| Previous Section | Index | Home Page |
5.4 pm
Dr. Evan Harris (Oxford, West and Abingdon) (LD): I congratulate the Government on introducing the Bill, which has many good aspects. I also congratulate the Minister on her stamina in sitting in the Chamber throughout our debate. That is most welcome.
I declare a personal interest in the organ retention aspects of the measure because my father was professor of child health at Alder Hey hospital before Professor van Velzen carried out his unacceptable practices. My father was mentioned in the Redfern report—because he was involved in van Velzen's appointment—but he was completely exonerated by the General Medical Council.
Mr. Dobson: I thank the hon. Gentleman for correcting me. I said the wrong name in my speech. Van Velzen was indeed the villain of the piece.
Dr. Harris: I am glad that the right hon. Gentleman could make that point.
Events at Alder Hey are an example of what happened throughout the country, and of an old-fashioned paternalistic attitude. Something that was unacceptable on deeper reflection became routine practice. There is no doubt that, at Alder Hey and perhaps elsewhere, there was deviousness if not malice in the continuation of such practices, not simply with thoughtlessness or recklessness about consent, but with disregard to whether consent had been given.
As far as the Bill's provisions on retaining organs for research go, they are an appropriate response, as was the Government's action when the Alder Hey affair came to light. However, it should be stressed that pathology is an honourable profession. Pathologists are an essential part of a modern and effective health service. It can only be regretted that some of the side effects of the controversy mean that they have felt personally oppressed by some press coverage. That also applies to some extent to paediatricians. We can only be pleased that the reputation of Alder Hey hospital's clinical work, which, as others have said, is second to none, has been maintained after the controversy.
I want to consider presumed consent. I acknowledge with due humility the long-standing contributions of the hon. Member for Linlithgow (Mr. Dalyell) and the right hon. and learned Member for Rushcliffe (Mr. Clarke).
The hon. Members for Broxtowe (Dr. Palmer) and for West Bromwich, East (Mr. Watson) introduced ten-minute Bills on the subject, and I understand that the hon. Member for Mitcham and Morden (Siobhain McDonagh) intends to introduce one. A broad cross-section of hon. Members have therefore made contributions on the issue. In 1998, I introduced a ten-minute Bill on it.My interest arose from the time that I spent working on a renal ward as a senior house officer. I saw the other side of the equation—the people who were literally dying while waiting for transplants. However, in my three years in acute hospital practice, I also saw the donor side and how often that was handled badly, if at all. I am a member of the British Medical Association medical ethics committee and of the Transplant Partnership. I spent four years on a research ethics committee that considered research protocols, some of which used tissues. I currently chair the all-party kidney group.
Opinion is clearly split and we must acknowledge that both sides have strongly held views that have been powerfully expressed. However, the issue is so important that it places an extra onus on us beyond the usual practice of the House, which sometimes does not extend further than party political point scoring—I am as guilty as anyone else of that. There is an onus on the Government to allow a proper debate in the House and a public debate. As far as it is within their power, they should provide for a free vote, which should also apply to the payroll vote, given that the matter is an issue of conscience. Those of us who support presumed consent have a duty to try to deal with the concerns of the other side.
Those on each side of the debate have a duty not to fiddle the figures and to ensure that, when statements are verifiable and quantifiable, the evidence is presented at the same time. Simply making assertions and claiming that they are facts does not do justice to the issue.
We on our side of the argument must recognise the opposition of conscience of people who feel strongly about bereaved relatives' rights to consultation and veto. They may feel that those rights should be above the presumed wishes of the patients, above the interests of those dying while waiting and above the interests of the other set of relatives, who will soon be bereaved unless something is done. I hope that we make that recognition clear in our debates. However, we must start by recognising, as many have done, the need to increase the number of organs for donation, although I shall not repeat the figures that have been given. That is why we have a duty to be careful. I, for one, would drop my support for presumed consent if any of the following three things were demonstrated: that it was not effective; that there was public opposition; or that there was an ethical consensus against it. I hope, by the same token, that the Government and others, apart from those who have a fundamental objection of conscience, would drop their opposition to my proposal if they were shown evidence that it was effective, that there was public support and that there was not an ethical consensus against it. I hope that we will see that development in the coming debates.
It is important to deal with some of the arguments against presumed consent. First, we should say what presumed consent is. It would give adults—it is important to note that it would not apply to children—the right and opportunity to opt out in multiple ways, such as using post offices, driver's licences or electoral registration forms. Such a scheme would promote discussion among relatives who would be asked at the appropriate time, the opt-out register having been checked, whether they knew of any objection that had not been registered. Of course, relatives would also be asked the usual questions about social history required for screening purposes. There is no difference between the two schemes in that regard, so it is not appropriate for the Government to argue that that need means that presumed consent could not work.
The difference between the two schemes is that under presumed consent, relatives would have to volunteer their opposition. Organs would not be taken despite there being no opt-out or evidence of one if that opposition were significant and taking organs would cause the relatives major distress. But the presumption would be that donation would take place. That has been shown to reduce the stress on relatives who would otherwise have to second-guess, and to increase the number of organs made available.
Presumed consent is also more likely to give autonomy to the person whose organs are involved. We know that between 70 and 85 per cent. of people want their organs to be used, but that when relatives are asked, 50 per cent. say no. That cannot be right. We are talking not about going against a person's wishes, but ensuring that we are more likely to satisfy those wishes.
The hon. Member for Spelthorne (Mr. Wilshire), in his moving and eloquent contribution, was very helpful in pointing out the stresses on relatives during the current process, even if that process is not practised, as in his tragic case, when he was not approached. I have to say, however, that the point of presumed consent is that patients would come first because their wishes would not be vetoed by the family. The interests of the relatives would also be taken into account because they would be less likely to be feeling guilty for saying no at the height of their grief, despite the patient having had no known opposition, and some good would then have come from the death of their loved one. Relatives would not be asked, as the hon. Gentleman suggested, "Do you wish to object?" They would be asked, "Do you know whether your loved one had an opposition to organ donation that we have not found on the register?" If the relatives answered no to that, they would then be given an opportunity to volunteer their own fundamental objections, but that would not be fished for as at present. That system has been acceptable to the public and to relatives where it has been used.
That is the soft system of presumed consent. No one is suggesting that organs would be taken against the fiercely held views of relatives. Indeed, the Government recognise in the Bill that there is a clash. From my reading of clause 4, it suggests that if there is a donor card that satisfactorily fulfils the requirements for appropriate consent—as the right hon. and learned Member for Rushcliffe said—relatives will not be able to veto that consent, in that opt-in approach. The question
of relatives' views being against the presumed or actual views of the patient is not new in respect of presumed consent.I want to deal with the question of evidence. In a press release yesterday, the Government said:
- "There is no evidence that a policy of presumed consent increases the number of organs for transplantation."
- "In three western countries there is evidence that changing to a contracting out system resulted in an increase in organs".
In October 1999, Transplant Newsletter reported the findings of an expert committee of the Council of Europe. At section 4.6.1, that report said:
- "Presumed consent laws, when fully accepted, seem to benefit donation".
If the Government are going to keep saying that there is no evidence that such a policy would be effective, they have to provide the data to hon. Members, because the data that I can find suggest that the expert view is that it does produce an effect.
Presumed consent is not the only game in town and those of us who support it are not of the view that introducing it is the only thing that needs to be done. We recognise the other steps that the Government are taking.
In respect of public support, according to this morning's edition of The Guardian, the Government have claimed that doctors do not support presumed consent, but the British Medical Association overwhelmingly supported a move to presumed consent. At the moment, there is not sufficient opinion poll evidence to tell either way what the situation is. I certainly would not back as good opinion poll evidence a listeners' poll on the "Today" programme, but it was interesting and I pay respect to the powerful advocacy of Richard Spurgin, who made a case for a change in the law.
Although I acknowledge the Government's attempts to increase the supply of organs, the paper recently produced by UK Transplant shows that there is a significant problem: when relatives are asked about transplantation, 50 per cent. say no. Only a small number are never asked and there is only a small number of cases in which organ donation is not considered. That deals with the question of the "required request" that was raised by the hon. Member for Spelthorne. My proposal could have a powerful effect and I ask the Government to give it a fair wind. They should allow and join in a public debate on this important issue.
| Next Section
| Index | Home Page |