§ Order for Second Reading read.
§ 1.2 pm
§ Mr. John Marshall (Hendon, South)
I beg to move, That the Bill be now read a Second time.
When one introduces a private Member's Bill, the first question one is always asked is, "Whose Bill is it? Is it the Department's?" Oh, that it were. Then one is asked whether it is from an outside organisation. This Bill is not. In fact, it is a carbon copy of a Bill introduced in another place by the late Lord Finsberg. It is identical, down to the last comma, to the Bill that he succeeded in getting through all its stages in another place some two years ago.
The late Lord Finsberg was not only a colleague in the House but a near neighbour in that his constituency of Hampstead and Highgate was contiguous with mine. He had a good reputation and record of service to his constituents. He was one of the few men in British politics who saw service at the local level when he was the distinguished leader of Camden council, on the national stage in the House of Commons and on the European scene through his membership of the Council of Europe. The Bill is part of his legacy, and I am pleased to try to progress it this afternoon. When Geoffrey Finsberg died, it was said of him that his motto had been "Service to others before himself. Service to others is the philosophy of those who donate organs so that others may have a better life and a longer life.
Some of us are of an age that enables us to remember the reaction when Christiaan Barnard undertook the first heart transplant operations. The initial operations were medically successful in one sense, but the patients lived only a few days because they tended to reject the new heart. Heart transplants were initially a major step for medical science, but they did little to prolong the life of individual patients. Each one was newsworthy and we received daily bulletins on how the patient was doing, but what was newsworthy then is commonplace today.
Recently, I took part in a telephone appeal for the Jewish National Fund, which every year has a "Green Sunday" appeal, normally in January. I asked a certain individual whether he would be willing to make a donation and he replied that he had received a new heart nine years ago and that all the charitable fundraising and giving that he now did was for Papworth hospital where he had received his new heart, rather than for any other charity. Heart transplants today prolong life and transform the quality of life of those who receive them.
Some years ago, I received an invitation to join in the Kidney Foundation's London bridges walk and, as I had suffered from nephritis at a relatively young age, I agreed to take part. During that and subsequent walks, I have met many people who are awaiting transplants and many who have received them. On one occasion, I met a young boy whose mother had given him one of her kidneys, so she can now say that she has given her son the gift of life twice over—first when he was born and then when he subsequently received her kidney. He was a bright, cheerful active lad who was benefiting from his kidney transplant. On those walks and at photo calls—like some hon. Members, I am modest and reluctant to take part in photo calls, but I can occasionally be persuaded to do 1296 so—I have met people who are awaiting kidney transplants. The difference between the children who have had a transplant and those who are still waiting for one is amazing.
We all have friends and colleagues who have received a kidney transplant and we all remember the contribution of the late Michael McNair-Wilson to the House after having received a kidney transplant. He remained to the end an active Back Bencher. I shall always remember a visit that he and I paid to our right hon. Friend the Prime Minister in February 1992 to discuss the case for compensating those who had been infected with HIV on the national health service. The Prime Minister had previously agreed to compensate haemophiliacs who had been infected with HIV but, at that time, a small group of people who were not haemophiliacs were not going to receive compensation. Michael McNair-Wilson said to the Prime Minister, "The reason I'm putting this forward is that I might have been one of those people, because I was receiving blood transfusions and might have received infected blood." Those words persuaded the Prime Minister and, 10 days later, he announced a change of policy.
What happened to Michael McNair-Wilson has happened to many other people—a new kidney has immeasurably improved the quality of their life and has prolonged their life. Some years ago, there was a threat to the renal unit at the Royal Free hospital and I met several of the kidney patients there who were protesting and trying to safeguard their unit, which they did. Many of them had received a kidney transplant over 10 years ago. Before they had received the transplant, the quality of their life had been very low and the length of their life had been uncertain but, after the transplant, their whole life was transformed. They were no longer subject to dialysis—and the Treasury would say that dialysis was very expensive. However, this debate should be about not money, but principle. It should be about improving patients' quality of life.
Towards the end of his life, Winston Churchill was once asked how he was, and he said that he was all right, considering the alternative. The alternatives for a person on dialysis are either that he does not have dialysis and dies, or that he receives a transplant and lives a longer, better life.
Despite the tremendous benefits to individuals of kidney transplants, there is a huge shortage of donors of organs. We know that, at present, more than 5,000 people are waiting for a kidney transplant and we know that some of them will the before they have that opportunity. We also know that there are people waiting for dialysis and they are doing so because, until some people receive a transplant, they will continue to clog up the dialysis system. Some people are waiting for a kidney and may not get it and may die, and others are waiting to go on to dialysis because there are so many on it.
The situation is so grave that some people may have to receive a transplant from a living person. I mentioned the young boy who received a kidney from his mother. Recently, a husband received a kidney transplanted from his wife. They were fortunate to be compatible both in life and in their kidneys, because one of the problems with kidney transplants is the need to receive a compatible one. Those sacrifices are a sign of true love, but they are not recommended by doctors, who believe that it is unwise for a human being to be left with one kidney.
1297 Not only are there too few transplants, which has the corollary that many people must remain on dialysis for much longer, but as a result many people who would benefit from dialysis may not receive it. I have read a statistic—perhaps my hon. Friend the Minister can confirm whether it is still accurate—that we were 21st in the European dialysis league, ahead of Bulgaria but behind far too many countries.
On 16 and 17 November 1987, there was a conference of European Health Ministers, sponsored by the Council of Europe. Those who know me well will agree that I do not say that something is good simply because it is done in another European country. I do not say that something is good because it is done in the majority of European countries. However, considering what was said at that conference and the description that the conference gave of the law in other countries, I believe that we should re-examine the law in this country and change it.
I apologise for the fact that I shall describe the position in various countries alphabetically, but that is by far the easiest way. After all, I was not educated at a grammar school—but then, despite the new-found enthusiasm of the Labour party for grammar schools, many hon. Members were not educated in one either.
In Austria, it is regarded as acceptable to remove organs from corpses regardless of age, provided that the person has not expressed an objection during his or her life. The views of close relatives are not taken into account.
In Belgium, organs may be removed from Belgian citizens unless it is proved that they have expressed opposition during their life, but those who are not Belgian citizens must express consent.
In Denmark, it is acceptable under Danish law to remove organs from corpses provided that the deceased has not expressly objected to removal, and the views of close relatives will not be overriding. Thus, Denmark is one of the countries where one must opt out of organ donation, not opt in.
In France, it is acceptable to remove organs from corpses provided that the deceased has not expressed an objection to removal. People have to opt out rather than opt in; the views of relatives will be taken into account only if the deceased was a minor or incapacitated or if relatives can testify that the deceased expressed opposition to the removal of organs.
In Germany, consent has to be given before somebody dies for any organs to be removed; otherwise the consent of relatives has to be sought, but relatives cannot overrule the wishes of the deceased. It is a case of opting in rather than opting out.
You will be relieved to know, Madam Deputy Speaker, that in southern Ireland the rules are the same as in the United Kingdom. The wishes of relatives can overrule the wishes of the deceased.
In Italy, it is acceptable to remove organs on the basis of presumed consent when no express objection has been made by the individual during his or her life. Someone has to opt out of organ transplantation rather than opt in. The views of relatives will not be overriding.
In tiny Luxembourg, it is acceptable to remove organs provided the person did not object in writing during his or her life. The College of Physicians in Luxembourg has recommended that the views of relatives should be overriding.
1298 In Holland, organs may be removed provided that the deceased has given express consent or, in the absence of a donor card, the relatives of the deceased have given consent. In principle, the wishes of the deceased are paramount, but in practice the relatives have a right of veto, although the Dutch are seeking to change the law and may do so in the near future.
In Norway, which is outside the European Union, organs can be removed provided that the deceased has not expressed opposition. It is a case of opting out rather than opting in, and relatives cannot overrule.
In Portugal, removal cannot be performed if the deceased had objected during his or her life. People opt out rather than opt in.
In Spain, organs can be removed in the absence of an express objection during a person's lifetime, although the views of close relatives can override the views of the deceased.
In Sweden, organs can be removed if the deceased has given written consent.
In Switzerland, it is acceptable to remove organs provided the deceased had not expressed any objection. People have to opt out of organ transfer rather than opt in.
In Turkey, organs can be removed if the deceased has given consent. The views of relatives cannot override those of the deceased.
Most countries have a process of opting out of organ transplantation, not opting in. In almost all countries, the views of the deceased override the views of relatives. What people in this country find slightly surprising is that, when a person signs a card, it is often automatically assumed that his or her organs will be transplanted. We know that that is not so and that doctors will seek the views of relatives before they transplant the organs.
§ Mr. Piers Merchant (Beckenham)
Can my hon. Friend explain one point that puzzles me? Perhaps he can explain the point with regard to the practice in other countries, to which he referred extensively. What happens when the body of a deceased person is under the control of relatives, as may well happen, and those relatives object to transplantation or to the organs being removed? What are the authorities able to do? What do they do in practice? Do the police call at the house to take away the body? How do they pressurise grieving next-of-kin who do not want to release the body?
§ Mr. Marshall
If grieving next-of-kin said, "You cannot have the body. It is going straight to the crematorium", one would be unlikely to wish to intercept the body in the coffin and take it away. However, we must remember that a large number of people die not at home but in hospital.
One of the problems with our present system is that, in the United Kingdom, the relatives of 50 per cent. of those who die in intensive care beds and who have requested that their organs be used for transplants, refuse to allow organs to be removed. That is a high figure when we consider that, if we give someone else our heart, we give them a chance to live for years to come. When someone dies, we can give a kidney to two people because they get one each. So we can give two people the chance of life. We may give someone else our lungs. One Member of the House was given lungs by a donor. Corneas can also 1299 be donated. So we can benefit several people by donating our organs. The high proportion of relatives who refuse permission demonstrates the difficulties. I understand from the Department of Health that 25 per cent. of useable organs cannot be used because the relatives object. That seems a high figure.
Kidney dialysis is like a moving escalator. For every person who gets off it by receiving a new kidney, there are people at the bottom waiting to get on. Each time we have debated human transplants in recent years, the number of people waiting for a kidney transplant has been more than 5,000. The number of kidney transplants peaked in 1989, when there were 1,732. In 1995, the last year for which I have figures, there were 1,645. So more than 5,000 people have been waiting year by year. One of the reasons why so many people are waiting is the current law in the United Kingdom, which is different from that in many other European countries.
We are told that one of the reasons for not changing the law is that when doctors go to relatives and ask for the organs of the deceased, if the relatives say yes, the second question, in good taste, is whether the deceased was suffering from human immune deficiency virus, hepatitis C or Creutzfeldt-Jakob disease. I gather that CJD is difficult to detect even by doctors so I suspect that the average relative would not know whether the deceased had suffered from CJD. I suspect that many mothers do not know what their sons are up to and do not discuss over Sunday lunch whether their son has HIV. It is an issue which, perhaps for reasons of good taste, should not be discussed with relatives and one on which they may not give a good answer.
§ Mr. Bernard Jenkin (Colchester, North)
My hon. Friend said that the relatives of 50 per cent. of those who died in intensive care refused to allow organ transplant. Does that refusal come about as a result of the nature of the responses given to the secondary questions or do 50 per cent. give a flat no because it is not something that they wish to contemplate at that particular moment?
§ Mr. Marshall
It is much more the latter than the former, but we have to accept that our relatives do not always want to discuss that issue. They are traumatised by death. However, I believe that death would be less of a trauma to them if they were told that their relative had signed a card which was decisive and that, in dying, their relative was giving a chance of a much better and longer life to others.
We must accept that organ transplants have altered dramatically since the pioneering days of the 1960s. People have recognised that, in dying, they can give life to others. The gift of life is the greatest gift that one man can give to another. My Bill is designed to make that easier, and I hope that the House will give it a Second Reading this afternoon.
§ Mr. Nigel Forman (Carshalton and Wallington)
I congratulate my hon. Friend the Member for Hendon, South (Mr. Marshall) on raising an important subject, about which I am sure many of our constituents care deeply. Some of them will have been directly or indirectly 1300 involved in the decision-making that my hon. Friend described, which takes place at a time of great grief and difficulty for families. Others will have been involved in their role as medical professionals.
My hon. Friend treated the subject fairly and comprehensively. I congratulate him on that, and on taking up the torch, as it were, from one of our predecessors in the House, whom we all admired and respected. I am glad that my hon. Friend saw fit to do that.
I confess that I am deeply ambivalent about the Bill, which is one of the reasons why I am glad to have caught your eye, Madam Deputy Speaker. Like all hon. Members, I of course recognise the great contribution that transplant surgery, in all its wonderful forms, can make not only to people's quality of life, but to their very existence. I am well aware of the growing number of examples of people who would not be with us today, and would not be contributing to the community as they do, were it not for the miracles of transplant surgery.
I am equally aware that, as my hon. Friend said so fairly, transplant surgery depends on a reliable and regular flow of donated organs in an appropriate condition, so that they are not dangerous for the recipients, so that they are not rejected by the recipients' bodies and so that all the other medical criteria are satisfied.
I am, perhaps, slightly more aware of this than some might be because I have the good fortune to have the extremely successful St. Helier hospital in my constituency—you may well know it, Madam Deputy Speaker. My hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland) will know it well.
St. Helier hospital is well known for many facets of its work, but what is relevant to the Bill is the fact that we have a highly successful and respected regional unit for renal dialysis and transplantation at St. Helier. I know Dr. Eisinger, the director, very well, and I can speak with some authority in saying that the renal unit saves lives, improves the quality of lives and does invaluable work. That links up with my hon. Friend's argument because, clearly, without the techniques and raw materials, so to speak, the unit could not do all the wonderful things that it does.
I strongly support the donor card campaign to which my hon. Friend referred. I am perplexed, however, and I should be interested to hear from my hon. Friend or from the Minister why, legally and in practice, the possession of a donor card in one's wallet or handbag does not automatically conclude the issue. The Government, rightly, go to a great deal of trouble to promote the donor card as a sensible idea, especially in relation to people who have the tragic misfortune to die at a young age. The organs of such people are more desirable, if I may express it that way, because of their vigour and youthfulness.
Why, therefore, when people make the conscious decision to carry a donor card, can subsequent legal or practical difficulties arise after their death, when the relatives, in their grief and shock, often find that they cannot bring themselves to give approval, as my hon. Friend would wish, to the decision to remove organs?
My hon. Friend correctly devoted much of his speech to the onus of decision making. He asked whether the House favours the idea of opting in or opting out of the procedure, and whether it would be possible for relatives 1301 to play cards—if I may couch the argument in such terms—that are of a higher value than those held by the deceased when a decision is made.
Intuitively, I favour the opting-in argument, which I believe is more desirable ethically. In saying that, I am adopting a position that is likely—all things being equal—to reduce the number of available, suitable organs. We must face that consequence. However, I remain a little uneasy in this area. I believe that real value must be attached to the susceptibilities of the relatives of the deceased and to their grief and confusion. Such feelings are particularly strong when death occurs suddenly in hospital in a remote and rather impersonal environment. Perhaps we should take account of that aspect of the moral and ethical dilemma rather more than my hon. Friend suggested in his admirable speech.
I take a strong view on euthanasia: I am strongly and categorically opposed to it, whether it is voluntary, semi-voluntary or compulsory. Because I take that view, I am conscious—my hon. Friends may not share my misgivings—of a possible slippery slope regarding public attitudes. Provisions in law that override the misgivings and objections of families in tragic circumstances may lead—if we are not sensible in our law making in this and in subsequent Parliaments—to a situation where, for practical, technical and common sense reasons, it is deemed appropriate and utilitarian for people not only to plunder bodies for parts, but to take a rational decision, which I would regard as horrific, to end a person's life because that is what a cost-benefit analysis dictates. My hon. Friends may think that I am exaggerating the position and becoming a little hysterical. However, when considering ethical issues such as this, we must emphasise the likely long-term consequences of certain decisions which, in themselves, may seem perfectly correct.
I warmly welcome my hon. Friend's initiative. He has done the House a service in requiring hon. Members to re-think the matter. I sympathise with his argument, and I strongly support the tremendous efforts of the health professionals who are involved in this branch of medicine. I pay special tribute to the staff at the renal unit at St Helier hospital in my constituency. Having said that, I add two caveats: first, we should cling to the principle of opting in rather than opting out; and, secondly, it should be possible in the minority of cases—which is what it will become in the fullness of time—for the nearest and dearest to veto or trump the decision of the deceased. If we pursue our campaign of dramatising and publicising the great value of organ donation to society, it is clear that the practice will occur more often. That can only benefit the recipients. I congratulate my hon. Friend on the legislation, but I hope that he and the Minister will take account of those two important reservations.
§ Mr. Robert G. Hughes (Harrow, West)
I congratulate my hon. Friend the Member for Hendon, South (Mr. Marshall) on introducing an important Bill. As my hon. Friend the Member for Carshalton and Wallington (Mr. Forman) said so eloquently, the Bill turns on an extremely tricky area. However, my hon. Friend the Member for Hendon, South produced some very good arguments in advocating why we should go down the road that is set out in the Bill. I congratulate him warmly on that. I am sure that many people throughout the country will have a great deal of sympathy with everything that he said.
1302 I echo what my hon. Friend the Member for Hendon, South said about the late Lord Finsberg, who initiated the Bill. The fact that it is a measure started by Geoffrey Finsberg is almost a reason in itself why we should support it. It would be a tremendous tribute to him. He had a long and distinguished career in politics, in local government, in the House and in another place. His tragic death has left a hole in all our lives. All of us in the Conservative party in London feel his loss enormously and remember what he did in rebuilding the fighting machine that the London Conservative party became in the 1970s. I pay a warm tribute to my late hon. Friend for all that he did, including initiating the Bill.
It is almost impossible to speak on the issues raised by the Bill without making an on-the-one-hand, on-the-other speech. We could, of course, go along automatically with what my hon. Friend the Member for Hendon, South said in introducing the Bill, but it is not quite as simple as that.
There are 6,000 people waiting for organ transplants, of whom 5,000 are waiting for kidneys. We are told that there is no lack of money and that there is clinical expertise. I know that from what I have been told by hospitals in my constituency, and especially by the Clementine Churchill hospital, which carries out private operations. The problem lies with the shortage of organ donors. It is a worldwide problem and a worldwide business. One hesitates to call anything in such a sensitive medical area a business, but we must recognise that it is one.
The falling number of road accident deaths has meant that not so many kidneys are being made available. Advances in neurological practice have also had an impact. I understand that we were able to attract a great many foreign-sourced kidneys into the United Kingdom because we had a much better and quicker ability than other countries to match kidneys.
The allowable timetable has, of course, increased with better technology being available to keep transplanted kidneys. However, we were able to say that within the allowable timetable we would be able to ensure that a kidney that had come from another part of Europe, or more especially from the United States, would be made use of. We were able to say, "We can definitely make use of this kidney if you get it on to a particular flight." The United States would not have been able to match the kidney with a possible recipient. Technological advances and an increasing ability to datamatch in the United States have meant that we have lost out.
There is a shortage of organs and it is not surprising that that has prompted a number of people, including some doctors and my hon. Friend the Member for Hendon, South, to propose a change in the law with a view to retrieving more organs from deceased persons.
I ask my hon. Friend, however, to imagine a doctor in a hospital trying to take organs against the wishes of a distraught parent of a young person killed in a road accident, or against those of a pregnant woman whose husband has just been killed. It would be absolutely horrendous to put such a proposition to grieving relatives at that difficult time. In both those instances, the dying people would probably have expressed no wish about what should happen to their organs when or if they died because they would not even have thought that they might die. One can see that such a proposition would cause 1303 enormous damage, primarily to the dying person's family. The family would already be traumatised and would be further traumatised by that request.
I therefore wonder what would happen to the organ donor scheme. I understand that that is precisely what has damaged organ donor schemes in other European countries and we must take seriously the prospect that it could happen here. I do not seek to criticise doctors, but for understandable reasons, a doctor who believed that he could save a patient's sight, transform his way of life or even save his life might become over-anxious to get hold of a donated organ. Inevitably, the doctor would put more pressure on a dying person's family than would be suitable at such a difficult time. The doctor would not mean to do so, but doctors are only human and if they felt that an opportunity was available to them, they would try to take it.
As legislators, therefore, we must be extremely cautious in ensuring that that does not happen. Clause 1(3) is controversial as it removes the present provision for considering, in certain circumstances, the wishes of relatives. Clause 1(4) reinforces that provision by preventing anyone from prohibiting removal of any part of the body, except in specified circumstances. However, the Bill does not deal with the point that I made earlier: how an angry or grieving family could be prevented from prohibiting removal of an organ. That matter should be specifically addressed.
Before we allow ourselves to go down that route, we must deal with that matter because it would harm the cause of organ donation. Who would lay himself or his family open to such a provision if he believed that organ donation would become an automatic process, that control would be taken away from him, and that things that he did not want to happen would happen automatically in hospital in those circumstances?
It is a Government priority to maximise the supply of organs for transplantation and I am sure that relatives' refusal is a matter of concern which Ministers and the Department of Health are addressing. My noble Friend Lady Cumberlege, the Under-Secretary of State for Health, raised that point when the late Lord Finsberg presented the Bill in another place. A more fruitful course, however, would be to continue to promote organ donation through publicity and education, encouraging people to join the NHS organ donor register. We should also encourage them to discuss openly with their relatives their wishes and those of their family.
I hope that I am not robbing my hon. Friend the Minister of a point that he may wish to make later. He adds to my guilt that I do not have an organ donor card, as I see that he is studying his as he sits on the Front Bench. I notice that he has now quickly put it away, but it is a great credit to him that he has one and I must look into the matter for myself.
The Government have shown their commitment to increasing the supply of organs through a number of interesting initiatives in recent years. That has included television and other media publicity, organ consent boxes on driving licences, educating hospital staff about discussing donation with relatives and a reimbursement scheme for donating hospitals. All those are important and we have to get it as much as possible into the public consciousness that all those routes are open to people.
1304 The NHS organ donor register was launched in October 1994. I understand that already 4 million people have applied to join it. The register can be quickly accessed by transplant co-ordinators in hospitals and the families can then be consulted with sensitivity. The Department of Health continues to give considerable publicity to that register; we all should be pleased to note that, as the number on it increased, the number of refusals should therefore decrease. Currently, there are about 10 to 12 each week whose details were on the register—about half of the total number of donors—so it has had a significant impact.
In the Department of Health, as in any Government Department, such things are considered with a new perspective and perhaps with new thoughts. There may be new ways of doing it, but the fact that the total is about 10 to 12 each week is a tribute to the way in which the scheme was put together in the first place. I hope that we will be able to do even better. Therefore, rather than introduce a measure of compulsion, it is preferable that the Government should continue to promote organ donation through publicity and education and through encouraging people to join the register.
I should like comment on the study by the UK Transport Co-ordinators Association—[HON. MEMBERS: "Transplant."] The UK Transplant Co-ordinators Association. I beg hon. Members' pardon. What did I say? I am not going to suggest that I cannot walk and chew gum at the same time, but I cannot read a paragraph and talk at the same time. I was trying to say that the UK Transplant Co-ordinators Association and clinicians confirm that it is almost unknown for relatives to refuse consent if they know that the deceased has expressed a wish to be a donor.
That is the crux of the debate. If there were evidence that people were overturning the express wish of their deceased relative, we would have to think again, but there is no such evidence. Refusal nearly always occurs when the deceased has not left instructions that he or she wishes to donate. The study that I referred to by UKTCA and MORI shows that the commonest reasons for refusal are claims that the deceased has said that he or she did not wish to donate, and the inability of relatives to agree in the absence of instructions. Unless a future survey along the same lines proves that things have changed and that a barrier is going up against the deceased person's wishes, we have to go the way we are going.
The Bill has much to commend it. The thoughts behind it have much to commend them. Clearly, people who are desperate for a transplant operation want the Government to go much further, but our job as legislators is to say, "Hold on a minute. What is the balance of rights in this? What is the balance of rights and wrongs? What is the balance of people having control over their own lives and their future?" We have to say today that the balance has been struck about right and that, regrettably, the Bill goes just that bit too far.
I hope that, in responding to the Bill, the Government will introduce new measures that are along the lines that they have been advancing, and give us fresh thoughts about how to increase the number of organ donors and those saying that they wish to be an organ donor in the event of their death. In addition, I hope that the Government will not support the Bill's line, at least at the moment.
§ Mr. Hartley Booth (Finchley)
I commend this Bill, and I welcome the initiative of my hon. Friend the Member for Hendon, South (Mr. Marshall). The Bill is short—it is contained in one page. I wish that we had commendably short Bills such as this all the time, as it would make the work of the Chamber much easier. It harks back to the time when the Chamber frequently had short Bills. In 1876, Prime Minister Disraeli produced one of the most momentous pieces of legislation of the Victorian period, the Royal Titles Act. That, too, was only one page long.
This Bill deals with the sensitive area of death and what we do with the human body. My welcome for it is based on my knowledge that donors have saved lives with their kidneys, hearts, corneas, lungs, livers and skin grafts—although skin grafts often come from live donors. The way in which one neighbour helps another in this context is one of the most heartening parts of our so-called selfish society. I welcome the fact that people are coming forward honourably and generously to give their very own organs to save lives. I believe that to be heroic, and it is an adjunct to people giving blood to save lives.
It is right that a person who is giving a vital organ, or some other part of his body, expresses his own view about it. As a society, we have recognised for hundreds of years the right of an individual to decide on the disposal of his property after death. That has been true since this House passed the Wills Act 1837, which is still used as the determinant Act for the disposal of property. The same principle should apply to the human body. The Bill requiresa person lawfully in possession of the body of a deceased person to authorise the donation of the body or any specified part of the body for therapeutic or medical purposes if the deceased person had requested such a donation.That principle is at the heart of this Bill, and I am happy to support it.
As a lawyer who has acted in this area, I have experience of trying to recognise an individual's right to decide on what happens beyond death. I believe that one recognises a person's desires if that person at that point is of sound mind. I would like my hon. Friend the Minister, or my hon. Friend the Member for Hendon, South, to assure me that the form for the donor card will contain a requirement to assess whether the person who signs the card is of sound mind, so that we can honourably recognise his decision after his death. Perhaps that matter could come up in Committee. What will happen if, in future, medical science finds a way in which to perform human brain transplants? We may be many decades away from such transplants, but it is not ridiculous to suggest the possibility. In the 1920s, for example, it may have been thought ridiculous to suggest that we might transplant a human heart. I realise that, under our current understanding of the law and the Bill's provisions, we are not considering brain transplants—as the Bill deals with persons who are deceased, and of course the definition of "death" is based on brain death—but I believe that a parliamentary debate on the issue may be necessary in future, and that it will involve greater ethical issues. The thoughts on euthanasia expressed by my hon. Friend the Member for Carshalton and Wallington (Mr. Forman) are very pertinent to those ethical issues.
The main ethical issue today—I hope that my hon. Friend the Member for Hendon, South will assure the House that he had it in mind when tabling his Bill—is to 1306 ensure that, under the current system, it is never suggested to people who give their organs, "You would be better off dead, because someone else could use your organs." I say that bluntly, not because I think that such a suggestion is likely to be made but because it could be made. The House's job is to foresee possibilities, and I hope that, perhaps in Committee—with the addition of a few words or a small clause, although I do not resile from my praise of the Bill's brevity—we can ensure that such pressure is never put on people.
§ Mr. Booth
I am grateful for this opportunity to welcome the Bill, and I assure the House of my support for it, particularly because it deals with voluntary donations. I hope that the Bill's successful passage will send out a reminder to the public that to give a part of one's body can be life saving, that it is honourable and generous, and that it can be a human being's last act to help a neighbour. I hope that the Bill's passage and this debate will somehow increase such acts.
§ Mr. Kevin Hughes (Doncaster, North)
I congratulate the hon. Member for Hendon, South (Mr. Marshall) on promoting his Bill, which provides an opportunity to debate an important issue. The hon. Gentleman gave us a splendid tour of how organ donation operates around the world; I congratulate him also on his research. I doubt whether many people would argue with the proposition that there is a shortage of organ and tissue donors in Britain. The Bill is not the first attempt to address the issue of how to acquire more donors.
We should also remember that donors are needed in life as well as in death. We frequently hear calls, especially in the winter months, for more and new blood donors. Emergency appeals for bone marrow donors seem to be made more often these days, and we even hear appeals, occasionally, for living organ donors. However, the newly deceased provide the greatest potential supply of organs and human tissue. Kidneys, hearts, lungs and livers are needed for suffering patients; there is also a need for human tissue, such as corneas to restore sight. There is now an opportunity for deceased people to donate their skin for use as specialist dressings and grafting material for people suffering from very serious burns.
The Bill attempts to deal with the apparent and long-standing problem of a lack of donors. I say that it is an apparent problem because the United Kingdom Transplant Support Service Authority—the body responsible for overseeing these matters—does not collect figures annually or make estimates of the number of potential donors. Figures are certainly available for the number needing a donor. The Minister mentioned during an Adjournment debate last week that 6,000 people are awaiting organ transplants, around 5,000 of whom need kidney transplants.
Those figures seem to change little year on year. In March last year, for example, the Minister told the House in a written answer that 6,122 people were awaiting transplant surgery, 5,280 of whom needed kidney transplants. He also told us that 402 people had died in the previous year while on the waiting list. I have been affected by that—as has the House—because my good 1307 friend Jimmy Boyce, who was the Member of Parliament for Rotherham, died while waiting for a heart transplant. We all felt for Jimmy.
This is a continuing problem. Vigorous efforts should be made to encourage a greater supply of organs and human tissue. I hope that all hon. Members will join me in congratulating the NHS organ donor register on its efforts. Having 4 million people on the register is a good start, but I am sure that we can all make greater efforts.
In addition to the clear humanitarian reasons for increasing the supply of donors, there are sound economic reasons for transplantation. I understand from the National Kidney Federation that kidney dialysis costs around £10,000 per patient per year, but that supporting a post-operative kidney patient costs only £3,000 to £5,000—and the patient may have not only a more productive life after a transplant, but a better quality of life.
Modern medical advances and the great leaps forward that have been made in transplant technology and rejection suppression mean that the pool of people suitable for transplant grows continuously. It follows that the number of people whose quality of life could be bettered is also increasing.
The supply of organs for donation appears to have reached a plateau. Several solutions to that problem have been put forward. Elective ventilation—artificially maintaining the integrity of a dead patient's organs until consent can be obtained—is perhaps the most frequently considered. Another possibility is to require people to opt out of organ donation, rather than the current system of opting in through the national register and the donor card. I understand that that is favoured by the British Kidney Patients Association, among other interested groups.
Recently, it has been proposed that the organ supply problem can be solved by the breeding and use of transgenetic animals. There appears to be a broad consensus on the ethics of that approach, but there are still important public health and moral implications to be considered.
The Bill would impose an obligation on the person in charge of the deceased person's body to carry out the wishes of the deceased on organ donation. That is certainly a bold solution, but it is not without pitfalls. First, there is the problem of consent. The Human Tissue Act 1961 was clear that the possibility of a deceased person having withdrawn consent to organ donation was ground for refusing to allow donation.
The Bill would remove consideration of the possible withdrawal of consent. In theory, any consent document signed at any time by a deceased person could be viewed as an agreement to donate organs. There is a danger of people, mindful of the fact that they may later change their minds, choosing not to sign an organ or tissue donation consent form. It is therefore possible that the number of people volunteering to become organ donors will reduce. We certainly want to consider the matter further in Committee.
The Bill proposes to remove the veto from relatives and others who may have a connection with the deceased. It is often said that it is wrong to ask a spouse or other relative to sign a donor consent form at the time of a 1308 loved one's death. Strong emotions do not make for calm decisions. Perhaps there is some merit in amendment of the law, but I am sure that the House agrees that there are difficult legal questions about a deceased's remains. Those questions need to be addressed. Has the Minister taken advice about that? Will the Bill, should it become law, require consequential amendments to other statutes?
Finally, there is the issue of clinical opinion. I am told that, in the main, transplant specialists are opposed to any system of donation other than the current one. Has the Minister received that same view? If clinicians do not want to change the law, the Bill may be unworkable. However, if medical specialists are lobbying for a change in the law, the Minister should state what steps he and the Department of Health are taking to address clinicians' concerns.
The Bill raises important matters that I am sure the House will wish to consider further and in deeper detail. The hon. Member for Hendon, South has made a timely contribution to the debate on organ donation, and the Opposition hope to have the opportunity to study it further and in more detail in Committee.
§ 2.6 pm
§ Mr. Bernard Jenkin (Colchester, North)
We are debating an important subject and I join other hon. Members in congratulating my hon. Friend the Member for Hendon, South (Mr. Marshall) on presenting an opportunity to debate it. I join my hon. Friend in paying tribute to our late friend Lord Finsberg who so ably represented the constituency of Hampstead and Highgate for many years. I was born in Highgate and I know that he was a good and able Member of Parliament who gave the House, his constituency and his country distinguished service.
I have listened to the debate with interest and it is obvious that there is much concern about the lack of organs for transplant. Organs become available only in the most distressing circumstances. In every culture, in every society, and in every age, people are reluctant to discuss some issues. In Victorian England, people did not talk about sex, but they did talk about death and money. In modern Britain, death is the taboo subject. We need only to consider how we approach the friends or relatives of those who are faced with imminent death to know how sensitively we feel that we need to behave.
The problem with the matter that we are debating is that people think it is about death. The only time relatives are formally approached is when they are confronted by the death of a loved one. To approach the problem from the angle of a change in legislation—effectively to ride roughshod over the understanding and sensitivities of relatives—is to go about it in the wrong way. We need to change the terms of the discussion. We must explain to relatives, perhaps at a propitious moment, which would be before they are confronted by the death of a loved one, that the issue is not about death but about giving life—and a better life—to others.
I carry a kidney donor card, which is now called an organ donor card because I have ticked the box to show that everything is up for grabs in the event of my death, but I have never been asked to consult the next of kin who appear on my card about what I want; nor have my next of kin ever been asked to record their understanding of what they think should happen to my body in the event 1309 of my death. We need not an amendment of the law to turn over people's sensitivities, but a public campaign to change the instructions on the card that we carry to give someone a better life.
The organ donor register should, for example, contain not only the wishes of the donor, but the pre-death consent of the next of kin as to what will happen in the event of the donor's death. We need to change what happens so that obtaining the consent of the potential donor and his next of kin is not the end of the matter; in the event of the donor's death, the relatives must know what they will face.
The trouble with the present arrangement is that, although we have achieved a great deal in getting people to carry organ donor cards, we have not prepared the relatives for the shock of what will confront them. A dead person's relatives are often not in the correct psychological state to deal with the fact that someone has died, let alone to choose what happens to the body. That is precisely the kind of decision that they are incapable of making unless they can be persuaded that they have already made that decision.
I beg hon. Members to think about tackling the problem from the opposite direction. A change in the law is inappropriate; persuasion is the answer. There are examples of how we can change by invocation how people behave and what is regarded as acceptable. Twenty years ago, people thought nothing of getting into a car when they were over the limit, to drive home from the pub. That was part of the game that they played with the police. Such behaviour has become wholly unacceptable. How did we achieve that change? It was done without changing the law, the method of enforcement or the penalties—it was done by invocation.
We need a much better campaign of invocation and education—and perhaps a change in the system of recording the wishes of organ donors and their relatives. In that way, people will be ready to give the necessary consent at the appropriate time. It is therefore with regret and considerable anxiety, but some certainty, that I oppose the Bill.
§ Lady Olga Maitland (Sutton and Cheam)
I greatly appreciate the fact that my hon. Friend the Member for Hendon, South (Mr. Marshall) has introduced the Bill. I had long been an admirer of Lord Finsberg. In fact, I was part of his campaign team when he was first elected to Parliament, and I had remained in touch ever since. It is very moving that one of his last acts was to introduce the original Bill.
The crux of the matter is that about 6,000 people are now waiting for an organ. In 25 per cent. of cases, the families of potential organ donors resist the request that their relatives' organs should be made available to give life. That fact led me to discuss the issue with my husband because, years ago, I had signed an organ donor card, and so had he. What I had not realised is that, in the event of my death, my husband, even knowing that I had signed the card, could—in his distress or after having second thoughts—override my wishes. That card was simply a worthless piece of paper.
When I write my will, I know that my wishes will be carried out on my behalf in the event of my death by the trustees, who are obliged by law not to deviate one jot. 1310 How is it that a will in the form of a card, which I have filled in and which states my express wishes—I want my organs, whatever use they might be, to be made available to give life to another person—can be overridden, yet my final will and testament will be adhered to by the law? When one considers the matter in that way, it is logical and sensible that the wishes of a donor, when written down on a piece of paper in the form of an explicit request, should have the same power as any request that I might make in my will.
Therefore, I hope that the Bill will come to fruition. I fear that, today, we may not be successful because of lack of parliamentary time, and I regret that. The issue is of fundamental importance, because I believe that it is my human right to be able to ensure that my wishes are carried out.
Some interesting research has shown that, where a person has made an explicit request, on the whole and mercifully, the family rarely override that wish—but they can. A wider issue is that when someone who has not made an explicit request dies, the family has a right to say, "No, I do not wish this to go ahead", and that happens in about 25 per cent. of cases. We should examine their reasons for doing that and not be too harsh. They often say that, in the trauma of grief, they feel that giving the body up for a donation is somehow extra surgery. Even if it makes no logical sense to think that, because the person is dead, such considerations can have great emotional power over grieving relatives. Sometimes, relatives say, "My relative has suffered enough—don't do any more." We have to bear in mind that fog of emotion and the time has come to try to clarify what people can do and whose wishes should be respected.
I totally endorse the Government's endeavours to publicise the organ donor scheme. I have looked down the list of all their initiatives and can only say that, although we have had years when the Government have worked hard and pumped money into a big publicity campaign, that does not happen every year or with the same energy. Sometimes, people come across their cards haphazardly—for example, I had not realised until today that I should have signed the section of my driving licence that provides for organ donor consent. How many people in the Chamber have signed the consent on their driving licence so that there is no shadow of doubt that that is their wish? It is a brilliant idea and it should be built on and publicised because, nowadays, there is barely a person in the land who does not carry a driving licence.
The Bill is so important that I wish it the very best passage, and if it does not pass all its stages right now, I very much hope that it will be picked up on another day. It means so much to me to know that, in the event of my death, someone, somewhere will benefit. It would also help the relatives to know that the spirit of their loved one, in a sense, continues in service in another being, and has made a better life for them. It eases the pain, the sharpness of death, to know that good is coming out of a tragedy.
I very much hope that we shall carry on in our endeavours to ensure that all our wishes are adhered to and that other people may benefit.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Horam)
I join others in congratulating my hon. Friend the Member for Hendon, 1311 South (Mr. Marshall) on introducing the Bill. As we all know, he is a doughty campaigner on several health subjects—indeed, I would say relentless, considering the way in which he has pursued me concerning haemophiliacs. I noticed that he managed to get a well-contrived mention of the problems of haemophiliacs into his speech, which was otherwise about organ transplantation. His campaigning has been praiseworthy, although it is quite intimidating to be on the receiving end of some of his campaigns.
It is noteworthy that my hon. Friend the Member for Hendon, South has campaigned so much on health subjects when he is primarily an economist, and speaks also on economic matters. As a fellow economist, I am delighted by that, because it shows clearly that economists, who are often maligned, are also human beings. He will recall that one of the most famous of political economists, a Labour Member, was once called a desiccated calculating machine by another member of the Labour party. I do not wish to be disputatious about this, but it shows the low opinion in which economists are sometimes held. I am glad that my hon. Friend is striving manfully to present the other side of the coin.
My hon. Friend the Member for Hendon, South said, as have others, that the Bill is a replica of the Bill that was introduced by the late Lord Finsberg in 1995, which passed through the House of Lords but did not succeed in the House of Commons. Geoffrey Finsberg was my hon. Friend's neighbour in north London. There must be something about the air in north London that brings about—
§ Mr. Horam
Or perhaps it is the electorate in north London who bring about this admirable concern for selfless health matters, if I may put it like that.
My hon. Friend the Member for Hendon, South took us on a fascinating tour of Europe. Uncharacteristically for him, given his views on European Union matters, he brought into play the strength of the arrangements in other European countries and said that we were a long way down the list of European countries when it came to the provision of dialysis. That is a fair point.
On a happier note, more people are alive with transplanted kidneys in the United Kingdom than in any European country—15,000. As my hon. Friend would be the first to say to me, given the wonderful performance of successive Conservative Governments, we are now leaders in Europe on economic matters; we are also, clearly, leaders in Europe on transplantation matters, which is the subject of his Bill. I should like to put my hon. Friend's point about our relatively poor performance in renal dialysis in that perspective—we are excellent on transplantation.
I must correct my hon. Friend's point about the percentage of relatives who refuse to allow organs to be removed for donation from people who have died in intensive care. He mentioned the figure of 50 per cent., which was picked up by one of my Conservative colleagues. We have different evidence. In 1989–90, an independent study showed that 30 per cent. of families consulted refused permission; in 1993, a study showed 1312 that relatives refused permission in 26 per cent. of cases. I am not sure where my hon. Friend found the figure of 50 per cent.; it does not appear to coincide with the information that we have. Our information is not specifically related to intensive care units, but concerns all cases where permission has been refused by the relatives.
§ Mr. John Marshall
The information was contained in one of the speeches in the debate instigated by the late Lord Finsberg.
§ Mr. Horam
I shall check on that if I may. I am not saying that my hon. Friend is wrong about intensive care units, but there is contradictory evidence about what happens generally when permission has been refused. I shall look into the point raised by my hon. Friend.
My hon. Friend the Member for Carshalton and Wallington (Mr. Forman) gave a characteristically balanced and rational appraisal of the situation and asked a significant question. Why does not the possession of a donor card automatically close the issue? Why is the card not enough to show clearly the wishes of the deceased with no further argument? The possession of a signed donor card satisfies the requirements of the Human Tissue Act 1961, which my hon. Friend the Member for Hendon, South (Mr. Marshall) proposes to amend, and under which organs may be taken without anyone being consulted. That requirement is fulfilled under existing legislation. However, the Human Tissue Act also requires it to be established that the deceased had not changed his or her mind after signing the card; the only sensible way to check up on that is to consult the family. That is the first reason why relatives have to be consulted.
As my hon. Friend the Member for Harrow, West (Mr. Hughes) suggested, I was consulting my donor card. I was checking on the point raised by my hon. Friend the Member for Carshalton and Wallington. The donor card states at the bottom:Let your relatives know your wishes.In addition to carrying and signing the card, someone must let his relatives know his wishes. In that way, there can be no doubt that the wishes of the deceased remained as they were at the time of his signing the card and he has not resiled from them since.
My hon. Friend the Member for Finchley (Mr. Booth), who is no longer in the Chamber, mentioned that the donor should be of sound mind. We want to ensure that no one who signs a donor card is under a misapprehension about what it involves, as it is a significant thing to do.
My hon. Friend the Member for Harrow, West paid tribute to Lord Finsberg and raised an important point about the family. The relatives of the deceased will have memories and emotions of him or her. My hon. Friend made a telling point. One can imagine the situation where a young man has died in a car accident. His organs could be most usefully used in a transplant, but his relatives would be in shock; they would be particularly traumatised because he was young. It would be horrific if they made a decision and were then overruled so that organs were taken out of the young person against their wishes. If that happened, with all the tabloid publicity associated with such a gruesome incident, it would be a setback for voluntary organ donation, which we all support. We must address that problem. I am sure that my hon. Friend the Member for Hendon, South understands the problem and would not want to set back the cause of organ donation.
1313 My hon. Friend the Member for Harrow, West made the key point that, if a person has clearly said that he wishes his body to be used for organ transplantation after his death, permission is almost never refused by his relatives. In practice, under the current arrangements, the voluntary system works almost to maximum efficiency, which is crucial I am glad that my hon. Friend raised that point.
My hon. Friend the Member for Finchley made an interesting point about the shortness and simplicity of the Bill. I agree: if all Bills were as short as this one, the House would be extremely grateful. My hon. Friend spoke of the Royal Titles Act 1876. Disraeli had a thing about shortness and simplicity: his Cabinet consisted of only 12 members, one of whom was the Master of the Horse, Lord Cardigan. So Disraeli clearly had things worked out in a way that we have perhaps gone back on since then.
The hon. Member for Doncaster, North (Mr. Hughes) made a characteristically forthright speech. I congratulate him on his maiden speech from the Opposition Dispatch Box. As is traditional in these cases, I wish him a long sojourn on the Opposition Front Bench. I am sure that he will hone his skills to perfection in the long years ahead of him. As he was substituting for my usual opponent, the hon. Member for Rother Valley (Mr. Barron), there was no change in the friendly Yorkshire tones in which the problem was aired. The hon. Member for Doncaster, North mentioned Jimmy Boyce, the Member of Parliament for Rotherham until his sad death. He was my pair and I was personally in contact with him literally a few days before he died—
§ It being half-past Two o'clock, the debate stood adjourned.
§ Debate to be resumed on Friday 14 February.