Should you leave your conscience at home?

Following on from the popular session in the 2007 programme, Professor Deirdre Kelly and lawyer Tracey Lucas (left) led an interactive discussion on Tuesday 13th January on how we might deal with some of the major ethical issues of today.

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The first part of the evening was discussions on the ethics around organ transplants. Chris Rudge, the UK's National Clinical Director for Transplantation, made the following overview of the Government' Task Force Report in November 2008, saying that it did not recommend a change to opt-out legislation in the UK at this time.

"The Taskforce spent nearly a year considering the subject and arrived at a
very clear consensus, although the majority of members had probably started
the process with considerable support for opt-out - the evidence led them
to change their opinion.

Terminology - the Taskforce felt that as consent is an active process the
term "Presumed Consent" is not appropriate, as it is impossible to make an
assumption in the absence of active consent. Opt-out is therefore more
accurate.

The Taskforce looked at six specific aspects:
1. Law - there seems to be no fundamental basis that makes "soft" opt-out
legislation incompatible with Human Rights laws.
2. Practice - there are very significant practical issues that would be
associated with an Opt-out system. Just one example - to be valid, a system
of opt-out would require near-certainty that every individual in the UK was
aware of the new legislation, its implications, the process for opting out,
and the consequences of not doing so. Challenging - particularly the need
to cater for people whose understanding in general may be limited and for
those whose understanding of English is limited.
3. Ethics - this is a fascinating topic that raises many issues.
4. Faith groups - a broad generalisation would be that whilst all faith
groups in the UK are generally supportive of organ donation, for many this
fits more naturally within the "gift" concept which is not the way in which
opt-out is perceived.
5. Public - are divided, with very strong views in favour of opt-out and
equally strong views against.
6. Clinical - a major concern for clinicians caring for patients who are
possible organ donors is that opt-out laws would erode the trust of
patients and their families that the clinician's primary objective was the
best interests of that one patient.

Finally the Taskforce commissioned a major academic review of international
data - such as the high donor rate in Spain - and concluded that there is
no clear evidence for a causal link between opt-out legislation and
increased organ donation - many other factors are involved.

The Taskforce therefore recommended no change to UK legislation. It felt
strongly that the significant improvements to organ donation in the UK that
are so desperately needed could be achieved under existing legislation. The
earlier Taskforce Report, published in January 2008, sets out a detailed
series of inter-locking Recommendations that will together improve every
stage of the process, from general public awareness and understanding
through to detailed aspects of Critical Care and the work of Donor
Coordinators. Momentum is now building for implementation of these
Recommendations in a very wide range of organisations and there is real
high-level political support (and money) for practical steps to increase
organ donation.
This is a necessarily brief overview - both Reports from the Taskforce are
available on the Dept of Health website.
Finally - we can all, today, sign on the NHS Organ Donor Register on 0845
60 60 400, tell our families, and tell 5 other people to do so. 16 million
others have done this - why not join them and save lives yourself."

Chris Rudge FRCS
National Clinical Director for Transplantation.

This event was kindly sponsored and hosted by Mills & Reeve.