Examination of Witnesses (Questions 420
- 427)
THURSDAY 20 MARCH 2008
Dr John Jenkins and Ms Jane O'Brien
Q420 Lord Trefgarne: The coroner
does not own the body though, does he?
Ms O'Brien: He does not own the body. I do not
think anybody owns the body.
Lord Trefgarne: Somebody must do.
Chairman: Perhaps that is why you cannot
get an answer to your question.
Q421 Lord Wade of Chorlton:
This seems to me very, very unclear. We talk about what can happen
to a body afterwards but where ultimately would the decision lie?
Who legally has the right to make a decision about a dead body?
Ms O'Brien: I think a number of possible people.
As I say, when a death is reported to the coroner, the coroner
has the responsibility while the body is in his or her care. When
a person dies in hospital, responsibility will rest with the Trust,
as I understand it, to decide on the disposal of the body or the
removal of the body until—
Q422 Lord Wade of Chorlton:
The Trust has legal responsibility. Does the Trust then decide
whether its organs are used or not and overrule anybody else's
view?
Ms O'Brien: No, because I think that is covered
by the Human Tissues Act, as to who decides. That is clearly set
out in the Act, I think, about who is consulted where there is
not a clear indication from the deceased about what they would
want to happen. I do not think there is a single answer to that
question: it is quite a patchwork of what happens to the body.
Who decides whether the body is cremated or buried will usually
be the family.
Lord Trefgarne: You can leave your body
to somebody.
Chairman: I can see your fascination
with this question increasing but I will have to move you on.
Q423 Lord Wade of Chorlton:
My Lord Chairman is keeping me to order. I apologise for that.
What exchanges of information have you, the GMC, had on issues
relating to organ donation with professional colleagues in the
other EU Member States. Can you tell us about their views on organ
donation issues which are being held most widely by similar bodies.
Do you discuss these issues with your colleagues throughout Europe?
Dr Jenkins: The GMC has activity and interest
in what is going on in Europe. We have been involved with a number
of organisations which have those interests at heart, both other
healthcare professionals within the UK who reach out to Europe
and also within Europe itself. But the primary areas of interest
and activity in recent years have been more in relation to the
registration of doctors (for example, doctors who qualify in one
country and want to work in another country) and how those registration
particulars can be most easily transferred between jurisdictions
to facilitate the free movement of professionals in relation to
EU requirements, and, secondly, in relation to fitness to practise,
so that doctors who are in trouble with one country, if you like,
cannot just move across a border and practice somewhere else because
the other country would not be aware. Those have been the two
major areas of our activity in Europe. We are only beginning to
develop some interests in standards and ethics with our colleagues
in Europe and we are currently in the process of picking that
up but not to the extent which we have had any discussions with
colleagues in relation to transplantation.
Q424 Lord Wade of Chorlton:
Do you have any views on the added value that these proposals
for the Action Plan could have on the availability of organs and
the system throughout Europe?
Dr Jenkins: The GMC as a body does not have
a view, no.
Q425 Chairman: You talked
about having a code. Would it be helpful to talk to colleagues
across Europe about how they are looking at the ethical issues
in relation to organ donation? Would that be informing for doctors
generally or would you see that as the responsibility of your
colleagues in the BMA?
Dr Jenkins: We would be interested in beginning
conversations but at a much higher, more global level in relation
to the generality of standards and ethics. We would not foresee
any time in the immediate future where we would be able to get
into the degree of detail in relation to an individual specialist
area of practice. That, I suppose, is one of the areas where we
see our role as different from that of our colleagues in the BMA.
Where that is entirely appropriate, different specialist associations
within the BMA have those contacts and develop those contacts.
Q426 Lord Lea of Crondall:
You are saying that the GMC does not really comment on public
policy issues in a certain sense—but obviously you are giving
evidence to us this morning. Vis-a"-vis Brussels, would there
be some sort of line of demarcation between you and a body like
the BMA, to do with you having to give views about the proper
implementation of legislation but you are not an inputting body
into the formation of legislation?
Dr Jenkins: My understanding—and I am
probably not the best person in the GMC to answer that specific
question—from the point of view of standards and ethics,
which is my primary responsibility, and as a council member, is
that our activities in Europe have not extended to trying to work
with the development of legislation, although we do keep in touch.
For example, if we became aware that a piece of proposed legislation
in our view would have an adverse impact on the relationship between
doctors and patients in the partnership that I have described,
then we would certainly make representations through official
channels as to our concerns in relation to that.
Q427 Lord Lea of Crondall:
But you are not on a body in Europe in the same sense as the BMA
are on a body in Europe, or are you?
Dr Jenkins: I will ask Jane if she can specifically
answer that.
Ms O'Brien: I think we are not on that. We are
a member of two different organisations. One is called Health
Professionals Crossing Borders which is groupings of, basically,
the regulators rather than the professional associations of bodies.
We are a groping of broadly similar organisations to the GMC,
although health is regulated and managed in different ways across
Europe, so there are often not direct parallels. That is a group
which is looking particularly at the impact on doctors and patients
of increased mobility around Europe and those are quite specific
issues. We also belong to a group which represents health organisations
within the UK and is represented in Europe, but, again, it is
the health regulators, so we are very much looking at it from
the point of view of our four functions, which are keeping a proper
register and protecting patient safety in that way. Rightly or
wrongly, up until now the question of ethical professional standards
that we deal with has not been a high profile area in those contexts.
We have been thinking about how we would perhaps change that and
try to develop those discussions and exchanges. As John was saying,
we do not stand a chance and do not try to be specialists across
the vast range of medical practice. We are trying to set high-level
standards using a framework within which doctors can comfortably
work and develop more speciality-specific standards based on their
much greater knowledge of the problems on the ground and the real
issues which face doctors in these specialties, where we do not
think we can do such a good job. There is no point in trying to
replicate good work that is being done elsewhere. It is probably
not helpful to us either in our other functions, particularly
in our fitness to practise procedures, where we do not want to
create a great list of rules and standards, so that doctors must
do this, in the circumstances and for the reasons that Dr Nathanson
was saying before.
Chairman: Thank you very much indeed.
We have that picture and that is very helpful. Thank you both
for coming and giving us your time. It has been extremely helpful.
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