Swinson, Burke and Hare
*This image has been airbrushed and should not be confused with a photograph.
The Liberal Democrat MP for East Dunbartonshire, Jo Swinson, has recently been consulting views on whether organ donation after death should be ‘opt-out’. This to replace the current donor card ‘opt-in’ system. It would mean on death, unless your medical records stated an opt-out, or you carried some kind of ‘no-donor card’, the NHS might freely use your mortal remains for treatment and research.
The result of Jo’s survey showed 2:1 in favour in the idea.
We at Liberal Vision would count ourselves amongst the minority against. We suspect after a proper public debate we would be in the majority.
The thinking behind the proposed change, first put to the Commons (and heavily defeated) in 2003 as an amendment to the 2004 Human Tissues Act, by her former colleague Dr. Evan Harris, is to resolve the current shortage in the supply of organs for donation.
The donor card system does not work well in matching supply and demand and with the best of intentions Evan and Jo are looking for solutions. A world where lives are saved and quality of life enhancing treatments are more easily developed would be a good thing.
The problem is their recourse to illiberal statism. An opt-out scheme would create a presumption that the state, in this case the NHS, owns you on death, unless you remember to declare otherwise, and have some system to prove you have done so, either a card, medical records, or a national database.
A solution that would likely lead to many unfortunate incidents of human error where individual wishes would not be respected, NHS employees might be tempted to err on the side of incaution, not to mention the cost of the system and adminstration required to minimise those errors. It could end up looking something like the much unlamented ID-card scheme.
The simplest solution would be to create a regulated market for post-mortem organ donations. This might involve payment on delivery to a recipient according to the living wishes of the donor. Most often this would mean the NHS or pharamceutical companies, making a contribution towards funeral expenses.
That would dramatically increase take-up of the donor card scheme. It would be redistributive, benefitting those most in need of help with the costs of losing a loved one. It would be no more likely to incentivise murder than the current system of wills.
The worry about such a scheme, apart from absolutist, usually religious, objections to the sale of parts of the body, stems from the 19th century, and the trial of Swinson’s Scottish compatriots, Burke and Hare (currently getting the Hollywood treatment from Simon Pegg).
In a nutshell the University of Edinburgh in the 1820s had demand for the teaching of anatomy. A growing science and thus growing demand. The state restricted supply to executed criminals, then reduced that supply dramatically to 2-3 corpses a year, after the reppeal of the Bloody Codes. B&H were amongst many body snatchers plugging the gap, most from grave robbing. Dr. Knox, their customer, was trying, like Evan and Jo to advance medical science. Grave corpses though, being partially decomposed, attracted lower payments than fresh.
All the incentives were there for murder, largely as a result of a desire to save lives, prohibition and state control.
Skipping back to today, and the reasons for the 2004 Human Tissues Bill, we have the Alder Hey child organ scandal. Modern day Knox, Professor Dick van Velzen, falsified records in order to secure body parts from over 850 children for the Liverpool hospital. But he was not alone, many NHS hospitals including Birmingham and Walton had done similar things, some selling the parts to pharmaceutical companies.
The lack of a legal and transparent market had again encouraged black market behaviours. The cost to the NHS for Alder Hey alone, not counting the legal and inquiry bills, was £5m in compensation.
Neither the 2004 Bill, the Human Tissue Authority it created, nor Evan and Jo’s suggestion solves this problem. With an opt-out scheme there will be still be mismatches in supply and demand, errors of judgement and malpractice, lawsuits, compensation and inquiries. Liberals should on principle be opposed to nationalisation of corpses.
It would be interesting to see what the results of Jo’s next e-consultation would be if we pitted the status-quo against her scheme, and contributions toward funeral expenses. The result of most such surveys depends on how you frame the debate and questions.
November 24th, 2010 at 5:52 pm
I had to read this twice to make sure it wasn’t a late April Fool. What an absolutely ridiculous and idiotic comparison! The “opt out” proposals would produce nothing like the Burke & Hare comparison. It’s highly unlikely that the NHS would in any way accept donations without being certain of its origin, and certainly wouldn’t pay for it.
The second part of the piece does provide a more coherent and logical assessment, though still one that I’d disagree with. At the moment, the Donor Card carries no legal weight – even if the deceased carries one, doctors still have to ask relatives permission and this can still legally be withheld, despite the clear wishes and intentions of the deceased. In effect, the current position denies the individual the clear right to state what could happen to their bodies should they die.
The “opt out” process would avoid this in that the presumption would be in favour of donation. In the case of children, I would expect that, given children are not legally capable of deciding on their own treatment, parents would have to be consulted before donation. The Alder Hey case is an extreme example of a doctor operating outside his responsibility and, given that it happened within the existing scheme, there’s no guarantee that even now it wouldn’t happen again.
No system is perfect, you are correct. But an imperfect system which saves lives surely is more acceptable than an imperfect system which doesn’t?
November 24th, 2010 at 10:58 pm
Keith, apart from the general principle that we do not belong to the NHS, this attempt to stretch the welfare state from cradle to beyond the grave is profoundly illiberal, the key point here is that an opt-out organ donation scheme would legitimise aspects of van Velzen’s behaviour as the norm. It would create an enormous potential for error, distress, and litigation.
You are also not correct to cite van Velzen as some lone maverick. The Redfern report noted the organ collection at Alder Hey started in 1948, he didn’t start until 1988. It also cites the management at Alder Hey and the related university as culpable on seventeen points.
Further and more crucially the census that directly accompanied the Redfern report “revealed that over 104,000 organs, body parts and entire bodies of foetuses and still-born babies were stored in 210 NHS facilities. Additionally 480,600 samples of tissue taken from dead patients were also being held.”
The main change after Alder Hey was to shift from that inadequate and sometimes ignored consent system to one of “informed consent”. The opt-out proposal would take that back to a system of uninformed assumptions.
In respect of the market angle, it should be noted Alder Hey and Birmingham sold tissues to pharmaceutical companies. Tissue trading exists in a number of markets e.g. ova, and is contentious. It does though seem odd and inconsistent to say it is unethical to pay the family or favoured cause of the deceased for their bits, but o.k. for the next phase of the supply chain.
Have Evan or Jo estimated the revenue the NHS would make if opt-out led to an over-supply, and how they would explain that to that public? Would they burn the surplus or sell it?