Memorandum by Christian Medical Fellowship
1. INTRODUCTION
Christian Medical Fellowship (CMF) is interdenominational
and has as members around 5,000 doctors throughout the United
Kingdom and Ireland who are Christians and who desire their professional
and personal lives to be governed by the Christian faith as revealed
in the Bible. We have members in all branches of the profession,
and through the International Christian Medical and Dental Association
are linked with like-minded colleagues in more than 90 other countries.
This includes formal links with the associations in 16 other European
Union nations.
We regularly make submissions to Governmental
and other bodies on a whole range of ethical matters (available
on our website at www.cmf.org.uk/ethics/submissions/),
and welcome this opportunity to comment to the House of Lords
Select Committee on the European Union on their Inquiry into the
EU Commission's Communication on organ donation and transplantation:
policy actions at EU level.
2. THE SCOPE
OF THIS
SUBMISSION
Some individual members of CMF, working in the
field of transplantation, have already made submissions to the
Inquiry in their professional capacities. We believe we can best
contribute corporately by concentrating on 'questions which may
arise in relation to organ donation and transplantation from a
faith-based point of view' and from that perspective to comment
briefly on some ethical issues.
3. CHRISTIAN SUPPORT
FOR THE
PRINCIPLES OF
DONATION AND
TRANSPLANTATION
3.1 Although surprisingly little has been written,
Christians have since its advent generally been supportive of
the principle of organ transplantation and see no major ethical
problems per se. There was some initial concern when heart
transplantation was first performed, in that the Bible speaks
regularly of "the heart". However, Scripture is referring
to the totality of the identity, beliefs and character of the
individual, and this confusion was rapidly dispelled as churchgoers
came to realise that the heart being transplanted was only a sophisticated
mechanical pump and had no special spiritual significance.
3.2 The Old Testament gives the over-arching
themes that God is the Creator, Sustainer and Lord of all life
and that we are accountable to him for what we do in the world.1
All human life is made in the image of God, belongs to God and
should be treated with the utmost respect from its beginning to
its end.
3.3 In the New Testament Jesus summarises the
entire Law in the command to love, applied in two dimensions:
"Love the Lord your God with all your heart and with all
your soul and with all your strength and with all your mind"
and "Love your neighbour as yourself".2 The famous Parable
of the Good Samaritan, recorded among the four gospels only by
Luke the physician,3 makes clear that we should respond compassionately
as best we can to anyone we come across in need, and has been
taken by Christian health professionals as a paradigm for care.4
It is highly significant that the caring Samaritan was of an alien
race to the victim; hence the love for neighbour which is advocated
must cross national boundaries. This concept is relevant to the
Inquiry in that it provides support for the principle of a European
organ donor card.
This obligation to love is heightened when Jesus
Christ says, just before giving his life for all mankind—"My
command is this: Love each other as I have loved you".5 He
continues with the text that above all has inspired Christians
to give sacrificially: "Greater love has no-one than this,
that he lay down his life for his friends".6 Offering organs
after one's death or even offering live donation of a paired organ
is compatible with this level of love that the Lord expects of
his people.
3.4 As transplantation is such a clinically
effective and cost effective treatment for organ failure, it fits
well within our stewardship responsibility. The altruistic gift
aspect of donation which arises from fully informed consent fulfils
our Christian obligation to love our neighbour as ourself. Christians
therefore support the principles of organ donation and transplantation.
4. PROMOTING ETHICAL
PRACTICE
4.1 Justice issues in allocation
Justice is an important concept throughout the
Bible, and Christians must therefore strongly support principles
of equity and equal access to scarce organs for those in need.
Recognising that the necessary clinical prioritisation is contentious,
CMF affirms that, regarding the patients themselves as people,
we should "give effective service to those seeking our medical
care irrespective of age, race, creed, politics, social status
or the circumstances which may have contributed to their illness".7
We have already emphasised that positive 'neighbour love' should
cross boundaries.
4.2 Opting-in versus opting-out
We have not yet been able to hold a full debate
within our membership about this difficult question. We are aware
that the policy of the British Medical Association is to support
an opting-out principle and are aware of figures in several EU
countries that report increased retrieval rates after introducing
opt-out policies.
However, in a preliminary discussion we placed
much emphasis on the theological basis for our support for donation—namely
that of altruistic free gift in a context of fully informed consent.
A national opting-out policy would mean that at death the body
effectively became the property of the state, and for many Christians
this would conflict with the respect owed in biblical and church
tradition to the dead body. We commented extensively on this perspective
in 2002 in our submission to the Department of Health on "Human
Bodies, Human Choices".8 Pragmatically, there remains much
concern in the UK about the retention of tissue and organs following
the Alder Hey scandal, and this may have motivated Parliament
when it recently rejected an opting-out policy.
We recognise though the low rates of organ transplantation
in the UK. 68% of the public say they are certain or likely to
donate their body (for research or teaching), their organs or
their tissues but only 5% have already taken the necessary steps
to do so.9 We understand why an opting-out system seems attractive
and if the UK is to continue opposing it, we must all do more
to increase rates of donation. We make some suggestions in 6 below.
5. PREVENTING UNETHICAL
PRACTICE
5.1 Selling organs
Although some philosophers and ethicists argue
that the current taboo on payment for organs is hard to justify,
our preliminary view is that we have an over-riding Christian
obligation to protect the vulnerable. The only people who would
be attracted to sell their organs would be the poor and disadvantaged.
They would not be making an autonomous choice but being exploited
by the wealthy. Old Testament strictures support the poor, and
checks and balances built in there to limit the buying and selling
of private property10 may be relevant to this debate.
5.2 "Transplant tourism"
Like many others we raise the obvious questions
about the source of the organs. Have they been donated willingly
by people able to give fully informed consent? We therefore support
all EU attempts to fight illegal organ trafficking.
In this context we note that, whatever individuals'
views on sexual behaviours are per se, there is widespread
condemnation of the concept of "sex tourism". We believe
that measures against transplant tourism would receive widespread
European support.
6. CAN THE
CHRISTIAN CHURCH
DO MORE?
We conclude that more teaching should be given
within the Christian church to support the principles of organ
donation and transplantation. Any outstanding questions should
be answered. Such a policy should raise the numbers of Christians
on the donor register.
To the extent that Christian teaching influences
public choices we hope that this would increase national rates
of organ donation, though we note that people dislike planning
for death because they do not like intimations of mortality.
Some celebrities have lent their support to
blood donation and bone marrow donation. Prominent Christian figures
should join such role models in encouraging organ donation.
7. CONCLUSION
We are grateful to the Select Committee for
this invitation to comment and are willing to help further if
requested.
REFERENCES
1. Genesis 1 especially verses 28-31.
2. Luke 10:27.
3. Luke 10:30-37.
4. Fergusson, A. Hard Questions about Health
and Healing. London: CMF, 2005. p98-100.
5. John 15:12.
6. John 15:13.
7. Christian Ethics in Medical Practice—an
Affirmation:
8. Submission from the Christian Medical
Fellowship to the Department of Health on "Human Bodies,
Human Choices—the Law on Human Organs and Tissue in England
and Wales":
9. Dyer, C. Two thirds favour organ donation
after death, but only one in 20 take steps to facilitate it. BMJ
2007; 335:533.
10 See for example Leviticus 25:8ff.
October 2007
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