Memorandum by the Board of Deputies of
British Jews
The Board of Deputies, as the main representative
body of the Jewish community, has noted recent calls for a change
to an "opt-out" system of organ donation in the UK with
considerable concern. Likewise there are also considerable concerns
about any moves towards standardisation of European practices
towards an "opt-out" approach, which has thus far been
adopted in only a few European countries.
Therefore we welcome the opportunity to make
a submission to the House of Lords Select Committee on the European
Union Sub-Committee G (Social Policy & Consumer Affairs) about
the proposals.
There are several factors which lie behind these
concerns:
1. At present the UK Jewish community is
very conversant of the wide variations which confront Jewish communities
in different European countries in their approach to medico-legal
issues that are relevant to organ donation. There are disparate
approaches to ownership of parts of the body and / or of the whole
body. Even within the UK to death certification and "coroner
procedures" are not the same in Scotland as they are in England
and Wales. Thus far the recent UK Human Tissue Act, and the associated
Codes of Practice, has not been imitated in other countries. Hence
any planned Europe-wide initiative about changes in the method
of handling organ donation (as one specific form of tissue) is,
we believe, premature, and probably would be unworkable.
2. In the UK this Human Tissue Act, and
the Human Tissue Authority which administers it, are founded on
the principles of consent to the use of organs and tissues, and
have regularised the previous haphazard structures which were
shown to be open to neglect and abuse (as seen at Alder Hey, Bristol,
and in the Isaacs case). The Jewish community has worked within
this new system, which conforms broadly to Jewish views about
the status of parts of the body and/or of the whole body. Amendment
to this recent Act would have to be monitored closely to ensure
that these views continue to be respected.
3. The Jewish community is aware of the
difficulties faced by co-religionists in Austria (where autopsy
was compulsory, and where "opt-out" has now been introduced),
and Belgium. The most striking (and superficially successful)
example of a European country where an "opt-out" organ
donation system has been adopted recently is Spain. However, in
a report on the situation in Spain, the leader of the programme
commented that "the laws are necessary frameworks but they
do not make organisations function... ...transplant organisations
should be based on credibility, efficiency, impartiality and transparency
for the health professionals, for patient associations, for the
media, and for society in general". This latter view is consistent
with a Jewish religious view, and highlights how a balance between
law and practice is essential. Thus it seems clear that changing
the legal status, but without a strong commitment to education
(including education about different faith attitudes) and development
of a transplant co-ordinator network, would be futile.
4. The Jewish community has attempted to
contribute in a constructive fashion to initiatives to increase
donation rates. The general principles which underlie this approach
are outlined in the accompanying memorandum (Appendix A). Asking
doctors to persuade reluctant families, or to go ahead against
family opposition, would betray the trust and confidence envisaged
in this document.
5. The Jewish community believes that this
contribution to the Select Committee deliberations has to be seen
as closely linked to our ongoing work with the Department of Health
on Spirituality and End of Life issues. Several pertinent comments
have been raised in this work (Appendix B). There is some evidence
from Israeli studies that reversion to religious practices in
end of life situations (both in the dying and in their families)
may occur and this may in turn influence organ donation decisions
in either direction. An "opt-out" system would disturb
this sense of individual autonomy, and it is not clear that it
would increase transplant rates.
6. The Jewish community may be more aware
of these issues because the topic was aired during the 1960-70s
controversy in Israel about the family role in handling of body
parts and bodies after death. At that time Israeli legislation
did not require consent by relatives for an autopsy; this was
considered totally unacceptable in the UK. The Israeli law was
changed subsequently, motivated partly by a Jewish religious perspective,
as outlined below, and partly by issues of autonomy and consent.
However, during the same period, in Israel (in contrast with the
UK), the fate of operative specimens was controlled. After analysis
had been completed they could be sent for burial; likewise, there
was a very rapid throughput of autopsy histology, and this too
could be sent for burial. The "opt-out" system is analogous
to a certain extent to the former Israeli autopsy system, and
we believe that the combination of physician, patient and Rabbinic
disquiet which resulted should provide a salutary warning to the
advocates of change to "opt-out".
These views are the outcome of internal discussions
not only within the Defence and Group Relations Division of the
Board but also within the framework of Jewish physicians that
are involved in this field. If the select committee wishes to
have further information, or is intending to pursue the matter
with oral hearings, the Board of Deputies would be willing to
assist. In particular it may well be appropriate for the Board,
together with the Office of the Chief Rabbi, to arrange for much
fuller submissions relating to observant Jewish views about certain
key and central issues such as autonomy, consent, definition of
death, and trust.
We await further advice about submissions from
the Select Committee, and hope that these concerns will be taken
into account thoroughly during your deliberations.
2 October 2007
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