The Alder Hey scandal concerning unconsented retention of fetal organs from postmortems between 1988 and 1995, raised important questions regarding legality, morality and ethics in the medical community of that time. In light of the scandal, legal opinions were particularly critical of the structural issues at several institutions. Likewise, the intentions and ethical motivations of individual doctors were scrutinized. The Alder Hey scandal raises concerns as to whether retention of fetal organs after death is justified by their proposed contribution to medical advancement. It illustrates the failure of the dominant medial paradigm to prioritize patient ethics. This is demonstrated by the failure of several managerial bodies to recognize and question medical practices at the hospital.
 |
| Dick van Velzen, a Dutch national was eventually prohibited from ever practicing medicine in the UK again. httpkrant.telegraaf.nlkrantarchief19991224tekstenbui. vanvelzen.html |
Popular opinion places blame for the scandal on “one rogue doctor, Professor Dick van Velzen, and his associates”[1]. Media coverage was particularly scathing of Professor van Velzen and his controversial appointment to Head of the Fetal and Infant Pathology Unit at the University of Liverpool and Honorary Pediatric Pathologist at Alder Hey [2] [3] [4]. In light of backlash to the scandal, van Velzen was stood down from ever practicing medicine again in the UK[5]. This opinion of Prof. van Velzen and the extensive publicity that it generated, needs to be considered in relation with the attempt to reestablish a trusting relationship between the medical community and patients[6]. Placing responsibility for the scandal in the hands of one man simplistic. Van Velzen’s actions were selfishly motivated and well outside of medical law but his behavior was only allowed within a system that lacked structural efficiency and oversight.
 |
Michael Redfern QC, Chairman of the Royal
Liverpool Children's Inquiry, along side Dr Jean
Keeling, a pediatric consultant at the Royal
Children's Hospital and Mrs Elizabeth Powell
of the LiverpoolCommunity Health Council
httpwww.newsandstar.co.ukbody-parts-inquiry-minister-
apologises-to-sellafield-workers-families-1.780323 |
The Royal Liverpool Children’s report authored by Michael Redfern QC (The Redfern Report) and published in response to the Alder Hey scandal, catalogues failed areas of ethical, legal and managerial regulation at a variety of institutions including Alder Hey Hospital, the Coroner’s Office and the University of Liverpool[7]. For example there was a lack of performance management and supervision of staff at Alder Hey and senior personnel were found to have failed to acknowledge problem areas identified by independent review[8]. In light of the report’s findings, four members of staff at Alder Hey were suspended from their positions[9]. An additional 16 doctors were referred to the General Medical Council by the government’s chief medical officer. Two of the sixteen were singled out for a disciplinary hearing and later accused of lying to families about the nature of postmortem practices when asking for consent[10].
The paternalistic nature of the medical profession at the time of the scandal influenced the decisions of the doctors involved[11] [12]. Clinicians often avoided having difficult discussions with families particularly on the nature of postmortem and tissue retention, instead assuming that the family was in no fit state to decide or had no objection, as stated in the Human Tissue Act 1961[13]. This left clinicians in a position where they could make decisions without considering the interests of bereaved families and the deceased patients themselves. A census report of organs and tissues retained by pathology services in England since 1970, stated that over 54,000 organs, body parts, still births and fetuses were still in collections across Britain in 1999[14]. The scandal clearly demonstrates where some physicians believed they could bend structural regulation and sidestep institutional standards[15]. The paternalistic attitude of doctors and management staff toward the community of bereaved parents when the scandal broke, was also criticized in the Redfern report[16]. Today, communication and interpersonal skills teaching is included in medical training.[17] This accompanies recognition that patient-practitioner decision making is a more appropriate model of medical care[18].
 |
| University of Liverpool was criticized in the Redfern Report for failing to communicate with Alder Hey Hospital NHS Trust. httpwww.victorianweb.orgartarchitecturewaterhouse14.html |
Other institutions such as the NHS Trust, the University of Liverpool and the Coroner’s office were also found to be at fault[19]. The relationship between the Royal Liverpool Children’s Hospital NHS Trust and the University was very complex and inconsistent communication between the management boards of the two institutions was identified as a significant issue in the Alder Hey scandal[20]. The Coroner was found to have been lax when under taking Coroner’s procedures and contributed to a delay in identification of organ retention practices at the hospital[21]. Ultimately, the scandal revealed intrinsic, institution-wide, structural weaknesses within all of these services, leading to failure on several accounts to maintain ethically assured patient care.
The scandal caused additional stress and bereavement in the most vulnerable families under the public healthcare system[22]. This is demonstrated by anecdotal evidence presented by parents and caregivers to the Royal Liverpool Children’s Inquiry. Their stories of emotional turmoil in reaction to learning of organ retention practices are particularly impressionable, “It feels like body snatching. The hospital stole something from me. They have taken us back eleven years in our healing process”[23]. A number of support groups such as, Parents who have Interred Their Young Twice (PITY II) were established during the scandal to fill a need for ongoing community support[24]. The scandal illustrates the underlying class division between clients in the private sector and those in the public health system. Patients in the private sector can exercise a consumer right to choose the care they receive based on the treatment they will receive and the integrity of their doctors, a freedom that doesn’t exist in an NHS hospital. Private sector patients can still expect to benefit from medical research done on patients at public hospitals even when they do not to contribute to the studies themselves. Had practitioner training and ethics processes been reviewed and updated regularly by management boards of Alder Hey, this scandal may have been avoided[25].
The retention of young organs after postmortem without the consent of parents and caregivers concerned has caused added bereavement, especially considering how the organs were stored but were not used for educational or research purposes[26]. The concerns uncovered during the Alder Hey scandal were the result of institution-wide, structural inefficiencies at Alder Hey hospital, the University of Liverpool, the Coroner’s office and under the NHS Trust system. The paternalistic nature of the medical community at the time meant that contributing doctors failed to recognize the ethical weight of their actions and the implications for the families involved. The Alder Hey scandal illustrates a case where the retention of young organs without consent does not justify their intended use for education and research.
