§ Order for Second Reading read.
§ 1.57 p.m.
§ Sir Gerald Nabarro (Worcestershire, South)
I beg to move, That the Bill be now read a Second time.
We had a short debate prior to First Reading of the Bill, as it was inaugurated under the Ten Minute Rule, on Wednesday, 13th March, and I was then privileged to explain that a limited exercise only is here entailed in the matter of transplant of human organs. It is delineated very precisely in the Long Title of the Bill as toPermit removal from the body of a human person, duly certified as dead, of any kidney or kidneys required for medical purposes, unless there is reason to believe that the deceased during his lifetime had instructed otherwise.Substantially, this is an Amendment of the Human Tissue Act, 1961 and it may be questioned why this amending Bill is propitious. The answer is quite short.
During the seven years which have elapsed since 1961, the medical science of transplanting kidneys from a deceased person into the body of a living person, man, woman or child, has been largely perfected. We now know that the recipients of these human kidneys have lived for up to six years following the operation. The human kidney is the only blood-fed organ—for the cornea is not a blood-fed organ—which has survived for several years the hazards of tissue rejection. It would be wrong of me to talk about the chances of survival of those persons struggling for life at this moment who have been recipients of major organs, notably of hearts, in recent months.
The medical profession advises me, no doubt correctly, that the hazards arising from tissue rejection following the transplant of a major organ are very great. Indeed, it is indisputable that, at this moment the only blood-fed organ of the human body which has been moved successfully on scores of occasions from the dead to the living is the kidney. I do not know—I doubt whether the Minister does; I am informed that no reliable statistics are available—how many successful operations of this kind have 811 been accomplished, but it is certainly several scores.
I am advised by Professor Roy Cane of Cambridge—I hope that my hon. Friend the Member for Cambridge (Mr. Lane) will have an opportunity to speak later, when he will be able to confirm this from his own researches in Cambridge—that in Cambridge alone, in 1967, there were almost 30 successful renal transplants. There are, of course, other centres in Britain for renal surgery where similar results have been achieved.
It may be asked why it is necessary, in my view and in the view of the sponsors of the Bill, to legislate in the narrow sense of kidneys alone. Not only is this necessary because kidney transplants have so largely been successful during the last seven years but for a much more fundamental and physiological reason. Kidneys removed from a dead body are valueless for transplant purposes unless chilled or refrigerated within one hour of their removal from the dead body; or, alternatively, inserted by surgical means into the body of a sick living human being, to save life.
Under the 1961 Act it is necessary for the owner of the body to obtain the permission of the next of kin before the kidneys can be extracted. It is manifestly impossible to obtain such permission within one hour of the death occurring. When moving the Second Reading of the 1961 Measure, the then Conservative Minister, the late Miss Edith Pitt, who was for so many years a valuable hon. Member of the House, said:By Clause 1(2) the person in possession of the body may also authorise removal of the parts unless—having made such reasonable inquiry as may be practicable—he has reason to believe that the deceased had expressed an objection to this or that the surviving spouse or any surviving relative of the deceased so objects."—[OFFICIAL REPORT, 20th December, 1960; Vol. 632, c. 1232.]I cite a common case which is sad and grievous to relate but which is common in our society. A young man, driving a motorcar along the M1, perhaps drives too fast and, having been involved in a collision, is taken to hospital grievously injured. The hospital is near the motorway, but he dies there. There are scores of such cases every year. Sadly, in the majority of cases young men and women are involved.
812 The hospital registrar or the doctor in charge of the hospital can hardly conform to the requirements of the 1961 Act if he wishes to arrange for the hospital surgeon to avail himself of the kidneys after death following the accident—kidneys which are probably entirely healthy and able to be removed from a healthy young man or woman—because the hospital registrar cannot telephone the spouse or next of kin in these terms and say, "Sadly, your husband had a motor crash on the M1 less than an hour ago, was admitted in a dying condition and he died here half an hour ago. We hereby notify you of his death. Please may we have his kidneys?" That procedure would be unthinkable, callous and uncivilised, but it is the requirement of the law if the kidneys are to be obtained.
Although I cannot be sure of the statistics, the medical profession informs me that last year about 3,000 men, women and children died in Britain through kidney diseases and ailments. I am told that about 150 successful transplants were accomplished. The surgeons in charge of transplant operations have averred—they are unanimous about this—that the number of life-saving operations would have been infinitely greater last year had there been a generous supply of good healthy kidneys, chilled and refrigerated—a kidney bank, to put it that way—available for them to draw on, notably in the correct blood groups, just as it is commonplace today in the case of grievous accidents for surgeons and doctors to draw on blood banks in all parts of Britain although blood banks 20 years ago were unknown. Today human beings readily give their blood to these banks for the future saving of human lives.
If I am able to steer the Bill onto the Statute Book, I envisage that, with the passage of time, similar arrangements will be made and we will have kidney banks. However, for the present we should change the law because it is unduly restrictive and, as a result, it is gravely handicapping the work of surgeons and doctors in carrying out successful kidney transplants.
I recognise at once that there may be objectors to the Bill, on religious, moral and social grounds. On 13th March the hon. Member for Liverpool, West Derby 813 (Mr. Ogden) voiced shortly—he could not do more on that occasion—some of his objections. I have been unequivocal in all I have said and written on this subject in recent months in saying that I would provide the utmost safeguards in the Bill to facilitate objectors' making known their objections and, or, to put it in contemporary jargon, to contract out.
The present state of the law requires a man or woman to contract in. For example, the Automobile Association published in its magazine Drive a few weeks ago a form of certificate which said, in effect, "I wish to state that if I am killed in an accident I have no objection to the surgeon, after my death, removing my kidneys to save a sick human life." The Automobile Association says, in effect, that the certificate should be inserted in the driving licence normally carried in a motorist's wallet—and most people carry their driving licences with them. Therefore, the present law requires that the person should contract in, but I say that that would not be sufficiently widespread among the motoring public particularly, and among all men and women, to secure a large enough supply of fresh human kidneys from the dead.
I wish by this Bill exactly to reverse the law, so as to make it legal for any doctor to remove the kidneys of a human being after death, so long as the death has been certified by two doctors other than the surgeon who is to carry out the renal transplantation; to make it legal for the kidneys to be removed unless those who have died have said in their lifetime that they object to their kidneys being removed after death.
I shall, in a few moments offer evidence in support of what I seek to do, but I want now to deal with one or two surgical aspects of what I am putting to the House. It may well be considered by some people not informed in the matter that it would be barbarous to cut open a dead body in order to remove the kidneys. I claim that it is not barbarous to cut a dead body in the very limited fashion which the removal of kidneys requires.
The incision is clean, and relatively small—it is only a few inches long—and, after removal of the kidneys, it may be restored with precision and perfec 814 tion. A few weeks ago, studying every aspect of the problem, I said to my own doctor, "What is involved in taking out my kidneys, old boy?" He replied, "Not very much, Gerald. The good Lord has given you two. As far as I am aware, your kidneys are in good order, Gerald. You give me a sharp penknife, I will sterilise it, whip out a kidney and sew you up in a few minutes. The good Lord has provided that you, as a healthy human being will live many years on the one remaining kidney." Such is the perfect balance and construction of the human frame, in healthy condition. The point I seek to make is that the removal of kidneys from a dead body is relatively a small surgical operation—but the body has to be certified as being really dead by two doctors other than the surgeon who is to carry out the transplantation.
Let me go a stage further. Very often, an autopsy—a post mortem—is ordered. Those acquainted with this process will know that it involves the opening of the body from the gullet to the crutch—not a small incision at all—and then the resewing of the body. That search for the cause of death is not generally objected to by society.
Let me take the evidence a stage further. Fifty years ago, most men and women objected to cremation; today, for a variety of reasons, the majority of men and women opt for cremation—though, again, we do not know the exact figure. So it is innate in this option so freely expressed that the majority of men and women in our contemporary society accept the total destruction by fire of their remains, after death.
Those who have religious leanings believe that the spirit will go aloft but that the inanimate remains are dead beyond redemption, and that whether they are put in the fire and cremated and utterly destroyed and sprinkled as ashes, or put in a coffin and buried deep down so that when the coffin disintegrates they go to the worms, the result is still the total destruction of those human remains. I hope that I do not offend susceptibilities by putting these matters in a somewhat indelicate fashion, but I am obliged to do so now because we are talking of very fundamental things.
That leads me to my conclusion, which is a very important conclusion. I would go to any limits to save human life, especially 815 young life, and the tragic part of the nearly 3,000 deaths last year from kidney ailments and disease is that so many of the victims were young; lives that could have been saved had kidneys been available.
As to the ethical grounds, I said when bringing in this Bill:Following the diagnosis of death by conventional and accepted means, and death certified by two doctors, other than the surgeon conducting a renal transplantation, it is justified, in my view, on ethical grounds, to remove a kidney or kidneys for prolongation of life of a sick human being, always provided"—and, I repeat, always provided:there should be some safeguard for persons who do not wish this to be done for religious or other reasons".—[OFFICIAL REPORT, 13th March, 1968; Vol. 760, c. 1377.]That is exactly my position today.
Perhaps I may say at this point that I am most grateful to the right hon. Gentleman the Minister of Health for coming here on a Friday to listen to a private Member moving a Bill of this sort. It shows a great sense of Ministerial responsibility that I am not to be fobbed off by a Parliamentary Secretary. I congratulate the right hon. Gentleman on that sense of responsibility.
The Minister has convened an important conference of all the leaders of medical, surgical, religious, lay and philosophical thought in this field, going as wide in his choice as he possibly could, to consider the implications of transplantation of organs having regard to the massive position this matter now occupies in the minds of civilised men and women all over the world. We are captivated, of course, by the story of the transplant of a human heart and the fact that the man is still alive. We are not ready to deal with that development yet. I want to deal with an area of proven success, which relates to kidneys, alone.
The conference reached certain important conclusions on 6th March, 1968, which the Minister revealed on 25th March in reply to a Parliamentary Question from his hon. Friend the Member for South Shields (Mr. Blenkinsop). The reply stated:
§ Conclusions of the Meeting held on 6th March, 1968
1. The practioners engaged in kidney transplantation explained that this work is now
being held up by the difficulty of obtaining sufficient cadaver kidneys. This was partly because of the difficulty of making the necessary inquiries of relatives in the time available partly because of lack of co-operation from medical colleagues in charge of potential donors before death on whom the task of making such inquiries would fall. They would like…
§ Thus so far the conference recommends precisely what I recommend in this Private Member's Bill.
I shall not read all the Parliamentary Answer, but the only other relevant paragraph, which is the fourth paragraph:
The conference accepted that in the absence of cadaver kidneys the taking of single kidneys from living donors might still be justifiable but emphasised that there were special consideration affecting young persons under 18 which made it especially difficult to ensure that consent was free from outside influence."—[OFFICIAL REPORT, 25th March, 1968; col. 761, c. 217.]
§ I do not propose to deal with that in this Bill. I am only concerned in this Bill with the transplant of kidneys from dead persons to living persons.
§ The Minister has been kind enough to tell me that his conference has retired to consider further the one outstanding matter in regard to transplant of kidneys, that is, what safeguards there ought to be. I believe that the greatest safeguard of all is built into this Bill. That safeguard is to encourage men and women to express their wishes one way or another during their lifetime and not to rely upon their relatives to do what they themselves ought to do about their human bodies.
§ Most sensible men and women make a will. There are a few foolish people in all strata of society who do not make wills. That is because they have some sort of apprehension about making a will. I suppose that as educational standards rise in Britain the time will eventually come when everybody will make a will. I want people to proclaim in their lifetimes whether they object to their kidneys being taken after death. That is all I want them to do. Otherwise, if this Bill reaches the Statute Book, their kidneys would be taken. I say that that is not an unreasonable proposition.
The Bill itself is simple and requires very little explanation from me. Clause
1 seeks to extract from the Human Tissues Act, 1961 any matter relating to renal transplantation. The Act of 1961 would no longer apply to kidneys. Under Clause 2 it would become lawful, when this Bill reaches the Statute Book, to take
from the body of a human person, duly certified as dead, any kidney or kidneys required for medical purposes unless there is reason to believe that the deceased during his liftime had instructed otherwise.
§ Those words of mine may not be perfect to give effect to the sentiments which I believe are widely held, but of course they could be amended without difficulty in Committee.
Clause 3 covers the very important point I have deliberately repeated twice:
a death certificate must be signed by two medical practitioners other than the surgeon conducting the renal transplantation.
It is rather a pity that Mr. Speaker is not in the House at this moment for it is unusual—with deep respect to you, Mr. Deputy Speaker—to quote from the earlier activities of Mr. Speaker before he took the Chair, but in this context it is notable that Mr. Speaker of the House of Commons today, as the hon. Member for Southampton, Itchen was largely responsible for the support given to the Human Tissue Bill of 1960, which became an Act in 1961. He then said:
The Corneal Grafting Act, which is to be repealed…
The Minister of Health who is listening to me today—
under the Ten Minutes' Rule by Mr. Gerald Williams
the Conservative Member for Tonbridge in 1952—
and thanks to the generous co-operation of all Members of the House whom we had endeavoured to educate in the significance of the Measure, it got through all its remaining stages."—[OFFICIAL REPORT, 20th December, 1960; Vol. 632, c. 1240.]
I like Mr. Speaker's words:
whom we had endeavoured to educate in the significance of the Measure.
§ I have spelled out hundreds of thousands of words in the last two or three weeks explaining to hon. Members that I have no design on their kidneys during their lifetime.818
§ Sir G. Nabarro
This is largely an educative process. Hundreds of letters have descended on me since 13th March, about two-thirds supporting what I am seeking to do, and about one-third opposing, but most of the men and women opposing did not quite understand what I am seeking to do, or they have a religious objection to it which I respect.
It is very interesting that Mr. Speaker was the principal sponsor of the first human organ transplant Bill ever brought to this House, which also was a Ten Minutes' Rule Bill, like mine. It was called the Corneal Grafting Bill. It was brought in on 14th May, 1952 by the then Member for Tonbridge, Kent, Mr. Gerald Williams. The first sponsor was the present Speaker of the House, and the words used I think were significant and important to the case I am pleading today:If the cornea is injured, it can be replaced by the cornea from another eye, and this will enable sight to be fully restored. At the moment these corneas are taken from the eyes of living people. That is to say, if somebody has a disease of the eye other than of the cornea and the eye has to be taken out, provided that the cornea is in perfect order it can be used for grafting on to the eye of somebody who has a disease of the cornea."—[OFFICIAL REPORT, 14th May, 1952; Vol. 500, c. 1445.]This is exactly analogous.
Mr. Speaker, I am sorry to have been taking your name so largely in vain as to your activities before you were Mr. Speaker, but I am quoting from the speech of the then Member for Ton-bridge on 14th May, 1952 when he won permission to bring in the Corneal Grafting Bill of which you were first sponsor. You are the progenitor and initiator of human organ transplant legislation in this House by what you then did.
§ Mr. Speaker
Order. The hon. Member can refer to what Mr. Speaker did in a previous incarnation but he cannot pray Mr. Speaker in aid of this Bill.
§ Sir G. Nabarro
No, Sir; it is only a passing reference, and I am sorry if I have transgressed by quoting your earlier activities. I am a very enthusiastic supporter of what you did in those far off days, but there is this remaining difference 819 between the day when corneal grafting was first carried out in the year 1900 and the Bill which became the Corneal Grafting Act 52 years later. The Act of 1952 was the progenitor of the Human Tissues Act, 1961. Medical science and surgical evolution demanded that the law should be attuned to the then temporary condition. But the cornea is not a blood fed human organ; the kidney is. Since 1961 we have very largely perfected this process—it is not entirely perfected yet—but to facilitate perfection it is necessary to change the law in the sense that I have suggested.
§ Mr. Sydney Bidwell (Southall)
Does the hon. Gentleman know what surgeons advise as being how long it is that a kidney can be left in a dead body before it becomes unusable? I have in mind the feeling the people have about the whole question of organ transplanting, particularly the heart, which some people are reluctant to accept, fearing that one day one medical man will say, "Let us finish him off, because we have a more important person" and—
§ Sir G. Nabarro
I do not know, and I do not think that anybody knows. Heart transplantation is in a very embryonic state. I do not wish to pursue that matter too deeply, first, because it is not within the compass of the Bill, even on Second Reading, and, secondly, because it would be a trifle unfortunate if I were to proclaim my views on the opportunities for survival of the one man alive today with a heart transplanted from another human being.
There is a technical Parliamentary point which I hope will appeal to the Minister of Health. He is anxious to get the views of his highly informed conference on the safeguards necessary for renal transplantion. The Conference will meet again shortly. I hope that it will pronounce on safeguards at its next meeting. I fancy that it will, for this is not a matter of great difficulty, although it requires discussion among informed people. In the ultimate, it is a matter for Parliament and not a conference. A conference can make 820 recommendations, but it is for Parliament ultimately to establish the law.
I plead with the Minister not to oppose the Second Reading of the Bill, which is original legislation on blood fed organs, and to let the Bill go to Standing Committee in the sure knowledge, with all his Parliamentary advice from his Ministry and elsewhere, that the Bill could not be taken in Standing Committee until after the Whitsuntide Recess, which would be about the middle of June. Surely his conference will have pronounced by the middle of June, eight to 10 weeks hence. I plead with him, therefore, to support the Second Reading today, leaving to his conference, which amply supports the principles of the Bill—only this matter of safeguards still outstanding—and then enjoin his conference to pronounce on the safeguards it recommends before 1st June, so that we may all consider them in Committee, on this Bill.
I repeat that the Bill has all party support as well as medical and lay support in the House. There are 12 sponsors, 11 other hon. Members and myself. Six are medical doctors and six are laymen. Of the 12, six are Tory Members, five are Labour and one is a Liberal. I justly claim therefore that the Bill has powerful and widespread support.
§ 2.45 p.m.
§ Mr. Laurence Pavitt (Willesden, West)
Had I been told in my early days in the House that I would have been sponsoring a Bill by the hon. Member who in a previous incarnation we used to know as the "Biggest kidder from Kidderminster", I should have been very surprised. But the hon. Member for Worcestershire, South (Sir G. Nabarro) has introduced a Bill which deserves the widest support. As with so many things here, I disagree with the hon. Gentleman 99 times out of 100, but on the 100th time one has to accept that he has argued his case with reason and has brought before the House a subject which deserves consideration. On this occasion I have no hesitation in giving him my fullest support. I remember one other occasion when a most important Measure, dealing with the safety of paraffin heaters, found its way to the Statute Book because of the hon. Gentleman's efforts, and I congratulate him on that, too.
821 My voice in support of the Bill today may not be so important as the fact that the previous Bill on the Order Paper, the Hearing Aids Bill, in which I am passionately concerned, which I am sponsoring, which has all-party support and is designed to help people with hearing disability, I have deferred for further consideration to a later date, and I hope that that has assisted the hon. Gentleman by providing him with time as much as my words of mine.
He rightly said that at present there was a genuine limitation on the number of lives which could be saved, many of them young lives, because of the inadequate supply of kidneys to be transplanted into people who have had renal failure. Dr. Stuart Cameron, who has done some remarkable work at Guy's Hospital, recently invited a number of lion. Members from this side of the Committee to look at the dialysis and renal department of that hospital. He made that point with considerable force, impressing all of us. My hon. Friend the Member for Southall (Mr. Bidwell) asked flow quickly a kidney had to be transplanted. According to Dr. Cameron, if a kidney is removed within five minutes, that is extremely good; up to 30 minutes, it is all right, but beyond that difficulties start.
The Bill will mean that lives which would now be lost will be saved. The hon. Gentleman called the findings of a recent conference to his support and so do I. One of the most interesting aspects of the examination of the whole subject of renal failure has been the pioneering work at the Royal Free Hospital and the constant examination of these problems by a group of doctors, the Transplantation Group, which meets at the Royal Free Hospital from time to time aid which has the backing of many of the surgeons and the physicians interested in the subject in the London area and which recently decided to give strong support to this Bill.
Not only transplantation is important in renal failure. It should be known—and I wish that the Press would take more note of this—that this country leads the world in dialysis, the kidney machine. We have more kidney machines per head of the population than any other country. This development has saved countless lives by a machine which artificially 822 changes the blood when the kidney is no longer functioning. British work in this field is pre-eminent and it is something of which Britain should be extremely proud. Anybody working for an improved National Health Service should take pride in this fact.
We hear about dialysis machines only when they are not available through the N.H.S. or when somebody has saved pennies to buy one. But dialysis work needs the Bill, because successful dialysis on renal failure must be complemented by a transplant programme alongside and connected with the dialysis department, so that the treatment which restores happiness for a limited number of years can be extended. The process of dialysis takes 10 hours three times a week and allows a person with renal failure to carry on for the rest of his life, but he could be saved all this time and trouble if the dialysis could be complemented by having a kidney available at the time when a transplant could be made, and thus save the need of further dialysis.
Although there are matters on which we differ, I believe that my right hon. Friend is the finest Minister of Health we have had for many years. He has certainly done more for the Health Service in the past three years than was done in the previous 10. But however much he does, we cannot really supplement the hospital facilities, and overcome the shortage of beds, by home dialysis. That is a great help, but if we can have an effective transplant system most of the problems of training a relative and making sure that there is comprehensive coverage can be avoided.
I had an experience of the magnificent way in which the units work only a few weeks ago. The renal failure had taken place of a young lady aged 21. The weather was very bad and her blood needed to be changed constantly. At a time when we faced the frustrations and hazards of political life and a number of problems were vexing us all it was very encouraging that within one hour 50 people could be obtained on the telephone to give a pint of blood. In the hours that followed 35 pints were given. That was the measure of the way in which a renal unit, a dialysis unit, can extend itself to save life. If living people are prepared to give of themselves in 823 that way the least one can do is to be prepared, when one's body is of no further value to oneself, to give the kidneys from it to save life.
Unfortunately, after the night I gave my pint of blood, as one of the 35 who were able to do so, we were disappointed to learn on telephoning the next day that we had not been successful in saving the girl's life. But when I was having my cup of tea after giving the blood the touch on my shoulder by the father, who just said, "It is my daughter. Thank you", is the kind of sentiment that would make all of us think that if it is possible to save a human life by giving a pint of blood, 99 people out of of 100 would be only too pleased to know that they could save a life by the gift of their kidneys within five minutes of dying.
Therefore, I hope that the House will at least give the Bill a Second Reading. Owing to the Human Tissue Act, 1961, assent must be obtained before organs are taken. I have checked with three teaching hospitals in the London area and have found that the number of people who refuse is infinitesimal, and that is in the very trying and difficult circumstances when the relatives must be asked immediately on the point of death whether or not this can be done. Few people deny the chance to give kidneys in order to save a life, and obviously the Bill would receive widespread public support throughout the country. I hope that it will not be killed this afternoon. Let it have its chance, let it go to Committee and have all the advantages of the results of the Minister's conference. If it cannot make the grade and it is necessary to have a better and more comprehensive Bill, it might be possible to introduce one at a later stage. But I ask the House to accede to the hon. Gentleman's request and give the Bill its Second Reading now.
§ 2.43 p.m.
§ Mr. David Lane (Cambridge)
I congratulate my hon. Friend for Worcestershire, South (Sir G. Nabarro) on bringing the Bill before the House today and on what he has done, particularly in recent weeks, to inform and educate public opinion about what is at stake. I am pleased to give the Bill my support, because I believe that it is a modest but very useful humanitarian Measure.
824 I pay tribute to the work of doctors and surgeons in recent years in this field. The Human Tissue Act, 1961, has already been quoted, and the mere fact that in our view this Bill is necessary is witness to the extraordinary speed of advance in this field of medicine and surgery in the past seven years.
The Bill has in no way been accelerated by the recent heart transplant work and publicity about it. This problem has been obvious for many years in kidney surgery, and I acknowledge the work done by my predecessor, the former Member for Cambridge, Mr. Robert Davies, who was very aware of the problem and was already taking action soon after he came to the House in 1966 to put the facts before the Minister of Health.
I should like to quote the experience in my constituency as one practical example of the work that is going on and the problem faced by those concerned in it. We have a team of doctors and surgeons working on the frontier of medical and surgical science and practice, led by Professor Roy Calne, and we have the transplant surgery unit and dialysis unit working together. At present the team is carrying out about 30 successful operations a year, and over 50 per cent. of the transplants it has done so far have been successful in restoring the patient to normal life. But there is great scope for increasing the work in the Cambridge hospital, and that is the point of the Bill. In the past year in the Cambridge area alone about 20 young people died of kidney disease who might have been alive today if the law had been different.
We can make better use of the existing hospital facilities through this modest change in the law. It is essential that the kidney be removed within 60 minutes of death. The incision is very small, and the surgical team is always ready to go into action to make the transplant operation within a very few hours of notification of death and obtaining permission from the next-of-kin for the kidney to be removed. But under the existing law, which is unduly restrictive, we come up against a problem described by Professor Calne as follows:The great difficulty is"—and this must be stressed—that the kidney must be removed within an hour of death, otherwise it is of no use and 825 sometimes it is impossible to contact the relatives in this period or even if the relatives are contacted they are so distressed that to attempt a discussion on the removal of the kidneys would be an unwarranted additional burden.That very practical experience bears out what my hon. Friend said, and it is that difficulty which our Bill tries to overcome. I have quoted the experience of Cambridge, but there are many other places in the country known to hon. Members where the same work is going on. I do not say that the problems are necessarily so great in all cases, but it is a general rational problem.
I want to stress one or two points about the Bill. First, it is deliberately confined to kidneys. We are not raising the much wider and more difficult problem of heart transplants. If it is passed, the Bill will give considerably more scope to the doctors and surgeons involved. The medical profession is predominantly in favour of a change in the law. Under the Bill, it will no longer be necessary to put the next-of-kin through the embarrassment and additional grief caused by the present law. The change we suggest is absolutely in line with an important conference dealing with medical ethics which took place about two years ago. Organised by the firm of C.I.B.A., it was attended by doctors, lawyers and churchmen. There was general agreement at the conference in the following terms:In any designated hospital it should be lawful to remove from a dead person any organ required for medical or scientific purpose, unless the hospital authorities had reason to believe that the deceased in his lifetime had forbidden this to be done, provided that such removal should not disfigure the dead body.We know there are serious objections on the part of some people, and some hon. Members of the House. We heard the hon. Member for Liverpool, West Derby (Mr. Ogden) at the time my hon. Friend introduced his Bill, but it does seem to me that, as my hon. Friend has said, in a civilisation where cremation is becoming more and more general, where post-mortems are constantly done, disfigurement of the body by this operation is minimal. Of course, we absolutely respect the views of those who object, even if we do not agree with them, and who do not want their bodies maimed or disfigured in any way after death. So I stress the safeguards we are anxious should be contained in any new law or procedure in this field.
826 My hon. Friend has quoted clause 2 of the Bill, and mentioned cards which the A.A. has suggested motorists might carry—as it were, for contracting in. There are two other methods which I would mention for those who wish to contract out. They could carry, as many did in the war, a little bracelet saying they do not wish their bodies to be used for this purpose; and, looking a little further ahead, it might be possible to register the objections of individuals in some central computer, to which any hospital to which dead bodies are brought in could have immediate access. But I would suggest that objectors, whom we absolutely respect, would be amply safeguarded by the provisions of this Bill.
As for public opinion, there was a recent survey which showed that a clear majority, some two-thirds, would be in favour of this kind of change in the law, and this was borne out in the correspondence which my hon. Friend mentioned.
As for the Government, I too, should like to welcome the fact that the Minister has himself come here today. I hope he will smile kindly on the Bill. I am encouraged to think so because of the obvious interest he has been taking in recent months in this subject. Last December he appointed the Renal Transplantation Advisory Committee. My hon. Friend has already referred to the conference early last month whose conclusions were put to us the other day by the right hon. Gentleman in a Written Answer, and I should like to quote more of those conclusions in addition to those quoted by my hon. Friend. The first is this. The conference agreed thatno attempt should be made to lay down a legal definition of death or rules which doctors should observe in reaching what must be a clinical decision; but that to allay disquiet vital organs should not be removed until spontaneous vital functions had ceased and two doctors, each independent of the transplantation team and one of them being at least five years qualified, had certified that this condition was irreversible.I suggest that Clause 3 of the Bill is entirely in line with the spirit of that conclusion. Summing up, the conference said that itaccepted that Section 1(2) of the Human Tissue Act restricts the availability of donor organs to an extent which prevents the treatment of patients who will otherwise die. But the conference recognised that there are people, including the members of certain religious groups, who would object to the removal of 827 organs from their own bodies after death or from those of their close relatives. The conference did not reach firm conclusions on the safeguards which would be required for these people, and wished to meet again to consider them.I am pleased that in presenting the conclusions of the conference to the House the Minister appeared to have an open mind on this, saying he would await the outcome of the further meeting before deciding on the need for legislation and the form which it might take.
I believe, as the hon. Gentleman the Member for Willesden, West (Mr. Pavitt) has just said, that the right course for the House, if I may presume as a very new Member to suggest this, is to give the Bill a Second Reading, and points of doubt which are genuinely worrying people can be put right, if they need putting right, in Committee; but we are today looking at this Bill in principle, and I would have thought that any Measure designed to save human lives should commend itself in principle to this House.
§ 2.55 p.m.
§ Mr. Eric Ogden (Liverpool, West Derby)
I want to make it quite clear that I support the intention of the supporters of the Bill although I am almost wholly opposed to the methods which they propose to meet those intentions. This is the fundamental difference which I think it will be very difficult to meet.
I must say I found it rather strange that the hon. Member for Worcestershire, South (Sir G. Nabarro), the champion of individual freedom, the hon. Member who, on the Industrial Expansion Bill only a few days ago, objected to it because it was—what did he say about it?—a "proliferation of nationalisation" Bill, now brings forward a Bill to make available by the State, for the purposes to be decided by the State, the bodies of those who are dead. That is what the Bill does. I think a better title for it might be "The Nabarro (Nationalisation of the Dead) Bill".
I am told that it has enlisted the support of the medical profession. Whilst I have a very high regard for the medical profession, I think there are points of view on one side and the other about whether legislation should be entirely tailored to what the profession's proposals may be, and that the proposals should receive and be considered with a 828 certain amount of care. I am told that it has the support of my right hon. Friend the Minister of Health. I agree with the tributes which were paid to my right hon. Friend by my hon. Friend the Member for Willesden, West (Mr. Pavitt) a few moments ago. But I must say that this is a rather unholy partnership, a Burke and Hare Mark II "grave robbers" business, and not one I particularly support.
The hon. Member for Worcestershire, South referred to my objections when he introduced the Bill, and he said my objections were shortly voiced. He said they could not have been any other. If he looks at the record he will see that I took only three minutes to voice my objections, where I could have taken 10, but I think that at least the point was made, and I shall try to be as brief now as I was on that occasion.
The objection, as I said before, is not to the intention but to the method. The hon. Member for Worcestershire, South said that he wanted people to object in life, and that the objection should not have to be found only after death. I want people in life to decide consciously and positively what they want to do. He wants people to say, "You shall not take." I want them to say, "I propose to give". This is the difference, which I do not think we should be able to reconcile in this Chamber or outside.
I accept that the hon. Gentleman has, as I have, a high respect for the living and a high respect for the dead as well, but it is the duty of human beings to decide in good faith and in sound mind how his bodily remains should be disposed of after death, and to do it by a deliberate act and by design and not by default.
I have no objection to the operation. That does not distress me at all, certainly if the purpose is to save life. I was concerned when the hon. Gentleman said he would support any action if it meant the saving of human life. I think this is the way they began in Germany in the 1930s with some of the experiments which began there at that time.
My main, principal objection is that I want people to contract in and not contract out, as we have provided for with people who come forward to give blood transfusions. I am certainly glad that on this subject we do not have to be paid for our blood as people do in some other countries.
829 I have to recognise that the Bill was introduced by leave of the House by a majority of 155 to 40. I accept that majorities have their rights, but minorities also have rights. It would, perhaps, be a little difficult of me at this time to try to talk out the Bill. If I had waited a little longer, that might have been easier, but I do not think that was the purpose for which I was sent to this place. A decision will have to be made it some time, and objections should be dealt with as they come along.
I accept that the Bill is likely to receive approval either now or later because the Minister and the House seem to want it.
As to safeguards, about which so much has been said, the hon. Member for Worcestershire, South said:I reiterate that there would be adequate safeguards in the Bill proposed, for any religious or ethical objectors."—[OFFICIAL. REPORT, 13th March, 1968 Vol. 760, c. 1380.]I have waited for the publication of the Bill and I cannot see in the four Clauses of the Bill any provision for those safeguards.
§ Sir G. Nabarro
May I explain the point? The Ministerial conference has now decided in principle that we should proceed exactly in accordance with the terms of the Bill, except only on the matter of safeguards. The Bill was printed after the Ministerial conference list met. I hope the safeguards will be pronounced by the conference before the Bill is taken in Committee so that an extra Clause can be added to enshrine those safeguards.
§ Mr. Ogden
I accept to a large degree what the hon. Gentleman says, but I am not being asked to support or reject a Bill which may or may not have something added later. I am asked to support a Bill of four Clauses which is before the House now. As one who his some regard for Parliament, I must say that decisions are taken by this House and not by outside bodies. The safeguards to which the hon. Gentleman his referred are not in the Bill at the present time, but I accept that the intention is that some safeguards will be written Into the Bill later.
The type of safeguard is a difficult matter. Reference has been made to a card and a bracelet. Are we to go back to the days of carrying bracelets and 830 a tattoo mark on the back? What kind of 1980 science fiction is this. Reference was made to a central computer agency. Even with such a safeguard we would have to rely entirely on individual doctors making the inquiries.
Are those in criminal institutions to be automatically excluded? Are the insane to be automatically excluded? Are the mentally handicapped to be automatically excluded? Are the very young, who can neither make nor break contracts on their own behalf, to be automatically excluded? Are the very old, in geriatric wards, to be automatically excluded? There is a fear that there will be pressure in institutions, on those who have no protection for themselves. Will they not think something terrible might happen to them if they refused consent. Can we say it will be easier when dear Mrs. Jones has to go into hospital, and matron welcomes her and says, "We know you are rather ill, love, we are going to look after you, you need not worry. But in case things go wrong, can we have your kidneys?" How is the machinery to be worked out? In the same way as the hon. Member for Worcestershire, South, I also have had a great deal of correspondence, most of it supporting the point of view I put on the introduction of the Bill. It is fair, reasonable correspondence, not from the frenetic fringe, not from the lunatic fringe, but difficult to meet. There is in my city of Liverpool a Regional Urological Centre, and I have received a letter from a distinguished surgeon at this centre, which says in part:As the physician charged with the responsibility of initiating a transplantation programme, I am naturally responsible for such cases occurring in your constituency of West Derby. Perhaps you could arrange to be with me when I next have to tell some parent that I can do nothing for their child, or some young husband that I can do nothing for his dying wife. You will then share the grief and anguish of such an interview, and will, I think, come to realise which would be the lesser of the two evils.That phrase,the lesser of the two evilsmay be the key. I have since had correspondence with the physician. I hope to visit the centre during the Easter Recess so that I can learn more of the process. The reply of the physician to the letter I sent him contained this paragraph:Incidentally, you may be interested to know that I am also a little concerned about 831 paragraph (2) of the Bill and have written to Sir Gerald Nabarro suggesting some safeguards.The argument now is on, what kind of safeguards we can write into the Bill.
To state again the fundamental objection, I want people to contract in, whereas the hon. Member for Worcestershire, South wants them to contract out.
In spite of the propaganda campaign that may be building up for the extension of the proposed powers to other organs of the human body, I restrict my remarks to kidney transplantation. The passing of this Bill may diminish some of the respect that we have for the living and for the dead. The time may come when we begin to regard our bodies—these things of wonder and mystery—as collections of spare parts to be at someone else's disposal. I have already made provision for my own body. Parts of it may be useful to some hon. Member on this side of the House, but I have taken care to stipulate that they are not used for right hon. and hon. Members opposite.
Clearly this Bill will now go to a Standing Committee. If we cannot get the maximum number of safeguards into the Measure with the maximum publicity for them, I reserve the right to oppose it much more strongly than I have done so far when it comes back on to the Floor of the House.
§ 3.5 p.m.
§ The Minister of Health (Mr. Kenneth Robinson)
I recognise that the hon. Member for Worcestershire, South (Sir G. Nabarro) has introduced this Bill with the aim of assisting the saving of more lives by facilitating renal transplantation. I applaud his motives with sincerity, and I congratulate him on his speech.
Renal transplantation is still being developed, but I agree that recent experience now shows considerable promise that the results may reach a high level of success. I am very glad that my hon Friend the Member for Willesden, West (Mr. Pavitt) mentioned the complementary treatment of chronic renal failure by intermittent dialysis, and I am grateful to him for putting the position into better perspective than when reference is made to it in the Press. This country has a very good record in intermittent dialysis, and it is well that it should be known 832 and said from time to time. I thank my hon. Friend for saying so.
As the hon. Member for Cambridge (Mr. Lane) said, the Health Ministers have set up an Advisory Committee on the development of renal transplantation, as was announced to the House on 14th December last. It was not the intention that this Committee should, nor has it been asked to, extend its deliberations to possible amendments of the law.
I accept that the supply of kidneys for transplantation presents a real problem to the doctors concerned. Whilst living donors can be used. it is obviously preferable that the kidneys required should be taken from the dead. This is technically possible, provided that it is done very soon after death and that the kidney is itself suitable. The victims of road accidents are among the most suitable as potential donors, but equally the suddenness of death in such cases, often of young people, has the maximum emotional effect on the family and relatives.
The Human Tissue Act, 1961, went as far as was thought to be reasonable at that time to strike a balance between facilitating the possible use of organs to save another life and the feelings and religious beliefs of the dead person's family. I think no one would deny that these have their place and that changes which may be desirable to keep pace with advances in medical science and practice will not be generally acceptable unless such feelings are treated with due respect.
Thus we have, on the one hand, the claims put forward by many in the medical world that more lives could be usefully prolonged if it were easier to obtain organs for transplantation. They claim that many opportunities are at present lost to them, not because of objection by the donor or his relatives, which they would regard as decisive, of course, but because the time taken to carry out the procedure of obtaining consent under the 1961 provisions may render the kidney or other organ useless for transplantation. However, as most hon. Members have recognised, there is the clear need for safeguards to prevent unnecessary affront to the real and sincere feelings of those people who have objections to the removal of organs from the bodies of the dead.
833 I agree with those hon. Members who have said that we can be grateful to the Automobile Association for encouraging motorists to fill in and carry with them a card recording their willingness for their organs to be used in the event of death. Such action reduces the problems of consent very considerably, and I hope that today's debate will encourage even greater acceptance of the idea that another's life can be usefully prolonged by the transplantation of organs from a person whose life could not be saved.
It was with the idea of bringing representative opinion to a focus that I convened a private conference to discuss the whole subject, as was announced in answer to a Question on 13th February. I was able to publish in the OFFICIAL REPORT of 25th March an account of the conclusions of the conference at its first meeting. Here I made it clear that the conference wished to meet again to consider the safeguards which will be needed in any Amendment to the Human Tissue Act for people who would object to the removal of organs after death from their own bodies or from those of their close relatives.
Perhaps I should make clear at this point one matter on which I think the hon. Member for Worcestershire, South, may have inadvertently misled the House. In reading an extract from my Answer about this conference, he quoted the sentence:They would like the Human Tissue Act to be amended to dispense with the need for inquiries of the relatives…".—[OFFICIAL REPORT, 25th March, 1967; Vol. 761, c. 216–7.]"They" in this case are the practitioners engaged in kidney transplantation, not the conference as a whole. The conference expressed a view in slightly less unequivocal terms.
It will be about two months before this conference can be reconvened. I regret this, but for various good reasons it is impossible to make it earlier. As I have already said, I must await the views of the conference before I can decide on the precise form new legislation should take, in the event of the conference advising, as I believe is likely, that some change in the present law is desirable.
834 Turning now to the Bill before the House, I very much appreciate the motives of the hon. Member in bringing it forward, and his readiness to cooperate with the Government. I am content, therefore, to leave it to the House to decide whether to accord this Bill a Second Reading today, on the understanding that in about two months' time or so, when we have the report following the resumed meeting of the conference, we shall then recommend, after consulting the hon. Member, what action would be appropriate at later stages of this Bill, should it receive a Second Reading today.
§ Question put and agreed to.
§ Bill accordingly read a Second time.
§ Bill committed to a Standing Committee pursuant to Standing Order No. 40 (Committal of Bills).