The Intersection of Law, Religion, and Infectious Disease on the Handling and Disposition of Human Remains

Abstract

The 2014 West Africa Ebola crisis highlights the pressing need for effective laws and procedures governing the handling and disposition of infectious human remains. Existing frameworks, both domestically and internationally, are inconsistent and underdeveloped in ways that jeopardize public health and disregard decedents’ wishes concerning post-mortem disposition, trample on survivors’ quasi-property rights, and conflict with religious beliefs regarding care of the body. These issues become critically important when death results from a highly contagious deadly disease. For example, persons who die of Ebola have very high levels of the Ebola virus on their skin and on any leaked bodily fluids. Thus, when family members come in contact with the body, they can contaminate themselves and others. The World Health Organization noted that certain religious rites in the post-mortem handling of Ebola patients, such as washing, shrouding, and praying over the deceased, directly contributed to a significant number of new Ebola infections in the 2014 outbreak. In addition to its preparation and handling, the final disposition of the body also presents significant concerns. Although cremation may be viewed as an ideal scientific solution for final disposition of Ebola victims, it may violate moral values, cultural practices, and many religious beliefs, and meet significant resistance. When Liberian President Sirleaf decreed that Ebola victims had to be cremated, many in the community viewed the mandate as contrary to religious tenets and, instead, performed secret burials that led to even more infections. Without thoughtful and culturally sensitive laws and procedures in place, governments may, in times of crises, dictate particular methods of handling and disposing of highly contagious human remains that may not be as effective as needed and may unnecessarily infringe upon deeply held religious beliefs. The lack of an effective legal framework should be of serious concern to policymakers in all countries, including the United States. We propose the need for such a framework and provide guidance for decision makers confronting these issues. We suggest that any legal framework educate communities to understand the public health issues and empower them to address these issues in ways that respect religious beliefs. Moreover, in order to be truly effective, we also recommend that any solutions be inherently interdisciplinary and combine legal, medical, moral, humanitarian, and religious elements.