No consent should be needed for using leftover body material for scientific purposesForAgainst

Editor,

The debate over the consent requirements for using leftover body
material [1,2] is well timed given the current government consultation on
the removal, retention and use of human organs [3].

The tension between pursuing public benefits and the wish to promote
patient autonomy and protect patient rights is a real one that cannot be
reasoned away. Your ‘For and against’ contributors demonstrate that the
precedence given to either value is very much a personal perspective.
Moderate people will recognise that public benefit or personal autonomy
can never be absolute criteria since the concrete application of either
value will result in folly. We believe the ‘For and against’ authors are
moderate people; they recognise the need for balance and, it appears,
essentially agree with one another.

There are very real examples of harm resulting from un-consented use
of tissue, but there are also very real examples of un-consented use of
tissue resulting in great benefits without any evidence of harm. The use
of irreversibly anonymised specimens, that would otherwise be discarded,
for the national surveillance of HIV and hepatitis infections has been
ongoing in the UK since 1990; over seven million samples have been tested,
six annual reports published and much has been learnt about the changing
distribution of these viruses in the UK population [4]. As coordinators of
these studies, we are not aware of any adverse impact on individual
patients or on the relationship between patient and doctor. The key point
is in the opening line of the ‘against’ piece [2]. What is important is
what we ‘do to patients’. Using leftover tissue without explicit consent
may or may not ‘do’ something to an individual. In theory any tissue that
contains DNA, including discarded tissues such as hair and nails, could be
used for purposes that might seriously harm the patient. But it is
eminently possible to protect patients without blanket requirements for
explicit consent.

The use of leftover tissue without explicit consent is not, as
suggested by Savulescu [2], an attempt to enforce morality. Rather, it is
a pragmatic solution developed by scientists providing necessary public
benefits. Compromises between personal liberty and public good abound in
our society and there is no reason that health should be an exception.

Yours truly,

Dr Peter Horby
Consultant Epidemiologist

Dr O. Noel Gill
Consultant Epidemiologist

PHLS Programme for Unlinked Anonymous HIV Prevalence Monitoring
HIV/STI Division
PHLS Communicable Disease Surveillance Centre
61 Colindale Avenue,
London NW9 5EQ

References

1
van Diest PJ. No consent should be needed for using leftover body material
for scientific purposes. For. BMJ 2002 Sep 21;325(7365):648-51

2
Savulescu J. No consent should be needed for using leftover body material
for scientific purposes. Against. BMJ 2002 Sep 21;325(7365):648-51

3
Human Bodies, Human Choices. The Law on Human Organs and Tissue in England
and Wales. A consultation report. Department of Health and Welsh Assembly
Government, July 2002. Available on-line at:
http://www.doh.gov.uk/tissue/choices.pdf

4
Prevalence of HIV and hepatitis infections in the United Kingdom 2000.
Annual report of the Unlinked Anonymous Prevalence Monitoring Programme.
Report for the Unlinked Anonymous Surveys Steering Group, Department of
Health, December 2001. Available on-line at:
http://www.doh.gov.uk/hivhepatitis/hivhepatitis2000.pdf