Human Tissue Bill

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Dr. Harris: I am a little confused over whether the Minister is planning to deal now with the two cases that I raised about overruling, or whether she envisages sufficient time to do so in—I hope—a short clause stand part debate on clause 3. I look to you for guidance, Mr. Hurst, on whether I should continue to press the Minister on the points that I have raised?

The Chairman: I will certainly permit a clause stand part debate if the hon. Member wishes to raise matters then. It is for him to decide.

Ms Winterton: I can—I hope—quickly deal with the question of overruling by relatives of what is on an organ donor register card. I say to the hon. Member

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for Oxford, West and Abingdon, as I have said before, that we can seek to increase the number of people on the organ donor register. The hon. Member for Westbury was right to say that in the vast majority of cases relatives would give the necessary information about recent medical history. They would co-operate with requests about organ donation if there were a clear indication of what the loved one wanted.

We must be practical. We are talking about medical teams in difficult circumstances and about the practicalities for medical screening—the information that may be required from nearest relatives. Consent given by a person cannot be overridden by a relative as a matter of law. However, we cannot compel a medical team to take and use an organ in circumstances where they are facing great distress on the part of relatives. It is impossible to put people in that position. We as legislators sometimes have to recognise the practicalities.

There are many measures that we can take to increase the number of people on the organ donor register. The hon. Member for Westbury said that that ran into the hundreds of thousands. In fact, there are 11 million people on the register. We can do everything that we can to increase that, and we can take the measures that I will come on to in some of the later amendments that the hon. Member for Oxford, West and Abingdon has tabled. However, we must face the practicalities of implementation. When somebody has made a particular statement, but relatives, perhaps in a very distressed state, refuse to give information, it is asking a lot for a medical team completely to go against that. The team can say what the person has done and what the law is, but would have to be sensitive in such circumstances.

Dr. Harris: I accept to a large extent what the Minister says, but let us deal with the practicalities. I have been in the position of an approaching medical team. Where there is clear advance written consent, is it not best to state that there is consent and ask whether the relatives know of any reason why it has been withdrawn, rather than go fishing for permission from them? It is better not to ask, ''Is it all right with you?'', but to wait for relatives with severe distress—the term that the Minister used—to volunteer the relevant information before taking that into account? There have been so many cases where the practice has become to ask the relatives if they mind. That is different from only responding to severe distress.

Ms Winterton: The difficulty is that, for screening purposes, those in the approaching team would have to say that they knew, for example, that the person had been on the organ donor register and carried an organ donor card. The team would have to confirm what the person had wished to do and ask the relatives to give recent social and medical history, so that those matters could be clear for screening purposes. It is difficult to do that without saying what the reason is. It logically follows from that that the relative knows. If that causes great distress to the relative there and then, either they say, ''I'm not going to tell you because I don't want that to happen'' or they tell the team and

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only later realise what has happened. If a person feels very strongly, the situation is difficult for those in the medical team. We must understand that.

Dr. Harris: I am not arguing that relatives should not be informed and that information should be concealed. I am saying that the approach should be to say, ''This person is on the organ donor register, we have the donor card and it is our intention to use the organs, so we need to ask you some questions about recent medical and social history. Get the answers.'' In practice, relatives are asked, ''Do you mind?'' regardless of what the person thought, which ought not to happen where there is a clear opt-in. Where a relative says that they mind, organs are not taken and the decision is put down to distress. There is a difference between relatives volunteering the information during a consultation where the intention has been stated and not seeking it owing to distress.

Ms Winterton: I understand the hon. Gentleman's point, but I emphasise again that people refuse in less than 1 per cent. of cases where the deceased's wishes are known. In a sense, the hon. Gentleman is missing the point and anticipating situations that have a tiny chance of arising if we get the system right and get more people on to the organ donor register. We are considering other ways for people to carry donor cards, as well as all the other means that I have described. The real issue is about making the approach at the right time. As I said, the situation that the hon. Gentleman anticipates constitutes 1 per cent. of cases. It would be foolish for us to imagine otherwise.

The approach that we have adopted is the right one. We need to ask questions about the person on the organ donor register. To my ears, the phrasing that the hon. Gentleman used to describe the approach—''It is our intention to take these''—does not sound like the most the sensitive. It might have the opposite effect and make people feel that the procedure was being conducted insensitively, thereby making them object. We can argue back and forth about using a different approach, but we must return to the reality that we are talking about only 1 per cent. of cases.

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Dr. Harris: I am very disappointed that the Minister should use the words that I chose earlier to suggest that that is how I would recommend that relatives be approached. I was talking about the general approach, the principles of which are that one explains that the relative had a donor card and wished to donate in such circumstances, and that one should ask those questions that are necessary to provide certainty if there is no medical contra-indication. I do not suggest going up to relatives and saying, ''We intend to take the organs.'' If we are going to have a sensible, sensitive debate, we need to separate such issues from the practicalities.

Ms Winterton: This boils down to practicalities—the practicalities of approaching relatives to ensure that the wishes of the deceased are made known to them in such a way as to achieve maximum co-operation. We must not give the impression that we think, ''Whatever you say, we have the right to do

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this.'' We must have regard to the circumstances of every individual.

Dr. Murrison: We are in danger of labouring the point, so perhaps we should focus on what the Bill is about. Its provenance lies in the fact that relatives were not dealt with sensitively and properly at Alder Hey or Bristol royal infirmary. Despite the reassurances, I am not convinced that the formal wording that might come out of any changes that the hon. Member for Oxford, West and Abingdon wishes to make would be commensurate with that. I commend the Minister's robust stance.

Ms Winterton: I thank the hon. Gentleman for that intervention. I understand that the hon. Member for Oxford, West and Abingdon is anxious to ensure that we maximise organ donation—we all agree on that—but we are talking about the practicalities of the 1 per cent. of cases in which permission is refused.

Our intention is to ensure that enough people indicate their wishes on the register. If we introduce any feeling of pressure, we might create not only adverse publicity, but a perception that the Bill is about putting people under pressure, not consent. We have to be very sensitive to that. Any system that we introduce must be one that maximises in the most practical way possible the number of organs donated, and is based, as the hon. Member for Westbury said, on the principle of informed consent. It should deal sensitively with particular circumstances and recognise the situations that medical teams face.

Dr. Harris: We should all agree that this matter is about three things: maximising organ donation, maximising autonomy in respect of the persons whose organs are being donated and reducing, as far as possible, the stress and distress of relatives who, in almost all circumstances, are at the height of their grief. That applies not only in the short term; we have to bear in mind their long-term interests.

The problem is demonstrated by the evidence. I have one question to ask, and I hope that the Minister will write to me about it. The number of people registering on the organ donor register increases year on year, and I support the campaign for that. All my Christmas cards said, ''Sign one more card this year,'' and gave the number of the organ donor register and the donor card system. However, we have to be aware that as that number goes up, the number of organ donations is going down—the system is not working. Perhaps there will be a sudden turnaround.

Nevertheless, we know from opinion poll evidence that the number of people willing to donate organs has gone up from 70 to 80 per cent. to 80 to 90 per cent. Therefore, in spite of an increasing willingness to donate and increasing numbers opting in on the register, the numbers are coming down. That is a problem we must recognise. If only a small number of relatives are, in practice, overruling the deceased's wishes, that would be fair.

Ms Winterton: In the interests of speed, I should say that there are a number of reasons for that, including, for example, the number of people in intensive therapy units. However, I shall write not only to the hon. Gentleman, but to the wider Committee, with some

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reasons for refusal. They can be quite detailed, so it may be better to have them in writing.

 
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