Caring For Your Own Dead
FCAEM Guidelines for Burial or Cremation Without a Funeral Director
Caring for your own dead can be immensely rewarding and help ease the pain of grief. It is also emotionally demanding, and, because of the widespread misunderstanding of the law in Massachusetts, it can be difficult. The law clearly permits persons to care for their own dead. The state Department of Public Health (MDPH) has provided written guidelines (www.state.ma.us/dph/dcs/burial.htm) to the city and town clerks and boards of health advising them that the care of one's own dead is legal. Even the Board of Registration in Embalming and Funeral Directing has agreed to withdraw its objections to issuance of burial permits to persons other than undertakers.
The Fact Book for Death Registration of the MDPH lists the following contacts: Registry of Vital Records and Statistics at 617-740-2600 or the Division of Community Sanitation of the Department of Public Health at 617-983-6761.
If you are considering caring for your own dead, we recommend that you plan carefully and communicate in advance with the agencies you will have to deal with -- hospital, hospice, nursing home, board of health (Burial Agent), crematory, cemetery, etc. -- to be sure they will not cause difficulties because of their own uncertainties about the law. Please notify FCAEM if any agency tries to obstruct; we will be glad to help. Mount Auburn Cemetery and Crematory in Cambridge, Duxbury Crematory in Duxbury, and New Swedish Crematory in Worcester will accept a body for cremation or burial from anyone presenting a valid burial permit. We haven't surveyed other crematories and cemeteries, but expect that they will also be willing. Crematories in the western part of the state may have less experience with the law.
We also suggest that you consult Final Rights: Reclaiming the American Way of Death by Josh Slocum and Lisa Carlson. Order the book here and more than half the cover price goes directly to the national FCA to support their work.
Here are some things you will need to know:
A Death Certificate must be completed in the city or town where death occurs. The attending physician or hospital medical officer or medical examiner or registered nurse will provide the Death Certificate and complete his or her portion. You must complete Items No. 1-28, the portion that is usually filled out by a funeral director. We suggest you make a copy before filling in your part. Fill in the copy to the best of your ability and take it with the original to the board of health in the city or town where the death occurred. The Burial Agent, usually the health officer or town clerk, can then help you be sure the original is filled in with the proper format. (See the link below to the MDPH Death Registration Fact Book for more detailed instructions.) They are particular! Then when it is complete make several photocopies of both sides of the completed Death Certificate. You should order the number of certified copies that you will need as proof of death for various claims. But these may not be available immediately which is why we recommend making a copies before you actually file it, to use in the meantime. One of the copies must be presented to the crematory or cemetery.
If the death is attended by a registered nurse, he or she will also complete a Registered Nurse Pronouncement of Death form. But this must be followed by a Death Certificate signed by a physician.
Disposition/Removal Permit, formerly Burial Permit
The "Permit" is actually a permit to transport a body and dispose of it by burial, cremation or donation to a medical school. Once the Death Certificate is filed, the Permit is issued by the Burial Agent in the town where death occurred, even if cremation or burial will take place in another town. Even though it is legal to transport a body within the same town or city (from a Cambridge hospital to a home in Cambridge, for example) after receiving the Death Certificate but before obtaining a Permit, it is better to obtain the Permit before claiming a body from an institution such as a hospital. The law requires that you obtain a Permit before transporting a body across town or city lines, but we know of no case where this has been enforced.
To obtain a Permit, present the fully completed Death Certificate to the Burial Agent, usually the board of health or the town clerk. This is no problem in big cities, but it would be wise (particularly in small towns that are unfamiliar with this) to call before death occurs and explain that you will be requiring a Permit for private disposal of a body. If they say they will refuse to issue one to a person who is not a funeral director, document their refusal (in writing, if possible; otherwise by noting the exact time of your phone call or visit, and the name of the person you spoke with). Then call FCAEM at 617-859-7990. We will try to help. This is not an emergency line and is checked several times a week, which is why we recommend checking with the Burial Agent ahead of time. Even if we don't succeed, we can acquire evidence for a possible lawsuit.
Order for Cremation or Interment
This form, required by the crematory or cemetery, is provided and filled out by the cemetery or crematory staff, and signed by the next of kin requesting cremation.
Order of next of kin--spouse, or, if none, then children (all adult children must sign, and if sending in authorization by fax it must be notarized and the original sent by mail, if from another country consulate should verify the identity)
See the next section on how to provide the required authorization for cremation ahead of time.
Declaration of Intent Regarding Cremation
Massachusetts’ case law requires that a crematory give priority to the written wishes of the deceased. A form called "Declaration of Intent Regarding Cremation" is available from crematories and, ideally, should be filled out by the dying person and notarized before death occurs.
If the form or its legal equivalent is not presented when the body is brought to the crematory, the crematory staff must follow the instructions of next-of-kin, beginning with the spouse, even if that person has had no contact with the deceased for years. Or , if there is no spouse all adult children must sign. Obviously this can lead to lengthy delays, and can lead to painful disputes among family and friends. We therefore strongly advise that the Declaration of Intent be filled out as part of your normal preplanning.
The Declaration of Intent provides an opportunity for the dying person to appoint someone to authorize the cremation, rather than relying on the statutory rules for who is next of kin.
Between Death and Cremation or Burial
Time is an obvious constraint in carrying out the care of your own dead. Nursing homes often want a body removed immediately, even in the middle of the night. It is important to plan ahead. (Most hospitals have a morgue with refrigerated storage and will store a body for a few days if they are not full.)
In the case of violent or unexplained death, the body will be turned over to a medical examiner or coroner and may be kept several days, which gives the family time to make preparations.
According to Lisa Carlson, a human body can be kept in a cool room for at least 24 hours before decomposition begins. Heat in the room should be turned off in winter, and air conditioning should be turned on in summer. Dry ice can be used in lieu of refrigeration. Some traditions keep the body at home or in a place of worship for up to three days.
It is unlikely that infectious diseases will be contracted from a dead body. However, anyone caring for their own dead should take the precaution of wearing rubber gloves and avoiding all contact of body fluids on unprotected skin. Soiled linens and clothes should be cleaned as they would be for a living person. Disposable material should be put into non-leaking plastic bags and disposed of with household rubbish. Durable equipment should be disinfected with a strong solution of bleach.
Massachusetts' law requires that a body be viewed by a medical examiner before cremation, and that cremation not occur for 48 hours after death unless death was caused by an infectious disease. Some crematories (Mount Auburn Cemetery crematory, for example) will store the body for all or part of this period, provided they have room. Ask if this is possible in your case. In eastern Massachusetts the crematory will arrange for the medical examiner viewing. The yellow copy of the medical examiners bill is picked up at the crematory with the cremated remains. The $75 fee must then be sent in directly to the state. This is in addition to the crematory fee of $250 to $350.
There is no requirement to hold a body before burial. It can take place as soon as the cemetery is ready. Burial in Massachusetts usually takes places in a recognized municipal or private cemetery, but private-property burial can be permitted by a local health department.
Whether you are planning cremation or burial, the body must be in a rigid container lined with plastic sheeting to prevent leakage of body fluids. A box can be made of plywood for less than $100. A simple container for cremation, often called an "alternative container" can be obtained from a cooperative crematory or funeral director (Mount Auburn Crematory has one for $60). It will be a strong cardboard box, sometimes with a plywood base, and is designed to be destroyed during cremation. Containers for cremation must be combustible, not metal.
Caskets for burial can be homemade, made by a carpenter or cabinetmaker, or bought from cooperative funeral directors, and they are also now available directly from retailer stores. See Funeral Consumers Alliance: Caskets and Other Containers for an extensive list of casket options.
Outer Burial Containers
Most cemeteries require that the casket be placed inside a concrete grave liner to prevent the ground from subsiding. Some cemeteries offer them for sale, but otherwise you must buy one from a funeral director. In Massachusetts they cost anywhere from $400 to $1,000, installed. The best deal is almost always from the cemetery, if they sell grave liners.
"Burial Vaults" are more expensive, more elaborate grave liners that are usually sold by funeral homes. It is often claimed that they protect the casket, but there is no claim that they protect the body. All you need is a simple grave liner to meet the cemetery's requirements.
Cemetery charges for opening a grave vary considerably but will always amount to several hundred dollars, not counting lot and liner. Most cemeteries do not permit anyone other than their own staff to open or fill a grave.
Check with your cemetery about regulations regarding markers, monuments and plantings, and about the charge for grave maintenance.
Scattering, Burial or Storage of Cremated remains
Once cremation is complete, the crematory will return the ashes, usually in a box. If you wish to buy an urn, you can purchase one from any funeral director. Cremated remains can also be kept in any container -- in a beautiful pottery vase, for example, or in a box or container that was a favorite object of the decedent. They can be buried anywhere, in or out of a cemetery, or scattered in a particularly loved place. Some crematories have "columbaria," or rooms with niches where ashes can be stored. There is no restriction on the disposal of cremated remains in Massachusetts, except when they are buried in a cemetery. In that case, you must present the cemetery with a certificate from the crematory stating that the burial permit and the medical examiners' certificate were duly presented.
Organ and Body Donation
Although organ and body donation do not, strictly speaking, come under the heading of caring for your own dead, they do provide an alternative to conventional cremation and burial. Most of us are aware that there is an acute need for organ donations, and that in losing one's own life it is possible to give life to others. If you wish to be an organ or body donor, contact a medical or dental school and ask about their donation program. The Massachusetts medical schools require the donation to be arranged by the donor personally before death, not by the next-of-kin.
Requirements of schools vary, but here are some questions you should ask:
There are some restrictions on the acceptance of bodies. Ask about them, and always make alternative plans in case the school is unable to accept the body.
Completing a Death Certificate
For detailed instructions see Chap. 4 of the MDPH Death Registration Fact Book which was prepared for funeral directors, but as you will be acting in that capacity you must follow those directions. Below are more specific instructions for certain sections that may be unclear because in fact you are not a funeral director with a facility and license number. Appendix B of the Fact Book has copies of the various death registration forms.
The person responsible for disposal of human remains must complete items No. 1-22 on the Massachusetts Standard Certificate of Death. (The physician attending at time of death will fill in the rest.)
Type the answers or use black ink. You may not be able to answer all of the questions. In that case, write "Unknown." Do not leave any blanks. Be accurate. Do not cross anything out or use whiteout. We suggest making a copy of the original and filling in the copy as best you can. Then with the help of the Burial Agent copy it accurately onto the original and final form.
For those questions where it is unclear what to fill in because you are not a funeral director, which the form assumes you are, we advise the following:
[this document last revised November 20, 2010]