Printed from: https://archive.cmf.org.uk/advocacy/submissions/?id=50
Published: 25th February 2008
Christian Medical Fellowship is a UK membership organisation comprising some 5,000 doctors in all branches of the profession and 1,000 medical students who wish their personal and professional lives to be governed by the Christian faith as revealed in the Bible. We are non-denominational.
This Submission is made on their behalf, based on a broad consensus arrived at after discussions of our Medical Study Group, and we trust reflects the broad views of our membership. However, we do not claim to speak on behalf of any particular Christian church, denomination, or other grouping.
The Lords inquiry has already received a general submission, and we respond here as requested to four supplementary questions.
Q1. Please would you describe any particular aspects of organ donation and transplantation which are considered ethically problematic within the context of your organisation's religious beliefs – as these are perceived: (a) within the UK; or (b) in other EU Member States?
a. We have already expressed strong support in principle for the concept of organ donation and transplantation, as an altruistic free gift in the context of fully informed consent, and have no fundamental ethical concerns with donation per se.
Some members are concerned about lack of transparency in the information provided to potential donors and their families about the issue of the timing of cessation of ventilation. Organs to be retrieved are in the best condition if well perfused with well oxygenated blood, so the practice is to leave the donor on the ventilator until all the organs to be retrieved have been removed, and then turn off the ventilator. Those with concerns here have reservations about the concept of brain stem death and would argue that it is the act of removal of organs which ends the donor's life. They believe the ventilator should be turned off and removal of organs should not take place until classic criteria of death have been fulfilled – the donor stops any natural breathing and the heart stops.
Most members, fully aware of the situation about ventilation, accept the concept and criteria of brain stem death and have no such reservations. However, both sides would agree that consent by patients and families can only be truly valid if it is fully informed, and that information about this issue should be given transparently, even at the risk of lowering donation rates. The practice of organ donation must have public confidence and support.
b. We cannot speak for other EU Member states, though would expect our sister organisations in those countries to mirror the position expressed above.
Q2. Please would you explain if there is any significant tendency for individuals from your faith group to oppose organ donation either for themselves or for a family member on the basis of their own interpretation of the religious teaching of the group, rather than on the basis of how that teaching is more generally interpreted. If so, how, if at all, do you think this tendency might best be addressed?
There has been surprisingly little teaching from the Christian church about donation and transplantation. We are not aware therefore that there is significant 'religious teaching of the group' for individuals to interpret differently.
In our answer to Q1 we have mentioned one difference of interpretation among those well informed about the details of practice – namely the questions: when does death occur? And what was its cause? We have suggested that transparency leading to fully informed consent is the way to address this.
Q3. To what extent would a change to a system of presumed consent for organ donation in the UK (under which everyone would be assumed to have consented to donate their organs after death unless they explicitly opted-out from the system) be ethically acceptable for your faith group?
We would expect this to cause significant ethical concern for Christians in the UK, and quote our previous submission:
'We have not yet been able to hold a full debate within our membership about this difficult question. We are aware that the policy of the British Medical Association is to support an opting-out principle and are aware of figures in several EU countries that report increased retrieval rates after introducing opt-out policies.
However, in a preliminary discussion we placed much emphasis on the theological basis for our support for donation – namely that of altruistic free gift in a context of fully informed consent. A national opting-out policy would mean that at death the body effectively became the property of the state, and for many Christians this would conflict with the respect owed in biblical and church tradition to the dead body. We commented extensively on this perspective in 2002 in our submission to the Department of Health on 'Human Bodies, Human Choices'.[1] Pragmatically, there remains much concern in the UK about the retention of tissue and organs following the Alder Hey scandal, and this may have motivated Parliament when it recently [2004] rejected an opting-out policy.
We recognise though the low rates of organ transplantation in the UK…We understand why an opting-out system seems attractive and if the UK is to continue opposing it, we must all do more to increase rates of donation.'
Our position is unchanged. We would point out that the language of 'donation' becomes inappropriate when organs are 'taken' rather than 'given'.
Q4. If presumed consent were to be introduced in the UK, what would be your views about the idea that members of any particular groups should be assumed to be opted out as a whole without the need for individual opt outs? (An example of this is the case in Singapore, where Muslims are assumed to have opted out unless they expressly opt in.)
We have already stated that we cannot speak for the whole Christian church, though our view is that no such assumption need be made about any particular Christian group.
(We are unaware of the position on donation and transplantation of the Jehovah's Witness sect. We do not consider them 'Christian', but knowing their views on blood transfusion would expect them to reject donation and transplantation, as organs would inevitably contain blood.
We similarly do not consider Christian Scientists as part of the 'Christian' church, but would expect them to reject the medical treatments involved.)
We trust these supplementary responses are some help to the House of Lords' inquiry, and wish you well in your deliberations about this difficult matter. We are willing to help further if requested.
Steven Fouch (CMF Head of Communications) 020 7234 9668
Alistair Thompson on 07970 162 225
Christian Medical Fellowship (CMF) was founded in 1949 and is an interdenominational organisation with over 5,000 doctors, 900medical and nursing students and 300 nurses and midwives as members in all branches of medicine, nursing and midwifery. A registered charity, it is linked to over 100 similar bodies in other countries throughout the world.
CMF exists to unite Christian healthcare professionals to pursue the highest ethical standards in Christian and professional life and to increase faith in Christ and acceptance of his ethical teaching.
