We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
Ethics and Law in the United Kingdom
Published online by Cambridge University Press: 10 June 2014
We report on two areas in which UK law and ethics seem out of step with each other. 2013 saw the passing of the Human Transplantation (Wales) Bill, which will introduce an opt-out system of organ donation in Wales from 2015. In the first section, we discuss the convoluted evolution of the Bill and some potential problems that we consider may prevent it from achieving its intended goal of increasing the number of organs transplanted. The prospect of being able to enhance human cognition through cognitive-enhancing drugs (“smart drugs”) also presents a nexus of questions associated with future ambitions, hopes, and concerns as a society. How these drugs might affect the future of work and employment is beginning to generate wide public engagement in the UK and forms the focus of the second section.
1. The United Kingdom of Great Britain and Northern Ireland, along with the Republic of Ireland, together make up the British Isles. Great Britain is made up of Scotland, England, and Wales.
2. HTA 2004, part 1; available at www.legislation.gov.uk/ukpga/2004/30/section/1 (last accessed 8 Nov 2013), at 1c.
3. HTA 2004, schedule 1, part 1. Purposes requiring consent; available at http://www.legislation.gov.uk/ukpga/2004/30/schedule/1 (last accessed 20 Mar 2014), at 7.
4. See note 2, HTA 2004.
5. NHSBT. How to become a donor; available at http://www.organdonation.nhs.uk/how_to_become_a_donor/ (last accessed 8 Nov 2013).
6. Wilkinson, TM. Ethics and the Acquisition of Organs. Oxford, UK: Oxford University Press; 2011, at 101.Google Scholar
7. Richards, JR. The Ethics of Transplants—Why Careless Thought Costs Lives. Oxford University Press; 2012, at 156.Google Scholar
8. Welsh Government. Human Transplantation (Wales) Bill; available at http://wales.gov.uk/topics/health/nhswales/majorhealth/organ/?lang=en (last accessed 8 Nov 2013).
9. Organ Donation Task Force. The Potential Impact of an Opt-Out System for Organ Donation in the UK; 2010; available at http://www.odt.nhs.uk/pdf/the-potential-impact-of-an-opt-out-system-for-organ-donation-in-the-UK.pdf (last accessed 23 May 2014), at 6, 2.1.
10. Organ Donation Task Force. Organs for Transplant; 2008; available at http://www.bts.org.uk/Documents/Publications/Organs%20for%20transplants%20- %20The%20Organ%20Donor%20Task%20Force%201st%20report.pdf (last accessed 8 Nov 2013).
11. Keogh B 2013 Letter to the Organ Donation Task Force Delivery Board 19th April 2013 http://www.ics.ac.uk/latest_news/organ_donation_taskforce_b_keogh
12. BBC News 2013 Organ donation soars after past five years http://www.bbc.co.uk/news/health-22086086 Accessed November 8, 2013.
13. See note 9, Organ Donation Task Force 2010, at 1.1, 1.6, 1.8.
14. See note 9, Organ Donation Task Force 2010, at 1.14, 1.9.
15. See note 9, Organ Donation Task Force 2010, at 11.5.
16. Nuffield Council. Human Bodies: Donation for Medicine and Research; 2011; available at http://www.nuffieldbioethics.org/sites/default/files/Donation_full_report.pdf (last accessed 8 Nov 2013).
17. The countries included in the review were Belgium, India, Iran, Israel, Spain, and the United States (at both the federal and the state level). The review focused on specific issues for each country, rather than attempting a detailed overview of every aspect of the legislation governing the donation of bodily material.
18. See note 16, Nuffield Council 2011, at 2.26.
19. See note 16, Nuffield Council 2011, at 2.26.
20. NHSBT. Organ Donation and Transplantation—Activity Figures for the UK as at 12 April 2013; available at http://www.organdonation.nhs.uk/statistics/downloads/annual_stats.pdf (last accessed 8 Nov 2013).
21. NHS Organ Donor Register; 2013; available at http://www.organdonation.nhs.uk/statistics/downloads/united_kingdom_april13.pdf (last accessed 21 Mar 2014).
22. Wales, NHS. Designed to Tackle Renal Disease in Wales: A National Service Framework; 2007; available at http://www.wales.nhs.uk/sites3/documents/434/designed%20to%20tackle%20renal%20disease%20in%20wales%20-%20eng.pdf (last accessed 8 Nov 2013).Google Scholar
23. See note 22, NHS Wales 2007, at 142.
24. See note 22, NHS Wales 2007, at 144.
25. Welsh Government Assembly. Inquiry into Presumed Consent for Organ Donation; 2008; available at http://www.assemblywales.org/cr-ld7192-e.pdf (last accessed 8 Nov 2013).Google Scholar
26. Welsh Government Assembly. Discussion Document: Introduction of an Opt Out (Presumed Consent) System in the Context of Organ Transplantation; 2008; available at http://wales.gov.uk/dhss/publications/health/guidance/discussion/discussionconsente.pdf;jsessionid=FB078736449B5C511552F996531C8CF4?lang=en (last accessed 8 Nov 2013).Google Scholar
27. Welsh Assembly Government. Options for Changes to the Organ Donation System in Wales; 2009; available at http://www.wales.nhs.uk/sites3/Documents/773/Organ%20Donation%20consultation%201doc%20-%20English.pdf (last accessed 23 May 2014).
28. NHS Blood and Transplant. Organ Donation and Transplantation Activity Data: WALES; 2014; available at http://www.organdonation.nhs.uk/statistics/downloads/wales_mar14.pdf (last accessed 24 May 2014).
29. NHS Blood and Transplant. Organ Donation and Transplantation Activity Data: UNITED KINGDOM; 2014; available at http://www.organdonation.nhs.uk/statistics/downloads/united_kingdom_mar14.pdf (last accessed 24 May 2014).
30. See note 28, NHS Wales 2014.
31. Welsh Government. Organ donation; available at http://wales.gov.uk/topics/health/nhswales/majorhealth/organ/?lang=en (last accessed 8 Nov 2013).
32. Human Transplantation (Wales) Bill; available at http://www.senedd.assemblywales.org/documents/s18966/Bill%20as%20passed%20unchecked.pdf (last accessed 8 Nov 2013).
33. Consent for Organ Donation; available at http://www.dohc.ie/consultations/closed/Donation_of_Organs/consentoptions.pdf?direct=1 (last accessed 8 Nov 2013).
34. Rithalia, A, McDaid, C, Sukarran, S, Myers, L, Sowden, A. Impact of presumed consent for organ donation on donation rates: A systematic review. BMJ 2009;338:a3162.Google Scholar
35. Csillag C. Brazil abolishes “presumed consent” in organ donation. Lancet 1998;352(9137):1367. “Presumed consent” is a problematic term and should not in our view be equated with “opting out,” as it is possible to have an opt-out system that does not presume consent. It is interesting that in Wales the term “deemed consent” has been used in the actual Bill—though this term also does not necessarily equate with an opt-out system.
36. Dominguez, J, Rojas, JL. Presumed consent legislation failed to improve organ donation in Chile. Transplantation Proceedings 2013;45:1316–17.CrossRefGoogle ScholarPubMed
37. ETCO-EDC. IRODaT organ donation and transplantation activity data, various years; available at http://www.europeantransplantcoordinators.org/clinical-resources/irodat/ (last accessed 21 Aug 2012).
38. Xin, L. Forced organ removal in Singapore raises concerns. The Epoch Times; 2007; available at http://www.theepochtimes.com/news/7-4-3/53670.html (last accessed 8 Nov 2013).Google Scholar
39. Shaw, D. We should not let families stop organ donation from their dead relatives. BMJ 2012;345:e5275.CrossRefGoogle ScholarPubMed
40. See note 39, Shaw 2012, responses section of the online publication; available at http://www.bmj.com/content/345/bmj.e5275?tab=responses (last accessed 8 Nov 2013).
41. UK Parliament. Early day motion 2407; available at http://www.parliament.uk/edm/2010-12/2407 (last accessed 8 Nov 2013).
42. See note 41, UK Parliament.
43. Mayor, S. Opt-out scheme is still best way to increase organ donation, says BMA. BMJ 2012;344:e1098.Google Scholar
44. BMA 2013. Wales passes organ donation opt-out law; available at http://bma.org.uk/news-views-analysis/news/2013/july/wales-passes-organ-donation-opt-out-law (last accessed 8 Nov 2013).
45. Walsh F. “Stop families” from overriding donor consent; 2013; available at http://www.bbc.co.uk/news/health-23260057 (last accessed 8 Nov 2013).
46. Wilson, C. Scotland urged to follow Wales in organ donation opt-out. Glasgow Evening Times 2013 July 3; available at http://www.eveningtimes.co.uk/opt-for-life/scotland-urged-to-follow-wales-in-organ-donation-opt-out-129327n.21505753 (last accessed 8 Nov 2013).Google Scholar
47. Louise-Connolly M. Organ donation: Public to be consulted on proposed law change; 2013; available at http://www.bbc.co.uk/news/uk-northern-ireland-22757477 (last accessed 8 Nov 2013).
48. Welsh Government. Human Transplantation (Wales) Bill: Explanatory Memorandum Incorporating the Regulatory Impact Assessment and Explanatory Notes; 2012; available at http://www.assemblywales.org/bus-home/bus-business-fourth-assembly-laid-docs/pri-ld9121-em-e.pdf?langoption=3&ttl=PRI-LD9121-EM%20-%20Human%20Transplantation%20%28Wales%29%20Bill%20-%20Explanatory%20Memorandum (last accessed 8 Nov 2013).
49. Boyarsky, B, Hall, EC, Deshpande, NA, Lorie Rois, R, Montgomery, RA, Steinwachs, DM. Potential limitations of presumed consent legislation. Transplantation 2011;93:136–40.CrossRefGoogle Scholar
50. Johns Hopkins Medicine Press Release; 2011 Nov 29; available at http://www.hopkinsmedicine.org/news/media/releases/presumed_consent_not_answer_to_solving_organ_shortage_in_us_researchers_say (last accessed 8 Nov 2013).
51. Taylor P. Think positive: The rise of “smart drugs.” PMLiVE 2013 June 18; available at http://www.pmlive.com/pharma_news/think_positive_the_rise_of_smart_drugs_483056 (last accessed 14 July 2013).
52. Chilton M. Hay Festival 2013: Leading neuroscientist warns against “smart drugs.” Telegraph 2013 May 25; available at http://www.telegraph.co.uk/culture/hay-festival/10080593/Hay-Festival-2013-Leading-neuroscientist-warns-against-smart-drugs.html (last accessed 14 July 2013).
53. Sahakian, B, LaBuzzeta, JM. Bad Moves: How Decision Making Goes Wrong, and the Ethics of Smart Drugs. Oxford, UK: Oxford University Press; 2013.Google Scholar
54. Lennard, N. One in ten takes drugs to study. Varsity 2009; available at http://www.varsity.co.uk/news/1307 (last accessed 1 Feb 2012).Google Scholar
55. Parliamentary Office for Science and Technology. Better brains. POSTNote 2007 June;285; available at http://www.parliament.uk/briefing-papers/POST-PN-285.pdf (last accessed 11 July 2013).
56. Do cognitive-enhancing drugs work? BBC News Online 2011; available at http://www.bbc.co.uk/news/health-15600900 (last accessed 11 July 2013).
57. Maher, B. Poll results: Look who’s doping. Nature 2008;452:674–5.Google Scholar
58. Sahakian B, Morein-Zamir S, Robbins T, Turner D, Sakahian B. Mental capital and wellbeing: Making the most of ourselves in the 21st century. Pharmacological cognitive enhancement. Government Office for Science; available at http://www.bis.gov.uk/assets/foresight/docs/mental-capital/sr-e9_mcw.pdf (last accessed 8 Nov 2013).
59. Wellcome Collection. Superhuman: Exploring Human Enhancement from 600 BCE to 2050. London: Wellcome Collection; 2012, at 34.Google Scholar
60. Bevan, S. Cognitive enhancement—The next leap forward in productivity? The Work Foundation Blog; 2013 May 31; available at http://www.theworkfoundation.com/blog/1208/Cognitive-enhancement-the-next-leap-forward-in-productivity (last accessed 11 July 2013).Google Scholar
61. See note 60, Bevan 2013.
62. Academy of Medical Sciences, British Academy, Royal Academy of Engineering, Royal Society. Human Enhancement and the Future of Work: Report from a Joint Workshop Hosted by the Academy of Medical Sciences, the British Academy, the Royal Academy of Engineering and the Royal Society. London: The Academy of Medical Sciences; 2012 Nov, at 5; available at http://royalsociety.org/uploadedFiles/Royal_Society_Content/policy/projects/human-enhancement/2012-11-06-Human-enhancement.pdf (last accessed 11 July 2013).
63. See note 62, Academy of Medical Sciences et al. 2012, at 13.
64. Fund, King’s. Paying the Price: The Cost of Mental Health Care in England to 2026; 2008; available athttp://www.kingsfund.org.uk/publications/paying_the_price.html (last accessed 1 Feb 2013).Google Scholar
65. See note 62, Academy of Medical Sciences et al. 2012, at 16.
66. See note 62, Academy of Medical Sciences et al. 2012, at 16.
67. Bannerman, L. Bring “smart drugs” out of the closet, experts urge government. The Times Online; 2010 Feb 27; available at http://www.thetimes.co.uk/tto/science/medicine/article5102.ece (last accessed 11 July 2013).Google Scholar
68. Hyland, MJ. The drugs do work: My life on brain enhancers. The Guardian 2013 May 3; available athttp://www.guardian.co.uk/lifeandstyle/2013/may/03/brain-enhancing-drugs-mj-hyland (last accessed 11 July 2013).Google Scholar
69. Scan, Horizon, Office of Science & Technology. Cognitive enhancers summary. Drugs Future 2025?; available at http://www.bis.gov.uk/foresight/MediaList/foresight/media%20library/BISPartners/Foresight/docs/brain-science/∼/media/BISPartners/Foresight/docs/brain-science/cognition-enhancers-summary.ashx (last accessed 11 July 2013).Google Scholar
70. Travis, A. Government watchdog considers ban on IQ booster drugs. The Guardian 2009 July 28; available at http://www.guardian.co.uk/politics/2009/jul/28/watchdog-intelligence-performance-psychoactive-drugs (last accessed 11 July 2013).Google Scholar
71. See note 56, Do cognitive-enhancing drugs work?, 2011.
72. Medicines and Healthcare Products Regulatory Agency (MHRA). Press release: Warning over Internet sales of counterfeit weight loss medication; 2010 Jan 25; available at http://www.mhra.gov.uk/NewsCentre/Pressreleases/CON068520 (last accessed 11 July 2013).
73. Hirsch, F. Social Limits to Growth. London: Routledge & Kegan Paul; 1977, at 5.Google Scholar
74. Bostrom, N, Roache, R. Smart Policy: Cognitive Enhancement and the Public Interest; 2009; available at http://www.nickbostrom.com/papers/smart-policy.pdf (last accessed 11 July 2013).Google Scholar
75. See note 74, Bostrom, Roache 2009.
76. EU High Level Expert Group. Foresighting the New Technology Wave: Converging Technologies—Shaping the Future of European Societies; 2004; http://ec.europa.eu/research/social-sciences/pdf/ntw-report-alfred-nordmann_en.pdf (last accessed 11 July 2013), at 21.
77. See note 74, Bostrom, Roache 2009.
