A relationship of equality

IT has not been a good time for the medical profession. In the past week, it has emerged that the organs of more than a lakh of children have been kept in storage at the Royal Liverpool Children's Hospital. Most had been removed without the consent of parents. An inquiry which brought the macabre circumstances came to light attributed much of the blame to a Dutch pathologist, Professor van Velzen, who was on the staff of the hospital, and has now been suspended.

The Secretary of State (senior minister) for health, described the affair as one of the worst scandals to hit the National Health Service, and said that Professor van Velzen's "unethical" behaviour had been been compounded by the insensitivity of the hospital authorities.

Coverage of the scandal in the newspapers took up 1,378 column inches. Many members of the public understandably found the whole thing extremely shocking, and the doctors involved were accused of arrogance and insensitivity.

The charges are undoubtedly justified, and reactions are the more understandable because there have been other medical scandals in the past year or so, including the conviction of a general practitioner for murdering a large number of his patients. There are signs, however, that the response - of media and public, and indeed of the minister - has taken the whole business out of perspective.

The essential issue is consent - and the sensitivity of the approach to the bereaved parents. Clearly what was done in Liverpool was without consent, and the way in which it was done has been shown to be insensitive in the extreme. The need to keep things in perspective, however, is crucial, because research is vital if more lives are to be saved.

Demonising the whole medical profession because something has gone badly wrong is unrealistic and unreasonable, and is likely to make the saving of life more difficult. Fears are already being expressed that the number of hearts available for use in transplant surgery may fall because relatives of the dead may be unwilling to allow them to be used. Indeed, a campaign has been started in the Cambridge area to encourage more people to carry donor cards.

It would certainly be unfortunate if trust between the public and the medical profession broke down because of this, and other, admittedly horrific, incidents which have shocked the public's imagination.

In Britain, as in the United States, we have become much more critical of experts and professionals than we were a generation ago. We now expect to ask questions, and we expect to hold experts to account in a way that certainly did not happen in my youth, for example. The relationship between professionals - not just doctors - and the public is steadily becoming much more a relationship of equality.

I am convinced that this change is an improvement. Most of us, I am sure, would not be happy to return to the "us and them" relationships of a subservient society, and it would not be healthy in an educated democracy to do so. The change, however, is not without risks. Certainly my own, happily limited, experience of the medical profession, and that of my friends and family, has given me confidence that most of its members take their responsibilities seriously, and want to get their relationship with their patients right.

It has not been a good time either for politicians. or for the government. The resignation from the Cabinet of Peter Mandelson because of his apparent involvement in the application of Srichand Hinduja for British citizenship - or rather because of his imperfect memory of the matter - was a major embarrassment. It was, however, handled quickly by the Prime Minister.

Unfortunately for the Government, Mr. Mandelson is refusing to fade into the background but is insisting very publicly on fighting to save his reputation.

A week after the resignation, coverage of the Mandelson affair amounted to 5,382 column inches. He was not a popular minister with many of his colleagues, and they, and the public, have been watching the drama unfold with fascination.

This is understandable, just as the public reaction to the Liverpool human organs case is understandable. We do need to recognise, however, that we shall not make things better if we assume that all doctors' motives are flawed and their practices untrustworthy - any more than we shall enhance the quality of education in our schools, or justice in our courts or our democratic conduct of government, if we always think the worst of our teachers, lawyers and politicians.

BILL KIRKMAN

The author is an Emeritus Fellow of Wolfson College, Cambridge. E-mail him at wpk1000@cam.ac.uk

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