Supplementary memorandum by the Christian
Medical Fellowship
INTRODUCTION
Christian Medical Fellowship is a UK membership
organisation comprising some 5,000 doctors in all branches of
the profession and 1,000 medical students who wish their personal
and professional lives to be governed by the Christian faith as
revealed in the Bible. We are non-denominational.
This submission is made on their behalf, based
on a broad consensus arrived at after discussions of our Medical
Study Group, and we trust reflects the broad views of our membership.
However, we do not claim to speak on behalf of any particular
Christian church, denomination, or other grouping.
The Lords Inquiry has already received a general
submission, and we respond here as requested to four supplementary
questions.
Q1. Please would you describe any particular
aspects of organ donation and transplantation which are considered
ethically problematic within the context of your organisation's
religious beliefs—as these are perceived: (a) within the
UK; or (b) in other EU Member States?
(a) We have already expressed strong support
in principle for the concept of organ donation and transplantation,
as an altruistic free gift in the context of fully informed consent,
and have no fundamental ethical concerns with donation per
se.
Some members are concerned about lack of transparency
in the information provided to potential donors and their families
about the issue of the timing of cessation of ventilation. Organs
to be retrieved are in the best condition if well perfused with
well oxygenated blood, so the practice is to leave the donor on
the ventilator until all the organs to be retrieved have been
removed, and then turn off the ventilator. Those with concerns
here have reservations about the concept of brain stem death and
would argue that it is the act of removal of organs which ends
the donor's life. They believe the ventilator should be turned
off and removal of organs should not take place until classic
criteria of death have been fulfilled—the donor stops any
natural breathing and the heart stops.
Most members, fully aware of the situation about
ventilation, accept the concept and criteria of brain stem death
and have no such reservations. However, both sides would agree
that consent by patients and families can only be truly valid
if it is fully informed, and that information about this issue
should be given transparently, even at the risk of lowering donation
rates. The practice of organ donation must have public confidence
and support.
(b) We cannot speak for other EU Member
states, though would expect our sister organisations in those
countries to mirror the position expressed above.
Q2. Please would you explain if there is any
significant tendency for individuals from your faith group to
oppose organ donation either for themselves or for a family member
on the basis of their own interpretation of the religious teaching
of the group, rather than on the basis of how that teaching is
more generally interpreted. If so, how, if at all, do you think
this tendency might best be addressed?
There has been surprisingly little teaching
from the Christian church about donation and transplantation.
We are not aware therefore that there is significant "religious
teaching of the group" for individuals to interpret differently.
In our answer to Question 1 we have mentioned
one difference of interpretation among those well informed about
the details of practice—namely the questions: when does
death occur? And what was its cause? We have suggested that transparency
leading to fully informed consent is the way to address this.
Q3. To what extent would a change to a system
of presumed consent for organ donation in the UK (under which
everyone would be assumed to have consented to donate their organs
after death unless they explicitly opted-out from the system)
be ethically acceptable for your faith group?
We would expect this to cause significant ethical
concern for Christians in the UK, and quote our previous submission:
"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'.1 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 [2004] rejected an opting-out policy.
We recognise though the low rates of organ transplantation
in the UK ... 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".
Our position is unchanged. We would point out
that the language of "donation" becomes inappropriate
when organs are "taken" rather than "given".
Q4. If presumed consent were to be introduced
in the UK, what would be your views about the idea that members
of any particular groups should be assumed to be opted out as
a whole without the need for individual opt outs? (An example
of this is the case in Singapore, where Muslims are assumed to
have opted out unless they expressly opt in).
We have already stated that we cannot speak
for the whole Christian church, though our view is that no such
assumption need be made about any particular Christian group.
(We are unaware of the position on donation
and transplantation of the Jehovah's Witness sect. We do not consider
them "Christian", but knowing their views on blood transfusion
would expect them to reject donation and transplantation, as organs
would inevitably contain blood.
We similarly do not consider Christian Scientists
as part of the `Christian' church, but would expect them to reject
the medical treatments involved).
CONCLUSION
We trust these supplementary responses are some
help to the House of Lords' Inquiry, and wish you well in your
deliberations about this difficult matter. We are willing to help
further if requested.
REFERENCE
1. 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". www.cmf.org.uk/ethics/submissions/?id=23
February 2008
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