Funeral care preservation could be outlawed at home, following an amendment filed in context with the Health Care bill currently being discussed in Parliament. The reasons given by the Health Minister to forbid embalming at home refer to four official reports, considered to be in agreement:
– Report of the Supreme Counsel of Public Health in December 2012 and November 2009
– Report of the Human Rights Defender in October 2012
– Joint report of the General Inspectorate of Social Affairs (IGAS) and the General Inspectorate of Administrative Affairs (IGA) in July
The main arguments are repeated from one report to another, however they stand on some assumptions or incomplete, even biased assessments.
A) Is home-based passing doomed to disappear?
Of an average of 550,000 annual deaths, those occurring at home represented 27% in 2008, thus about 150,000 deaths (compared to 70% in the 50’s, but with a tendency to stabilize since the 90’s.)
Furthermore, of the 200,000 embalming acts reported (one third of the deaths), 23% were performed at home according to a study published in 2000, thus representing 46,000 acts.
Similar proportions exist by statistics: ¼ of deaths occur at home, as well as ¼ of embalming acts.
Therefore, it’s an exaggeration to state that « the principle place for funeral care preservation has forsaken the home for collective spaces» (IGAS/IGA Report of 2912, p.15)
In addition to that, the statistics are not very reliable. For example the percentages of embalming acts compared to the number of deceased vary considerably from one report to another: 25-30 % (Public Health Supreme Counsel) to 40-50 % (Human Rights Defender). This figure might be 15% in Paris and 43% in the provinces. The number of embalmers vary between 888 (Review of Employment and Health) to 1586 (Health Minister).
On a structural basis, it seems that a part of the population, (about ¼ ), especially in the rural regions, remain attached to keeping their loved ones at home until death and to performing the traditional funeral rites of the country at home : those rites usually entail funeral preparation, viewing of the deceased in the bedroom or a common room the evening before burial, having family members and neighbours visit the deceased before the closing of the casket. The deceased person thus stays “in his place of residence”, and can be visited without the time and organizational constraints of public places like funeral homes.
B) Do embalming acts pose non-negligible health risks?
In December 2012, the French Public Health Counsel gave a detailed analysis of the risks of infection which menace the embalming profession, principally biological and chemical infection, in its report which constitutes the basis of all public powers’ recommendations.
A close reading of the data put forward to justify the risks demonstrate that in reality, these studies and analysis are quite dated (more than 20-25 years), and mostly are situated in foreign countries, principally in the United States. The results are internationally controversial, often with non-significant differences between the control populations and the professionals involved.
Ultimately, the members of the technical work group appeared to be divided on the advisability of banning embalming acts at home. They concluded their report by saying: “It thus appears that the debate rests in fact on the acceptability of the risk by the embalmers, compared to the benefit expected for the families of the deceased, which is a societal consideration.”
It’s precisely a societal debate that’s lacking, and at no moment have the different reports considered the sociological, cultural or religious stakes of keeping the deceased at their home. Only sanitary arguments and administrative controls have been taken into account.
As far as the July 2014 IGAS-IGA consolidated report goes, it cites the principle of precaution and standardizing practices, faced with a “high-risk occupation”. Nevertheless, even if this profession is at more risk than others, it has not been proven that accidents occur, and above all, that they would have more chance of occurring at home rather than on other sites. The French Institute for Health Watch “recognizes that they have no data on the accidents with blood exposure for embalmers, nor concerning professionally acquired viral contaminations.”
The Senator, Isabelle Debré, during the parliamentary debates of October 1, 2015, hence summarized the situation: “The principle of precaution? I don’t believe so, since we have interrogated the actors involved in this practice, as well as the order of doctors: they assure us they have never had a case of contamination”.
It is certainly possible to organize the embalming profession better and to maintain a high level of sanitary protection, as the government rightly wishes, without banning home embalming, by improving the initial training and continuing to train all professionals, wherever their place of practice might be.
Likewise, it is possible to authorize care of people affected with HIV or hepatitis, without banning home-care, but with reinforced sanitary regulations, such as vaccinating embalmers. A compromise measure might be to reserve treatment to specific sites whenever the death certificate mentions one of these infections.