context of very early pregnancy loss.

This issue is currently being explored and is an example of where a Bonomy recommendation, fully accepted at the time of publication, may reasonably be modified in the light of additional or more recent expert advice and information. The Committee's understanding of the requirement on them to e.g. annually review the Code of Practice to ensure it stays up-to-date, provides a clear steer that Bonomy Recommendations can be so modified, if required.