Introduction and Overview
Individuals caring for deceased relatives and friends are encouraged to plan carefully and communicate in advance with any facilities and agencies that may be involved, such as a hospital, hospice, nursing home, board of health, funeral home, crematory or cemetery, to avoid confusion about the law or other requirements. There are generally two options for final disposition of a body in Massachusetts: cremation, or burial in an approved cemetery. Cremation must occur in a crematory approved by both the Massachusetts Department of Public Health and by the Massachusetts Department of Environmental Protection, and burial must occur in a cemetery that has been approved by the local board of health and authorized by the municipal government (e.g. - town meeting).
In order to facilitate the death certificate process in Massachusetts, an individual must be either a funeral director registered with the Board of Registration of Embalmers and Funeral Directors (Board), a funeral director or embalmer licensed by an another state authority with which the Board has entered into a reciprocal agreement under M.G.L. c. 112, s. 85A, or an “other authorized person” or “other designee.” An “other authorized person” or “other designee” means a family member, friend, or other acquaintance that facilitates and prepares the death certificate without compensation. Facilitating a death certificate for compensation by an individual who is not a registered funeral director constitutes the unlicensed practice of funeral directing under Board regulations at 239 CMR 3.01 and is subject to penalties.
Prior to moving a deceased person, a family designee must obtain documentation from the certifying physician or nurse practitioner. The document received will be different, depending on whether the certifier uses the online Electronic Death Registration System (EDRS) or whether they use the manual fax attestation process. In most cases, the family designee will receive a Certifier Worksheet from an offline certifier or an Attestation Copy form from an online certifier, but this may vary somewhat by practice and facility. If a Registered Nurse Pronouncement of Death Form (R-312) is used to move the remains initially, a certification of death must still be obtained from the certifier. The family designee will then work with the City or Town Clerk in the community where the death occurred to complete an online record of death, by providing the Clerk with the Certifier Worksheet, Nurse Pronouncement Form, and a completed Informant Worksheet that will provide the legal and personal information about the decedent. The City or Town Clerk will enter the information into the EDRS, and release the electronic record to the burial agent for review prior to issuance of a burial permit.
In September 2014, the Massachusetts Registry of Vital Records implemented an online system for death certificates and burial permits. An individual who chooses to make arrangements for the final disposition of a body has the same responsibilities and obligations as a funeral director, including timely reporting and filing of death certificates and permits. For more information about the death certificate process, please visit http://www.mass.gov/dph/edrs.
Disposition Permits (“Burial Permits”)
In order to obtain a burial permit, an individual must be a funeral director registered with the Board, a funeral director or embalmer licensed by another state authority with which the Board has entered into a reciprocal agreement under M.G.L. c. 112, s. 85A or a family member, friend, or other acquaintance who obtains the burial permit without compensation. Obtaining a burial permit for compensation constitutes unlicensed practice of funeral directing under Board regulations at 239 CMR 3.01. Whenever possible, individuals who are not funeral directors and will be obtaining a burial permit for the final disposition of a body should notify the burial agent of the city or town before death occurs that a burial permit will be sought.
A burial permit is issued by the local board of health or its agent (often the town clerk) in the town where death occurred, even if cremation or burial will take place in another town. A complete death record, with a Registered Nurse Pronouncement of Death form, where applicable, must be submitted to the burial agent prior to issuance of the permit (M.G.L. c.114, s.45). The family designee will work with the City or Town Clerk in the community where the death occurred to complete the electronic death record for submission to the burial agent. As soon as possible (preferably within 36 hours after death), a burial permit must be obtained. As soon as the electronic death record has been released to the burial agent, the family designee may obtain the permit, provided that the record and disposition plan is approved by the burial agent. Upon burial or cremation, the person in charge of the cemetery or crematorium will countersign the burial permit and return it to the issuing municipality.
In order to transport a body, an individual must be either a funeral director registered with the Board, a funeral director licensed by an another state authority with which the Board has entered into a reciprocal agreement under M.G.L. c. 112, § 85A, or a family member, friend, or other acquaintance who transports the body without compensation. Transporting a body for compensation constitutes the unlicensed practice of funeral directing under Board statute and regulations at G.L. c. 112 § 82 and 239 CMR 3.01.
Individuals who are not undertakers and who will be transporting a body should consider the length of the box in choosing the vehicle for transportation to ensure the dignity of the body is preserved at all times.
It is legal to transport a body within the same town or city (from a Boston hospital to a home in Boston, for example) after receiving the death certificate but before obtaining a burial permit. However, a burial permit must be obtained before transporting a body across the town or city line. If death occurs in Massachusetts, but families wish to transport the body to another state for disposition, families should contact the health authorities for those states the body will pass through for specific requirements.
Preparing the Body
Time is an obvious constraint when preparing a body for burial. Nursing homes and hospitals often want a body removed immediately, even in the middle of the night. It is important to plan ahead whenever possible.
The common sense measures to prevent spread of infection in persons who need nursing and other care before death should apply after death as well. Such measures include good hygiene, avoidance of direct contact with body fluids, and most importantly, thorough hand washing.
The human body decomposes rapidly after death. Care must be taken to keep the body as cool as possible in order to slow the decomposition that results in noxious odors and the leakage of body fluids from body orifices. 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 the winter, and air conditioning should be turned on in the summer. Ice can be used instead of refrigeration if necessary.
Infections are spread from person to person through coughing, sneezing, contaminated hands, intimate contact or through contact with contaminated drainage, blood or body fluids. Thus, many infections are not likely to be transmitted after death unless body fluids containing the infectious agent come in contact with living persons in a way that allows the infections to be passed.
Some infections are silent (with no signs or symptoms in the person who is infected), especially infections spread through the blood or other body fluids. Since persons may have blood-borne infections without a diagnosis or without their knowing it, all blood and other body fluids, regardless of source, should be considered infected and capable of transmitting infection. Barriers, such as rubber gloves, protective clothing, and eye protection should be used when contact with blood or other potentially hazardous infectious materials is likely. In general, any approach that prevents exposure to blood and body fluids prevents transmission of infection. In fact, exposure of intact skin rarely results in infection, so hand washing is an important way of limiting infection risk.
Soiling of the environment or materials with body fluids should be avoided. Soiled equipment, sheets, clothes, etc. should be carried out as they would in the care of a living person who is ill. Disposable materials should be bagged in non-leaking plastic and disposed of in the rubbish. Non-disposable materials should be disinfected. A half cup of household bleach in a gallon of water is an effective disinfectant.
Cremation requires an additional certificate from the medical examiner stating that he has viewed the body and that no further examination or judicial inquiry concerning the same is necessary (M.G.L. c.114, s.44). Such authorization is for the protection of evidence relating to the deceased, because once a body is cremated, all evidence from the body of possible crime is destroyed. Some crematories will hold a body under refrigeration for all or part of this period, provided they have room. The crematory will arrange for the medical examiner to view the body and provide certification for the cremation. . Unless the death has been attributed to a communicable disease, cremation cannot occur until 48 hours after death.
Cremation must be carried out in a facility with by-laws and regulations approved by the Department of Public Health pursuant to M.G.L. Chapter 114, Section 9, and an air pollution control permit issued by the Massachusetts Department of Environmental Protection pursuant to 310 CMR 7.00. There are no restrictions on the disposition of ashes once cremation has occurred. However, prior to the dispersal of cremated remains, permission should be obtained from the land owner or the applicable agency (e.g. – municipal government for town land, or the Department of Conservation and Recreation for a state park, etc.)
There is no requirement to hold a body for a period of time before burial. Burial can take place as soon as a permit is issued and the cemetery is ready. Burial must take place in a municipal or private cemetery approved by the local board of health. If cremated remains are to be buried in a cemetery, a burial permit must be provided to the cemetery. Local jurisdictions should be contacted if a second burial permit is required. In the case of violent or unexplained death, the body must be turned over to a medical examiner or coroner and may be kept several days while the cause of death is investigated.
Containers/Outer Burial Containers
M.G.L. Chapter 114, Section 44A, requires a body to be placed in a "suitable receptacle" in order to be cremated. The body should be placed in a rigid container lined with plastic sheeting to prevent leakage of body fluids. The use of a simple covered box allows for some dignity for all involved in the handling and moving of a body, regardless of final disposition. A simple container, often made out of strong cardboard, which is designed to be destroyed during cremation and often called an "alternative container," can be obtained from a crematorium or funeral director. For additional information options consumers may choose from when selecting funeral services, please see the FTC’s Funeral Rule at: http://www.consumer.ftc.gov/articles/0300-ftc-funeral-rule.
Most cemeteries require that the container be placed inside a concrete grave liner to prevent the ground from subsiding. These may be purchased from some cemeteries or at a funeral home. Most cemeteries do not permit anyone other than their own staff to open or fill a grave.
A “green” burial or natural burial is a method of final disposition of a body with fewer environmental impacts than traditional burial. Generally, a green burial means that the body is not embalmed, no metal or hard wood are used to make the casket, no gravel liner or vault are used, and a low profile grave marker is used or no marker at all. There are no laws in Massachusetts that directly address green burials, but anyone interested in green burial should keep certain considerations in mind. First, there is no law requiring a body to be embalmed, but one should be aware that decomposition sets on quickly. It is possible to store a body for a limited period of time and measures such as turning on the air conditioning or keeping dry ice in the room can help suppress decomposition for a period of time. Second, people interested in green burial are still required to obtain burial permits from their local cities or towns. Finally, there are no standards for green burials and currently no exclusively green cemeteries in Massachusetts. Therefore, anyone interested in green burials should speak directly with a cemetery about performing a green burial. Cemeteries may have their own requirements regarding burials, including the use of gravel liners.
Burial at Sea
Burial at sea is regulated under 40 CFR § 229.1 in federal waters and MGL Chapter 38, Section 14 in state waters. According to federal regulations, human remains or cremains transported on U.S. vessels or planes travelling from U.S. ports may be buried at sea. The human remains must be prepared for burial at sea in accordance with accepted practices and any requirements set forth by the United States Navy, United States Coast Guard, or other civil authority charged with this responsibility.
For non-cremated remains, the burial must take place at least 3 nautical miles from land and at a depth of at least 600 ft. In Massachusetts, compliance with this depth requirement typically means the burial must take place between 25 and 75 miles offshore. The body must also be weighted down to sink quickly and permanently. For cremated remains, there is no depth requirement but the ash scattering must take place at least 3 nautical miles offshore. Decomposable flowers and wreaths may also be scattered where the final disposition takes place.
All burials taking place in federal waters must be reported to the proper Regional Administrator of the Environmental Protection Agency in the Region from which the vessel carrying the remains departed within 30 days of the burial. Massachusetts is in Region 1, and you may contact the EPA Burial at Sea Coordinator with additional questions. The report must include the name of the deceased, date of the burial, type of remains, burial site latitude and longitude, distance from land, depth of water (for non-cremated remains), and name/contact information of the funeral director or person responsible for the burial.
Inland water burials are governed according to the Clean Water Act and require a permit from the appropriate local and state agencies. This act was meant to protect waterways from pollution and human cremated remains generally don’t contribute to pollution or pose a health hazard. Local prohibitions against scattering human remains may exist in some waters.
Under M.G.L. Chapter 38, Section 14, a medical examiner must examine the body and determine the cause and manner of death for any body intended for cremation or burial at sea. The examiner shall not authorize the cremation or burial at sea until he is satisfied that no further examination or judicial inquiry into the death is necessary.
Those wishing to have a burial at sea performed by the U.S. Navy or U.S. Coast Guard must submit additional paperwork to those entities. In order to be eligible, the deceased must have been an active duty member of the uniformed services at the time of death, a retiree or veteran honorably discharged, a dependent family member of active duty member, retiree, or veteran of the uniformed services, or U.S. civilian marine personnel of the Military Sealift Command. The Navy accepts both cremains and casketed bodies for disposition, but the Coast Guard will only accept cremated remains.
A home burial, meaning burying a person on privately owned residential property that is not an approved cemetery, is not explicitly prohibited by law but there are many important issues to be resolved before considering this. First, unless your property has already been approved for burial use, you must attain written approval from the local board of health where the land is situated. After obtaining written approval from the local board of health, those seeking to bury a person on their property must also get the permission of the local city or town government. There is an exception to the requirement of approval from the BOH and city or town in cases where a body is being temporarily stored on private property in a tomb, which is defined as a receiving vault designed for the temporary storage of a casketed body which is not to be interred immediately, in this case no such permission is required. Also, since any area of land that is set aside and dedicated for the final disposition of the remains of a deceased person is considered a cemetery under M.G.L. Chapter 114, Section 1, use of privately owned residential land to bury a body would require that the land where the body would be buried be designated and operated as a cemetery and the owner of the land would need to comply with requirements to establish a cemetery corporation. In addition to obtaining the required local approvals those seeking to have a home burial must meet certain environmental standards. Unless the property in question was approved for burial prior to 1908, land that is situated so that surface water or ground drainage enters a pond, stream, well, filter gallery, public water supply, or tributary source cannot be used for burial purposes unless the Department of Environmental Protection has given written approval to the plan. Finally, those who do a home burial will need to note the burial on the deed for that property where the body is buried before the property can be transferred, as a home burial is likely to be viewed as a encumbrance on the land.
Requirements for Disinterment
Disinterment (removing a buried body) without proper authorization is a crime under Massachusetts law punishable up to $4,000 or two and one-half years in prison. In order to have a body disinterred, the person seeking the removal must get a removal permit from the city or town in which the body to be disinterred is located. This requirement also applies to any relocation of human remains within a cemetery. Upon the removal of the body, the superintendent or other officer in charge of the cemetery shall “indorse upon the coupon accompanying the permit the fact of the removal and the date.”8 Also the superintendent must keep a record of the removal, including any recitals in the removal permit relative to service of the deceased as a veteran and the location of the grave.9 In situations where the Department has determined that a body has become a menace to the public health and the owner of the property has failed to address the problem to the satisfaction of the Department, a court may order the owner of the land to remove the body to a suitable location at the property owner’s expense.10
Organ and Body Donation
Persons wishing to be an organ donor should obtain a donor card from the Registry of Motor Vehicles, which, after being signed and witnessed, is attached to an individual's driver’s license. Individuals wishing to become a body donor should contact a medical or dental school and ask about their donation program. In Massachusetts, donation must be arranged by the donor personally before death. There are some restrictions on the acceptance of bodies to schools. It is important to make alternative plans in case the school is unable to accept the body.
Massachusetts Department of Public Heath
Registry of Vital Records and Statistics
150 Mt Vernon St, 1st Floor
Dorchester, MA 02125-3105
Funeral Consumers Alliance of Eastern MA (serving Eastern and Central Massachusetts)
66 Marlborough Street
Boston, MA 02116
Funeral Consumers Alliance of Western MA
P. O. Box 994
Greenfield, MA 01302
Funeral Consumers Alliance
33 Patchen Road
So. Burlington, VT 05403
Caring for the Dead: Your Final Act of Love (1998)
Upper Access Books
P.O. Box 457
Hinesburg, VT 05461
Massachusetts Cemetery Association, Inc.
P.O. Box 282
Milton, MA 02186