Views & Reviews Personal View

Can I cremate my own leg?

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39534.654711.59 (Published 03 April 2008) Cite this as: BMJ 2008;336:774
  1. Simon Marlow, vascular surgery department, Royal Cornwall Hospital Trust, Truro
  1. simon.marlow{at}rcht.cornwall.nhs.uk

    If I wished to, could I cremate my own leg? The short answer is no.

    During my first foundation year post, two patients asked for their amputated leg to be “cremated.” Is this an unreasonable request? I argue not. If you wish to be cremated on death, you may want the ashes from all of your body at your funeral.

    Unusually, the patients were both relatively young (28 and 40 years), and the indication for amputation was for chronic pain rather than vascular pathology, secondary to a childhood injury and a congenital abnormality. These young patients had made a long, difficult decision to have their troublesome leg removed rather than suffer with chronic pain and long term opioid use. They would be expected to make a quick and full rehabilitation with the use of an artificial limb. Their youth and prognosis may cause them to stop and think about the disposal of their leg. After such a traumatic decision process, they might want their ashes as a memorial or simply consider how they would like their amputated leg treated with dignity.

    A crematorium cannotcremate any human tissue or organs from a living person. Paradoxically, patients are within their rights to sign for their leg and take it away with them; they may bury it themselves or burn it on a bonfire. However, they cannot arrange for their leg to be cremated under their own authorisation. The hospital’s waste management service, which would normally incinerate human remains in bulk, can incinerate a limb and retain the ashes. This has to be done without contact with the patient and therefore does not have the support of a spiritual or religious centre, and the incinerator environment is not one in which people may wish their human remains to be dealt with. This is the option we were able to offer the two patients that inspired this discussion.

    The reasons for this strange dichotomy are as follows. The Human Tissues Act states that “material taken from the living should normally be disposed of by incineration in accordance with current guidelines.” However, the Ministry of Justice states that the act does not have “any provision that would prevent a crematorium cremating the leg of a living person.”

    Why crematoriums cannot cremate tissue from a living person seems to be down to their own acts and regulations. These stipulate that crematoriums handle human remains from deceased. The legislation itself states that there has to be confirmation and certification of death before cremation. Furthermore, the Cremation Regulations Amendment of 2006 has put in place legislation required for cremation of a body part that can be separated from the body before death, but again only against current Cremation Regulation (14A)—that of requiring death certification. So if the members of a deceased person’s family feel that a body part should be cremated they can organise this. But if you want your own limb cremated while you are alive you cannot.

    The amputees leaving the vascular unit are offered much support as part of the “amputee pathway.” This is aimed to aid the physiological, psychological, and social transition to living without a limb. I’m sure there is also support for spiritual transition from local organisations, bereavement officers, and chaplains. But can a person’s spiritual needs truly be met if a part of their body can’t be prepared in the same way as the rest of their body would be after death?

    Of course, a reasonable compromise is the incineration of human tissue by the hospital, the provision of ashes, and support from the hospital’s bereavement and mortuary staff. Such requests seemingly not being that rare, I am surprised that there are not guidelines or a standard procedure for such provision.

    The principles of medical ethics would suggest that patients with capacity have autonomy to decide how they would like their remains to be dealt with. Might offering cremation of an amputated limb benefit a patient’s spiritual needs? I argue that it would. Would offering this service cause harm to the patient or family? I argue that it would not. Could you offer this to everyone on an equal standing? Yes, if the regulations were in place to provide a cremation service (or standardised incineration service with provision of ashes) to amputees. This is a simplified ethical argument, but I fail to see the reason why crematoriums themselves could not provide this service. The only restriction is that they require provision of adequate identification and certification of death.

    With it being a reasonable request to deal with a living person’s remains in such a way that their spiritual and religious beliefs are considered, should we not be able to cater for the cremation of human tissue after an amputation? I would be interested to hear other opinions on this issue and whether this is a problem nationwide.

    A patient may bury their leg themselves or burn it on a bonfire, but they cannot arrange for their leg to be cremated under their own authorisation

    Footnotes

    • With thanks to the bereavement office and mortuary staff of the Royal Cornwall Hospital, Jeff Adams (of the Home Office’s forensic science regulation unit), Barrie Thurlow (Ministry of Justice), and the Human Tissue Authority.

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