Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-10T05:06:00.216Z Has data issue: false hasContentIssue false
  • English
  • Français

Guarding the Public Interest: England's Coroners and Organ Transplants, 1960–1975

Published online by Cambridge University Press:  02 September 2015

Helen MacDonald
Get access Rights & Permissions [Opens in a new window]

Abstract

From the mid-twentieth century, England's coroners were crucial to the supply of organs to transplant, as much of this material was gleaned from the bodies of people who had been involved in accidents. In such situations the law required that a coroner's consent first be obtained lest removing the organs destroy evidence about the cause of the person's death. Surgeons challenged the legal requirement that they seek consent before taking organs, arguing that doing so hampered their quick access to bodies. Some coroners willingly cooperated with surgeons while others refused to do so, coming into conflict with particular transplanters whom they considered untrustworthy. This article examines how the phenomenon of “spare part” surgery challenged long-held conceptions of the coroner's role.

Type
Articles
Information
Journal of British Studies , Volume 54 , Issue 4 , October 2015 , pp. 926 - 946
Copyright
Copyright © The North American Conference on British Studies 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Legal correspondent, “Death Certification and Coroners,” British Medical Journal 4, no. 5785 (November 1971): 498–500, at 499Google Scholar.

2 Ian A. Burney, Bodies of Evidence: Medicine and the Politics of the English Inquest, 1930–1926 (Baltimore, 2000), 52–3.

3 Quoted in ibid., 42.

4 Elizabeth Hallam, Jenny Hockey, and Glennys Howarth, Beyond the Body: Death and Social Identity (London, 1999), 88, 90, 92–93.

5 For the medieval period, see Hanawalt, Barbara A., “Violent Death in Fourteenth- and Early Fifteenth-Century England,” Comparative Studies in Society and History 18, no. 3 (July 1976): 297–320CrossRefGoogle Scholar. For the early modern period, see Michael MacDonald and Terence R. Murphy, Sleepless Souls: Suicide in Early Modern England (New York, 1991); Loar, Carol, “Medical Knowledge and the Early Modern English Coroner's Inquest,” Social History of Medicine 23, no. 3 (December 2010): 475–91CrossRefGoogle Scholar. For the Victorian period, see Behlmer, George K., “Deadly Motherhood: Infanticide and Medical Opinion in Mid-Victorian England,” Journal of the History of Medicine and Allied Sciences 34, no. 4 (October 1979): 403–27CrossRefGoogle ScholarPubMed; Higginbotham, Ann R., “‘Sin of the Age’: Infanticide and Illegitimacy in Victorian London,” Victorian Studies 32, no. 3 (Spring 1989): 319–37Google Scholar; Emmerichs, Mary Beth, “Getting Away with Murder? Homicide and the Coroners in Nineteenth-Century London,” Social Science History 25, no. 1 (Spring 2001): 93–100Google ScholarPubMed; Laragy, Georgina, “‘A Peculiar Species of Felony’: Suicide, Medicine, and the Law in Victorian Britain and Ireland,” Journal of Social History 46, no. 3 (Spring 2013): 732–43CrossRefGoogle Scholar.

6 MacDonald and Murphy, Sleepless Souls.

7 Higginbotham, “‘Sin of the Age,’” 319; Behlmer, “Deadly Motherhood.”

8 Stark, James F., “Bacteriology in the Service of Sanitation: The Factory Environment and the Regulation of Industrial Anthrax in Late-Victorian Britain,” Social History of Medicine 25, no. 2 (May 2012): 343–61CrossRefGoogle Scholar.

9 Zuck, D., “Mr. Troutbeck as the Surgeon's Friend: The Coroner and the Doctors—An Edwardian Comedy,” Medical History 39, no. 3 (July 1995): 259–87CrossRefGoogle Scholar.

10 Burney, Bodies of Evidence, 142.

11 Ibid., 152.

12 Ibid., 159.

13 Ibid., 159–60.

14 Gavin Thurston, Coroner's Practice (London, 1958), 25.

15 Ibid., 66, 25.

16 Susan Lederer, Flesh and Blood: Organ Transplantation and Blood Transfusion in Twentieth-Century America (New York, 2008). See also Thomas Schlich, The Origins of Organ Transplantation: Surgery and Laboratory Science, 1880–1930 (Rochester, 2010).

17 M. F. A. Woodruff, “Transplantation: The Clinical Problem,” in Ethics in Medical Progress: With Specific Reference to Transplantation, ed. G. E. W. Wolstenholme and Maeve O'Connor (London, 1966), 6–13, at 11.

18 Joseph E. Murray, “Organ Transplantation: The Practical Possibilities,” in Wolstenholme and O'Connor, eds., Ethics in Medical Progress, 47.

19 An International Eye Bank had been established in Washington, DC, and in England at East Grinstead. See P. V. Rycroft, “A Recently Established Procedure: Corneal Transplantation,” in Wolstenholme and O'Connor, eds., Ethics in Medical Progress, 43–50, at 47.

20 The National Archives (hereafter TNA), Ministry of Health and Department of Health and Social Security (hereafter MHDHSS), Human Transplantation: Cardiac Transplantation Committee (1968), MH 150/413/3, W. G. Robertson to Mrs. Poole, “Human Tissue Act Amendment,” 24 July 1970.

21 Margaret Lock, Twice Dead: Organ Transplants and the Reinvention of Death (Berkeley, 2002). See also Martin S. Pernick, “Brain Death in a Cultural Context: The Reconstruction of Death, 1967–1981,” in The Definition of Death: Contemporary Controversies, ed. Stuart J. Youngner, Robert M. Arnold, and Renie Schapiro (Baltimore, 1999), 3–33.

22 M. F. A. Woodruff quoted in Murray, “Organ Transplantation,” 71.

23 Roy Calne quoted in ibid., 72.

24 Quoted in Lock, Twice Dead, 65–66.

25 Pernick, “Brain Death in a Cultural Context,” 10; Lock, Twice Dead, 103.

26 Woodruff, M. F. A., “Ethical Problems in Organ Transplantation,” British Medical Journal 1, no. 5396 (June 1964): 1457–60CrossRefGoogle ScholarPubMed.

27 Quoted in Sharp, Lesley A., “Organ Transplantation as a Transformative Experience: Anthropological Insights into the Restructuring of the Self,” Medical Anthropology Quarterly 9, no. 3 (September 1995): 357–89, at 362CrossRefGoogle ScholarPubMed.

28 For post–World War II US experiments, see David J. Rothman, Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making (New York, 1991); for the United Kingdom, see Duncan Wilson, The Making of British Bioethics (Manchester, 2014), 44–47.

29 Ayesha Nathoo, Hearts Exposed: Transplants and the Media in 1960s Britain (Basingstoke, 2009).

30 On the rise of bioethics in Britain, which occurred later there than in the United States, see Wilson, The Making, 5. See also Nathoo, Hearts Exposed.

31 MacDonald, Helen, “Considering Death: The Third British Heart Transplant, 1969,” Bulletin of the History of Medicine 88, no. 3 (Fall 2014): 493–525, at 524–25CrossRefGoogle ScholarPubMed; British Transplantation Society, “The Shortage of Organs for Clinical Transplantation: Document for Discussion,” British Medical Journal 1, no. 5952 (February 1975): 251–56CrossRefGoogle Scholar.

32 TNA, MHDHSS, Renal Transplantation: Atkins Advisory Committee (1971–1976), MH 150/434, Health Service Circular (Interim Series) HSC(IS)156, at 5.

33 TNA, MH 58/497, undated and unaddressed draft, prob. January 1961; MH 150/434, Health Service Circular HSC(IS)156.

34 For a full discussion, see MacDonald, Helen, “Conscripting Organs: ‘Routine Salvaging’ or Bequest? The Historical Debate in Britain, 1961–75,” Journal of the History of Medicine and Allied Sciences 70, no. 3 (July 2015): 425–61CrossRefGoogle ScholarPubMed.

35 Until then, a coroner's premortem involvement had been confined to two kinds of cases: when a judicial execution was to occur, and when deaths were expected as a result of a multiple fatality. Thurston, Coroner's Practice, 34–35.

36 TNA, MH 150/413, W. G. Robertson to Mrs. Poole, “Human Tissue Act Amendment,” 24 July 1970, 3.

37 Legal correspondent, “Death Certification,” 499.

38 TNA, MHDHSS, Ethical and Legal Aspects of Organ Transplantation (1969–1975), MH 150/402, “Record of the Committee's Discussion with Mr. Donald Longmore, of the National Heart Hospital and Professor Stanley Peart of St. Mary's Hospital, Paddington at the Home Office on 20th September, 1968,” 2–3.

39 Calne, R. Y., “Cadaveric Kidneys for Transplantation,” British Medical Journal 2, no. 5656 (May 1969): 565–68, at 566CrossRefGoogle ScholarPubMed.

40 Legal correspondent, “Coroners and Transplants,” British Medical Journal 1, no. 6073 (May 1977): 1418Google Scholar.

41 “Kidneys ‘Taken from Body without Consent,’” Times, 9 November 1974, 2.

42 Jones, Robert, “Kidneys in Chaos,” New Scientist 63, no. 915 (19 September 1974): 707Google Scholar.

43 Legal correspondent, “Kidney Transplants and the Law,” British Medical Journal 3, no. 5975 (July 1975): 107–8, at 108Google Scholar. Legal correspondent, “Coroners and Transplants,” 1418.

44 Catherine Kelly and Imogen Goold, “Introduction,” in Lawyers' Medicine: The Legislature, the Courts and Medical Practice, 1760–2000, ed. Imogen Goold and Catherine Kelly (Oxford, 2009), 1–16.

45 TNA, MH 150/402, “Record of the Committee's Discussion with Sir George Godber at the Home Office on 20th September, 1968,” Committee on Death Certification and Coroners, 3.

46 Report of the Committee on Death Certification and Coroners (London, November 1971), quoted in Hallam, Hockey, and Howarth, Beyond the Body, 78.

47 Bewick was a controversial surgeon. In 1990 the General Medical Council found him guilty of “serious professional misconduct” following a kidneys-for-sale scandal in London. See Noticeboard, “Kidney Sales,” Lancet 335, no. 8694 (April 1990)Google Scholar: 906; Tannenbaum, Joel, “‘Tiger Country’: Kidneys for Sale in London in the 1980s,” Configurations 22, no. 3 (Fall 2014): 337–60CrossRefGoogle Scholar.

48 “Coroner Blocks Kidney Transplants,” Health and Social Services Journal (14 February 1985), clipping in TNA, MHDHSS, Brodrick Committee on Death Certification and Coroners (1968–1985), MH 150/400.

49 Frances Gibbs, “‘Confusion’ on Law on Organ Transplantation,” Times, 29 February 1980, 2; TNA, MH 150/400, clipping, “Surgeon Hits out at Denial of Access to Donor Kidneys,” Hospital Doctor, 31 January 1985.

50 Ibid.

51 The society, its membership voluntary on payment of an annual fee, had been established in 1846 to provide coroners with mutual support and a corporate voice. See Zuck, “Mr. Troutbeck as the Surgeon's Friend,” 259–87, at 260.

52 British Transplantation Society, “The Shortage of Organs,” 252. By 1974, Westminster had forty-five hospitals and reported 3,800 deaths.

53 “A Definition of Irreversible Coma: Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death,” Journal of the American Medical Association 206, no. 6 (August 1968): 337–40Google Scholar; Machado, C. et al. , “The Declaration of Sydney on Human Death,” Journal of Medical Ethics 33, no. 12 (December 2007): 699–703CrossRefGoogle ScholarPubMed.

54 TNA, MHDHSS, Conference on the Transplantation of Organs (1968), MH 150/394, Littlewood to McDonald, 20 February 1968, emphasis added.

55 For a full discussion see MacDonald, “Considering Death.”

56 TNA, MH 150/394, Draft, Conference on the Transplantation of Organs: Introductory Paper by the Health Departments (February 1968), 3.

57 National Archives of Scotland, Edinburgh, Ministry of Health H.S. 2Da, Human Tissue Act 1961: Proposed Amendment to Ease Difficulty in Obtaining Organs for Transplantation (1968–69), HH101/3434, Godber to Thurston, 9 April 1968.

58 TNA, MH 150/400, J. A. W. McDonald to A. P. Wilson (Home Office), 9 August 1968.

59 Neither Patrick Ryan nor Derek Birbeck had donated their hearts; rather, relatives permitted this.

60 TNA, MH 150/400, Memorandum by J. A. W. McDonald, 12 August 1968.

61 At the inquest one doctor considered that Ryan had died at King's College Hospital, another that he had done so in the ambulance while in transit, and a third (the opinion Thurston selected) that the death had occurred at the moment it was “certified” in the operating theatre at the National Heart Hospital (Nathoo, Hearts Exposed, 119–20).

62 TNA, MH 150/400, newspaper clipping, “Coroners Give Heart ‘Rules,’” Daily Mail, 30 July 1968.

63 This was despite the fact that the DHSS itself was concerned about the practice of transporting donors, which they considered to be “highly undesirable.” TNA, MH 150/400, Dr. Dennis to Miss Hedley, 6 August 1968.

64 TNA, MH 150/400, note on file by J. A. W. McDonald, 23 August 1968.

65 TNA, MH 150/400, Catherine Dennis to Miss Hedley, 6 August 1968.

66 For an in-depth analysis of this transplant see MacDonald, “Considering Death.”

67 “Donor's Heart ‘Switched off’ by Doctors,” Times, 29 May 1969, 1.

68 “Great Transplant Debate,” Daily Mirror, 30 May 1969, 1.

69 Ibid.

70 “Advice from the Advisory Group on Transplantation Problems on the Question of Amending the Human Tissue Act 1961” (London, July 1969), 5.

71 “A Definition of Irreversible Coma,” 85.

72 B. P. Bliss, “On Defining Death,” British Journal of Hospital Medicine (April 1970): 606–7, at 606.

73 “Transplant Surgery,” Speeches to the House of Commons, 20 June 1969, Parliamentary Debates, Commons, 5th ser., vol. 785 (1969–70), cols. 855–919.

74 TNA, MH 150/402, “Record of the Committee's Discussion with Mr. Donald Longmore and William Peart,” 20 September 1968, 1.

75 Ibid., 2.

76 Ibid., 1.

77 TNA, MH 150/402, “Minutes of the 37th Meeting of the Committee Held at the Home Office on 20 September,” 3.

78 Kennedy, Ian, “The Donation and Transplantation of Kidneys: Should the Law be Changed?,” Journal of Medical Ethics 5, no. 1 (March 1979): 13–21, at 16CrossRefGoogle Scholar.

79 TNA, MH 150/402, “Record of the Committee's Discussion with Mr. Donald Longmore and William Peart,” 3.

80 TNA, MH 150/402, Note by W. G. Robertson, 21 August 1970.

81 TNA, MH 150/402, “Transplant Operations” (draft), 8.

82 TNA, MH 150/402, Mrs. Poole to W. G. Robertson, 21 August 1970.

83 TNA, MH 150/402, “Transplant Operations” (draft), 7.

84 Lederer, Flesh and Blood, 170–79.

85 TNA, MH 150/402, W. G. Robertson to A. Wilson, 11 August 1970.

86 TNA, MH 150/402, “Report” (draft), Committee on Death Certification, 20 September 1968.

87 TNA, MH 150/402, Note for Record, W. G. Robertson, 19 August 1970.

88 Report of the Committee, 211.

89 Ibid., 207.

90 Ibid.

91 Ibid.

92 Ibid., 213.

93 Ibid., 211.

94 Ibid., 213.

95 “‘Dead’ Man Coughed in Operation,” Guardian, 16 March 1974, 1.

96 Ibid.

97 TNA, MH 150/653, newspaper clipping, Aubrey Chalmers, “This Mistake ‘Must Not Happen Again,’” Daily Mail, 16 March 1974.

98 “‘Dead’ Man Coughed,” 1.

99 Peter Fairley, running sheet for ITV News, 15 March 1974, http://jiscmediahub.ac.uk/mediaContent/open/scripts/1974/19740315_LT_01_ITV.pdf, accessed 20 November 2014.

100 Ian Hepburn, “Horror at the Transplant Operation,” Sun, 16 March 1974, 5.

101 Paul Connew, “A Matter of Life or Death,” Daily Mirror, 16 March 1974, 6.

102 Report of the Committee, 192.

103 “‘Dead’ Man Coughed,” 1.

104 TNA, MHDHSS, Transplant Advisory Panel, Note of Meetings 1 and 2 held 30 May and 13 December 1974 (1974–75), Henry Yellowlees to Professor Sir Cyril Clarke and Mr. Rodney Smith, 25 July 1974.

105 TNA, MH 150/672, Minutes, Working Party Comments on Definition of Brain Death, n.d.

106 “Diagnosis of Brain Death,” Lancet 308, no. 7994 (November 1976): 1069–70CrossRefGoogle Scholar.

107 Ibid., 1069.

108 TNA, MH 150/672, Minutes, Sub-Committee of Transplant Advisory Panel convened to consider establishment and certification of death in patients who may become transplant donors, 29 April 1975.

109 TNA, MH 150/400, Miss M. L. C. Williams to J. H. Garlick, DHSS, 16 August 1974.

110 TNA, MH 150/400, Miss P. M. C. Winterton, DHSS to Miss M. L. C. Williams, Home Office, 2 July 1974.

111 “Diagnosis of Brain Death,” 1069.