A key facet of understanding the Alder Hey organ scandal, both why it occurred and what triggered the subsequent reaction, is in comprehending the conflict of ideals between doctors and the wishes of patients.
The scandal itself occurred at a time when the ethics of medicine were going through large changes, becoming closer to what we consider ethical today. However, there were those who believed that these modern ideals are in fact contrary to the profession’s interests. In 1983, K. Leffler wrote that institutions which gave doctors authority were being eroded, meaning the positions they held were no longer able to carry the same level they once did due to a dissemination of power.[1] He claimed the result of antitrust groups challenging the authority of such institutions is a degradation of quality, that in removing power from medical establishments there would be a decrease in the quality of work, as well as the means to establish the legitimacy of a practice.
Bernard Baber stated that this view is one which is common for the medical profession, the innate conservatism medical professionals feel as their core ideas are confronted similar to that which occurs in most groups.[2] For doctors, this conservatism is perhaps understandable, in light of the quote “everyone has a right to lay the dead to rest”, made by a parent of a young teen whose organs were harvested in the incident.[3] While of course one can understand the emotions of the families of the deceased, it is noticeable how there was a personification of the corpses of loved ones, as the dead cannot rest. One can understand why sentimentality towards individuals who had already passed may have become an afterthought to a doctor, their profession of saving lives being one the vast majority certainly take extremely seriously. An appreciation of their position is vital, life and death literally in their hands. When working with a vast number of patients, percentile changes to efficiency result in real, tangible deaths, ones which a doctor must shoulder.
Perhaps in light of this distance between doctors and the individual, the attitude of the public towards traditional medicine during the latter half of the 20th century was increasingly skeptical. While it would perhaps be inaccurate to say medicine of this sort was no longer at the centre of the medical world, alternative treatments were growing in popularity.[4] Many members of the public at the time of the Alder Hey scandal broke out no longer trusted older scientific institutions, skeptical that medical organisations had their interests as an individual at heart. One might trace this mistrust of medical authorities to the little consideration they gave to individuals. Historically, after passing the rights of a deceased individual and their family were given little thought, particularly for the poor, and the next steps came at the discretion of the physician.[5] Such a dehumanising view of the deceased children was undoubtably present in the Alder Hey scandal, families signing vague consent forms given to them by doctors, who were not interested in truly understanding their wishes.[6] In the modern era, this comes across as an abuse of the doctor-patient relationship, trust being placed in the doctors to act in their patient’s best interests. With the advances in technology across the 20th century, it is understandable that patients and the public at large expected a greater level of both interaction and transparency with doctors, one which was often not present in medical models.
Additionally, one cannot ignore the psychological effect having children as the subjects the scandal had on the minds of communities. From when van Velzen became head of foetal and infant pathology in 1988, to 1999 when the Redfern investigation began, child mortality rates had fallen from 9 per 1000 live births, to 5.8.[7] Historically, child mortality rates have almost always been on a downtrend, as 22.5% of children at the turn of the 20th century did not live to reach 5 years old, compared to 0.5% today.[8] With the death of a child becoming something far more impactful in modern times, a case can be made that a general abhorrence towards the very fact that a child died at all would colour public perceptions. Insight can also be gained when considering the fact that not all of the body parts kept were from youths and children, but foetuses too. An article speaking on abortion and moral perceptions across the 1980s to 1990s concludes that for many, the issue of abortion fell to rights.[9] For the foetus, it was the right to life, and for the mother, it was the right to choose. With regards to the scandal, one can see how this reflects earlier ideas of the patient or family’s power to choose. The conflict of interest with Alder Hey however was not between the foetus and the potential mother, but between physicians and the families of the departed.
[1] Leffler, K. (1983). Economic and Legal Analysis of Medical Ethics: The Case of Restrictions on Interprofessional Association. Law and Human Behavior, 7(2/3), 183-192. Retrieved from http://www.jstor.org.ezp.lib.unimelb.edu.au/stable/1393540
[2] Barber, B. (1978). Perspectives on Medical Ethics and Social Change. The Annals of the American Academy of Political and Social Science, 437, 1-7. Retrieved from http://www.jstor.org.ezp.lib.unimelb.edu.au/stable/1042488
[3] ‘Everyone has a right to lay the dead to rest’ (2001, January 31st). The Guardian. https://www.theguardian.com/uk/2001/jan/31/alderhey3
[4] Coulter, I. & Willis, E. (2007). Explaining the growth of complementary and alternative medicine. Health Sociology Review, 16, 214-225. http://www.samueliinstitute.org/File%20Library/Knowledge%20Center/Publications/Coulter%20growth%20of%20CAM07.pdf
[5] Brazier, M. (2008). Exploitation and Enrichment: The Paradox of Medical Experimentation. Journal of Medical Ethics, 34(3), 180-183. Retrieved from http://www.jstor.org.ezp.lib.unimelb.edu.au/stable/27720036
[6] Dyer, O. (2002). Gmc Clears Alder Hey Doctor Of Dishonesty. BMJ: British Medical Journal, 325(7375), 1258-1258. Retrieved from http://www.jstor.org.ezp.lib.unimelb.edu.au/stable/25453016
[7] Elizabeth, M. Child mortality in England and Wales: 2014. (2017, 19th April) https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/childhoodinfantandperinatalmortalityinenglandandwales/2014
[8] Roser, M (2018) – “Child Mortality”. Published online at OurWorldInData.org. Retrieved from: ‘https://ourworldindata.org/child-mortality’
[9] Cohen, S. (2014). ABORTION AND MORAL PERCEPTION. Public Affairs Quarterly, 28(1), 1-18. Retrieved from http://www.jstor.org.ezp.lib.unimelb.edu.au/stable/43574645
Alder Hey Scandal 