Counsellors And Acolytes

Are ethical principles relative to time and place? A Star Wars perspective on the Alder Hey affair

BMJ 2002; 325 doi: (Published 21 December 2002) Cite this as: BMJ 2002;325:1493
  1. Kim D Arcus, research assistant (,
  2. Anthony S Kessel, directorb
  1. a Program for Policy Decision-Making, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada L8N 3Z5,
  2. b International Programme for Ethics, Public Health and Human Rights, London School of Hygiene and Tropical Medicine, London WC1E7HT
  1. Correspondence to: K D Arcus

    The problems at Alder Hey Hospital around how, when, and why parents'consent should be sought for research on their dead children's tissues has raised some old philosophical questions. In particular, to what degree can practices be morally defended on the grounds of context? To help shed light on this, Kim D Arcus and Anthony S Kessel went to a different time and place and requested help from a galaxy far, far away—from Dr Luke Skywalker and his mentor, Obi-Wan Kenobi

    Dr Luke Skywalker: Obi, I need some advice.

    Obi-Wan Kenobi: Ahhh, you only see old Obi when you need advice these days, huh?

    Dr Luke: Obi, you know the Force is a delicate balance. Now, let me explain my scenario. Occasionally organs and tissues from babies and fetuses are retained after postmortem examination for research and education. Current practice is to obtain informed consent to retain them, but 10 to 20 years ago this wasn't commonplace. Recently in England some of these organs were kept at some pathology laboratories without consent—such as at Alder Hey Hospital. 1 2 Parents feel they were misled into thinking that they were burying their deceased children intact, whereas in fact some organs and tissues were missing. From the pathologists' point of view, this old paternalistic approach was warranted in the interest of avoiding parental distress and generating benefit to society through research and training. The way I see it, this is a matter of context, and politicians and the media have exaggerated the issue of consent out of proportion. Paternalistic actions of yesteryear are being judged by today's ethical standards. Surely ethical principles change and are relative to time and place?

    “An awareness of moral relativism, utilitarianism, Kantian ethics, and biomedical ethics will help.”

    Obi: Mmmm. You can look at this difficult problem from several perspectives; the parents' and pathologists' are just two. However, a look through …

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