CONSENT: noun: permission for something to happen or
agreement to do something.
It is the issue upon which the whole baby-organs scandal centred. Yet,
despite an official inquiry, there is still no agreement over how to formalise
the way doctors ask relatives for the right to investigate the dead.
Last month, Britain鈥檚 chief medical officer, Liam Donaldson, launched a
proposed code of practice for pathologists. It includes forms which oblige
doctors to seek informed consent for every stage following someone鈥檚 death.
鈥淕ood has come out of Alder Hey,鈥� says a spokeswoman for the Department of
Health. 鈥淚nformed consent is now at the centre, and the whole process is built
around the interest of patients and their relatives.鈥�
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Pathologists say they started making changes before Alder Hey, and have
consent forms for everything from the post-mortem, to examining a tissue slide
months later.
But patient groups are still intensely concerned about what they say is a
gaping loophole in the proposals. Though Dick van Velzen, the pathologist at the
centre of the Alder Hey scandal, was banned from practising in Britain, he was
never charged with a criminal offence. Anyone who violates the new code will
still not face criminal charges. 鈥淲e want some form of legislation, for it to be
an offence,鈥� says Ruth Webster of family support group NACOR. 鈥淲e wouldn鈥檛 be
happy with voluntary arrangements.鈥�
The pathologists however, would still prefer to regulate themselves. 鈥淪imply
saying something鈥檚 a criminal offence won鈥檛 be practical,鈥� says brain
pathologist Jim Lowe. He says that grief-stricken families may verbally agree to
an autopsy, but might not want to go through detailed forms which take more than
an hour to complete. And if things went wrong, who would be prosecuted? Would it
be the doctor or nurse attending to the relatives, or pathologists who remove or
receive tissues assuming forms are filled in?
Lowe says that the government鈥檚 proposed forms are similar to ones that the
Royal College of Pathologists introduced before Alder Hey. The forms ask
relatives for permission to do a post-mortem, and whether it should be limited
to the site of disease or injury. They also ask whether they can keep tissues,
for how long and what should be done with them after examination.
The Department of Health plans to canvas medical and public opinion by
publishing another consultation document which will specifically consider
whether the law should be changed on the removal, retention and use of human
organs and tissue. It will ask whether people think unethical practices should
be made a crime.
But whatever the process, it will ultimately depend on the professionalism of
doctors and bravery of relatives. And here, patients are challenging doctors on
the front line, rather than pathologists. 鈥淐linicians should take some of the
blame for not asking parents or relatives,鈥� says Jan Robinson of support group
PITYII. 鈥淭hey must have the courage to ask families for consent and take
responsibility. They can鈥檛 keep blaming Alder Hey for not doing what鈥檚 right.鈥�
