Headline Bioethics: Change to organ donation law in Wales?

January 9, 2013

[A printable version of this Headline Bioethics Commentary is available via this link]

OptOutMediumAuthor: Christopher Jones

Clip: Will Wales change organ donation law?

Date of story: 8th November 2011

Summary of story: The Welsh government’s has published a White Paper Proposals for Legislation on Organ and Tissue Donation: A Welsh Government White Paper in which they outline their intention to change the law regarding organ donation. In keeping with the rest of the UK, Wales current has an “opt-in” system, in which a person has to actively indicate (e.g. by signing organ donor register) that they give consent for their organs to be used by the NHS. Under the proposed system of presumed consent, all adults resident in Wales will automatically be placed upon the register; if anyone wishes to withdraw their consent they must actively remove themselves from the list. Many countries already operate this “opt-out” system; including, in Europe, such countries as France, Spain, Austria, Belgium, Norway and Sweden. In the news coverage, Glyn Davies MP state his opposition to the proposal, highlighting concerns about both the efficacy of the new system, and whether adequate consideration will be given to ethical aspects of the change.

Discussion of ethical issues: One ethical argument against presumed consent suggests that it violates the patient’s right to make an informed decision, and so does not uphold respect for their autonomy (Gillon, 1994). The specific purpose of informed consent is to protect a patient’s right to autonomy, as made clear by both the Universal Declaration on Bioethics and Human Rights (UNESCO, 2005) and the Declaration of Helsinki (World Medical Association, 2008). Enforcing presumed consent would remove the need for informed consent, and as such would be “a violation of an individual’s autonomy” (Kurosu, 2008).  Presumed consent, it is argued, forces patients either to become donors, or to state their wish to not become donors; in both instances the patient’s autonomy is violated, as  “compelling patients is unethical” (Kurosu, 2008). This deontological argument suggests a move to presume consent in Wales would be intrinsically unethical. Similarly, Kennedy et al. (1998) consider that a government body “assuming possession of our body parts” would be “a step too far”. Read the rest of this entry »

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Whose cells are they anyway?

December 24, 2010

Rebecca Skloot's book has received critical and popular acclaim in 2010

In hundreds of research labs around the world, including within my own Department, scientists carry out experiments using a human cell line known as “HeLa”. Most cells die after a defined period of time, but mutations within the HeLa cells have allowed them to continue dividing outside of these normal contraints, and as such they are said to be “immortal”. The original tissue sample from which HeLa cells are derived was taken from the cancerous cervix of an African-American woman Henrietta Lacks (the name of the cell line being an abbreviation of her name).

The Immortal Life of Henrietta Lacks, a captivating account of the human story behind these amazing cells, has recently won many plaudits, including the prestigious Wellcome Trust Book Prize.

Read the rest of this entry »


Fighting Talk (Doctors) – a duty to disclose?

July 24, 2008

(Warning: contains plot spoilers!) This is an old episode of the BBC’s daytime drama Doctors, centred on the Mill Health Centre, a fictional midlands clinic. The relevance is probably limited to clinical ethics training for medical students, but it’s great for that purpose so worthy of a quick note here.

In Fighting Talk (TRILT ID: 0059FD65, first broadcast on BBC1, 15th June 2006), Dr Greg Robinson is faced with a dilemma when local bully Darren Waters has beaten up geeky pupil Kevin Dobson on his way to school. What Darren doesn’t realise is that Kevin is HIV positive. When Darren presents at the clinic with a bleeding hand and then Kevin later comes in with cuts to his face, Dr Robinson realises there is a risk that the virus has been transferred from victim to bully. Does he have a duty to disclose the details to Darren and his family?

In truth, the episode is entirely focussed on this story, punctuated with snippets of longer term issues for those who work at the Mill Health Centre. One short section, however, conveys all that needs to be told as a case study for tutorial group discussion. In the section starting at 16:23 Dr Robinson visits Kevin and his mother trying to persuade them to let him tell Darren. Kevin’s HIV status is mentioned openly, it had only been hinted at in early clips. The scene runs onto 19:17, but is best stopped at 17:50 when Kevin’s mum puts her hand on his shoulder – the rest of the clip is window dressing.

For completeness, the clips in which the story unfolds are: 02:00-02:58 (the fight), 03:40-05:03 (mum patches Kevin up), 07:52-10:00 (bully goes to GP), 10:26-12:40 (Kevin goes to GP), 12:40-13:37 (Dr Robinson discusses what to do with colleague), 14:10-15:55 (Doctor visits Dobson family), 16:23-19:17 (HIV status discussed), 20:11-20:50 (Doctors discuss ethical duty), 20:50-21:10 (Kevin visits clinic to give consent), 21:37-23:38 (Dr Robinson tries to get Kevin’s mum to agree), 24:22-26:12 (Kevin persuades his mum).