In his claim on 16 January 2001 to have been 'distressed and appalled' over revelations that bodies were kept on the floor of a hospital chapel in Bedford, UK health secretary Alan Milburn appeared to be responding to an upsurge of public outrage.
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Similarly, the apology by chief medical officer Liam Donaldson on 11 January 2001, for the practice of retaining organs after autopsy without specific consent, seemed to be a response to a number of relatives' campaigns set up around this issue.
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In fact, the origins of this furore are to be found within the medical establishment.
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Unlike many waves of popular sentiment, the beginning of this one can be precisely dated: May 2000, when Professor Ian Kennedy published his interim report on the inquiry into the Bristol children's heart surgery unit. Kennedy drew attention to the fact that organs - specifically hearts - had been removed from many of the children at autopsy and not returned for burial or cremation. He publicly denounced the doctors involved for their 'arrogance born of indifference' (1).
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While a senior figure at the UK Royal College of Pathologists complained at Kennedy's 'strident and sneering tone', this same tone had a provocative impact on the families of children who had died undergoing surgery at Bristol. Already anguished by the outcome of the earlier General Medical Council inquiry - which had led to three doctors being struck off the medical register - parents found a new focus for their grief, which was renewed and compounded by these revelations.
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An academic lawyer and moral philosopher, Ian Kennedy has become a key player in the medical elite. It is now more than two decades since his Reith lectures, subsequently published as The Unmasking of Medicine in 1981, mounted a systematic assault on medical practice and the medical profession. His conclusion was that 'a wholly new system of supervision and sanction must be created' in place of the existing framework of professional self-regulation (2).
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A long-standing member of the General Medical Council, Kennedy has worked closely with its president Sir Donald Irvine to implement this reform agenda, which was gradually accepted by key medical politicians in the 1990s. Determined to use Bristol to accelerate the pace of reform, Irvine personally presided over the GMC inquiry, displaying such hostility to the doctors involved that his impartiality was questioned. Kennedy's appointment to the official inquiry into Bristol signalled the government's determination to use this case as a stick with which to beat the medical profession into line.
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Kennedy's demagoguery, eagerly amplified by the media, now highly attuned to the resonance of medical scandals, both intensified the distress of the Bristol parents and encouraged further investigations elsewhere. After all, it was widely acknowledged that the retention of organs removed at post-mortem had long been a routine practice.
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Sure enough, new scandals followed - at Alder Hey in Liverpool and at the Princess Diana Hospital in Birmingham. In turn, these revelations led to last week's summit presided over by the government's chief medical officer. Professor Donaldson led a distinguished panel of leading physicians and pathologists in a grovelling apology to families for this practice, together with the offer of an 'amnesty' on the return of retained organs and new guidelines to cover clinical practice in this area.
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Within days, photographs appeared of bodies lying on the chapel floor in Bedford Hospital and Milburn proclaimed his distress and denounced the local hospital management. The regional NHS director also rushed to condemn this 'totally unacceptable practice' and the chief executive was forced to resign. Relatives of the deceased were subjected to a media onslaught (though nobody appeared to question either the propriety or the taste of the photographer and editor who considered these images newsworthy).
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Far from assuaging popular anxieties provoked by the earlier cases, each successive public confession or apology by a senior medical figure has the effect of widening and deepening morbid suspicions. In a society in which death has become privatised, rendering it more rather than less terrifying, the exposure of the dead body to public view unleashes deep-seated fears of impending mortality.
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Transparency is a fashionable concept, but it is not without its costs. The medical elite, having lost confidence in itself, believes it has lost the confidence of the public. It further believes that the solution to this problem lies in opening up the internal procedures and practices of the profession to public scrutiny and regulation.
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But an open window into the pathology laboratory or the mortuary yields sights that many people might prefer to be kept concealed. This window reveals a world in which the human body is not - and cannot be - treated with the ritualised respect of the funeral parlour or the requiem mass. In the pathology lab the human body is a source of organs and tissues for study and research; in the mortuary it is dead meat to be rendered suitable for disposal.
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Doctors' leaders should stop apologising for medicine's coldly scientific attitude to the cadaver and also stop indulging in populist gestures that only promote atavistic prejudices. Those who cannot stomach the sights of death and decay should express their gratitude to those who carry out these difficult but necessary tasks, and avert their eyes (and their cameras).
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Dr Michael Fitzpatrick is the author of MMR and Autism, Routledge, 2004 (buy this book from Amazon (UK) or Amazon (USA)); and The Tyranny of Health: Doctors and the Regulation of Lifestyle, Routledge, 2000 (buy this book from Amazon UK or Amazon USA). He is also a contributor to Alternative Medicine: Should We Swallow It? Hodder Murray, 2002 (buy this book from Amazon (UK) or Amazon (USA)).
Read on:
The body parts scandal goes on by Dr Michael Fitzpatrick
(1) British Medical Journal, 20 May 2000
(2) Ian Kennedy, The Unmasking of Medicine, London, 1981, p139
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