:00:09. > :00:12.could easily bring them victory in On Newsnight Scotland tonight. It
:00:12. > :00:16.may be impractical to sell a kidney to someone who needs it, but is it
:00:16. > :00:18.immoral? And if you can't make a legal
:00:19. > :00:22.market, how do you supply the increasing need for transplant body
:00:22. > :00:25.parts? Also tonight, has the Cadder ruling,
:00:25. > :00:34.that suspects have a right to a lawyer, led to a rip-off of
:00:34. > :00:39.innocent solicitors? Good evening. It is a classic
:00:39. > :00:41.dilemma for a medical ethics text book or Radio 4's Moral Maze. The
:00:41. > :00:45.demand for kidneys needed for transplant vastly outstrips the
:00:45. > :00:49.supply. So should we pay people to donate a kidney and potentially
:00:49. > :00:55.save a life? We'll discuss that in a moment, but first a short film
:00:55. > :00:59.which contains some images perhaps not for the squeamish.
:00:59. > :01:04.Every day three people in the UK die while waiting for a kidney
:01:04. > :01:08.transplant. Thousands more are on dialysis, a process which is
:01:08. > :01:14.growing for the patient and expensive for the NHS. For most,
:01:14. > :01:19.the only option is a transplant. Each year, around 2000 kidneys are
:01:19. > :01:23.transplanted but five times that number on the did. This research
:01:24. > :01:29.fellow from Dundee University has suggested paying donors over
:01:29. > :01:33.�20,000 for a kidney to increase the donors. We allow a stranger
:01:33. > :01:38.donation, we are getting some altruistic donations, but we need
:01:39. > :01:44.to ask the British public, not the doctors, not the charities, but the
:01:44. > :01:49.British public, about whether they would entertain the possibility of
:01:49. > :01:53.doing it for a reasonable sum. And I have set that reasonable sum as
:01:53. > :01:58.the average annual income in Britain so it would appeal across
:01:58. > :02:02.many strata. The British Medical Association has rejected the idea,
:02:02. > :02:07.saying that the risk to the health of the donor makes the payment in
:02:07. > :02:10.appropriate. Another potential problem is that the donor might be
:02:10. > :02:14.tempted to lie about the state of their own health in order to get
:02:14. > :02:19.the money. Or policing has been waiting for seven years for a
:02:19. > :02:23.kidney but thinks there are better solutions. I think it is the wrong
:02:23. > :02:29.idea. I think what they should do is look at other countries like
:02:29. > :02:39.Spain, where you are automatically a donor and miss you opt out, which
:02:39. > :02:40.
:02:40. > :02:45.makes sense. -- you opt in unless you opt out. It is not just kidneys,
:02:45. > :02:49.it is other organs. The demand for donor kidneys is likely to rise
:02:49. > :02:53.with increasing conditions like diabetes and high blood pressure.
:02:53. > :02:56.Should we stop being so squeamish about introducing money into the
:02:56. > :02:58.equation? I'm joined now by Professor Hugh
:02:58. > :03:01.McLachlan, who teaches medical ethics at Glasgow Caledonian
:03:01. > :03:07.University, and in Edinburgh Dr Calum MacKellar, who's director of
:03:07. > :03:13.eesearch at the Scottish Centre for Human Bioethics. Thank you both
:03:13. > :03:16.very much indeed for coming in. If we look at this basic principle,
:03:16. > :03:22.should the NHS to regulate the market in which kidneys are bought
:03:22. > :03:26.and sold? The fundamental question is, it is not whether the practice
:03:26. > :03:33.is wise or whether it is even ethical, I think the question is,
:03:33. > :03:39.should it be legal? I don't think we need to justify having actions
:03:39. > :03:46.as illegal. The question is, is there a justification for making it
:03:46. > :03:51.a criminal offence to buy or sell an organ? There might be such a
:03:51. > :03:56.reason and if there is, I would be happy to make it illegal but I have
:03:56. > :04:02.not come across such a reason. you a sympathetic to the proposal?
:04:02. > :04:05.Yes. I am not an enthusiast but I have not heard justification for
:04:06. > :04:10.making it a criminal offence. then you come up against questions
:04:10. > :04:15.like how much we should pay. Whatever the market will bear.
:04:15. > :04:22.Let's see what people are prepared to pay. Let's see what price people
:04:22. > :04:26.would expect for their kidneys. Would you have to take in
:04:26. > :04:34.calculations about what the cost of the Kip Meek transaction would be
:04:34. > :04:38.as compared with Daedalus's for many years -- kidney transaction?
:04:38. > :04:45.Yes. You would offer a price and see if the other person was
:04:45. > :04:53.interested. What should be the age of consent? Let's say it 18th.
:04:53. > :05:02.you have any reservations at all? - let's say a team. -- 18th. We are
:05:02. > :05:06.quite happy to say that people should donate kidneys. You might
:05:06. > :05:12.donate a kidney and find that the kidney you have got left doesn't
:05:12. > :05:17.work. That could happen, with the you so you could mean all with the
:05:17. > :05:26.you donate it. -- with their you sell your kidney or where they you
:05:26. > :05:35.donate it. There is also concern about commotion, family members, if
:05:35. > :05:45.a kid any is needed. -- about coercion. There can become Russian
:05:45. > :05:47.
:05:47. > :05:53.on family members to provide that. That is to do with family members,
:05:53. > :05:57.not whether it should be illegal to sell it. There could be more
:05:57. > :06:03.coercion and emotional blackmail in terms of those that rely on their
:06:03. > :06:07.relatives than selling to a stranger. So if it is not
:06:07. > :06:11.absolutely illegal then don't rule it out. Doctor, what do you make of
:06:11. > :06:17.that proposition that there is not really a sound argument at the
:06:17. > :06:22.moment to say it should be illegal? I believe there are some very sound
:06:22. > :06:26.arguments. Legislation is based on ethics. Ethics comes first, then
:06:26. > :06:31.legislation. From the ethical perspective, there are three
:06:32. > :06:37.reasons why the selling of organs is concerning. An organ is part of
:06:37. > :06:42.a living person. It is part of his or her body. A person has no price
:06:42. > :06:46.and therefore the body has no price and therefore the organ has their
:06:46. > :06:53.price. The fact that bodies and people have no price is a reason
:06:53. > :06:58.why we cannot seller sells into slavery. -- we cannot sell
:06:58. > :07:04.ourselves into slavery. On their bases that we have this inherent
:07:04. > :07:09.dignity to not have a price, to then put a price on skin and organs,
:07:09. > :07:15.or where do you stop? Does the body then eventually have a price? Can
:07:15. > :07:19.you put a monetary sum to a body? The second reason is that people
:07:19. > :07:24.who will be tempted to sell their organs will usually be the people
:07:24. > :07:29.who are vulnerable in society. The people who need this money and
:07:29. > :07:34.needed very quickly. It will not be that rich people selling their
:07:34. > :07:38.organs. There is already a lot of unfairness in society between rich
:07:38. > :07:43.and poor and this proposal would compound the problem. The third
:07:43. > :07:46.reason, in medical ethics the concept free, informed consent is
:07:46. > :07:51.extremely important and putting undue pressure on people to sell
:07:51. > :07:57.their organs does not make it a free decision, three, informed
:07:57. > :08:02.consent. People will be encouraged and may be under pressure, they may
:08:02. > :08:06.be desperate at one time and then regret their decision, as is
:08:06. > :08:10.happening in India. This makes it extremely concerning for people to
:08:10. > :08:16.even suggest the proposal of selling organs. I don't accept any
:08:16. > :08:24.of these reasons for making it illegal. In terms of thinking it is
:08:24. > :08:28.unethical. I don't think that is sufficient reason for prohibiting
:08:28. > :08:38.other people from giving it. If that is the way you feel, don't do
:08:38. > :08:40.
:08:40. > :08:43.it yourself. In terms of... Sorry. Carried on. In terms of compression
:08:43. > :08:48.and people may be changing their mind and doing something against
:08:48. > :08:51.their interest, that is people's own responsibility. Often we do
:08:51. > :09:01.things that are mistakes but it does not mean it should be a
:09:01. > :09:05.
:09:05. > :09:11.If it some body feels like they would rather have more money than
:09:11. > :09:15.it two kidneys because they are driven to the wall, if they think
:09:15. > :09:20.it will serve their interests to have one kidney and more money, who
:09:20. > :09:25.are we to say they are wrong? It might turn out they made a mistake
:09:26. > :09:31.but why should they not be allowed to take that chance?
:09:31. > :09:36.I will let you answer that but first, it is already the situation
:09:36. > :09:41.that people are paid to take part in medical trials which are
:09:41. > :09:47.potentially risky. You have conceded there is our legal market
:09:47. > :09:51.where people can go overseas to buy organs. So once you get into the
:09:51. > :09:57.ethics of all that you see no advantage in a properly regulated
:09:58. > :10:03.system in this country? When people get paid to take part
:10:03. > :10:10.increment -- clinical trials, there being compensated. The risks being
:10:10. > :10:17.taken and the money made provide no comparison. Secondly, people are
:10:17. > :10:23.going abroad, are going abroad from the UK even, and I believe that is
:10:23. > :10:27.exploitation. Exploitation of the poor. And I believe our society has
:10:27. > :10:33.a responsibility to protect the vulnerable, make them think about
:10:33. > :10:39.these issues, and even stop them. There is a law in the UK which says
:10:39. > :10:44.you cannot sell yourself into slavery. That is because there is a
:10:44. > :10:48.concept of inherent human dignity which everybody has and for
:10:48. > :10:54.somebody to be able to sell themselves under minds this
:10:54. > :11:00.inherent dignity. When you get to selling body parts, organs,
:11:00. > :11:04.yourself, it is a step on the ladder, or down the stairs, to
:11:04. > :11:12.denying the inherent to human dignity everybody has.
:11:12. > :11:22.But the air would also be a legal concept of personal autonomy.
:11:22. > :11:22.
:11:22. > :11:30.there would also be a regal concept. People believe they have inherent
:11:30. > :11:35.human dignity. If you believe another person has no human dignity
:11:35. > :11:41.then you do not respect their autonomy. One that does not trump
:11:41. > :11:48.the other. Of course. But it is not against
:11:48. > :11:53.human dignity to allow some body to sell a kidney, if they so wish. You
:11:53. > :11:59.are respecting their autonomy whether you approve or not. You are
:11:59. > :12:04.not going to prohibit them from doing it.
:12:04. > :12:13.There is a difference between donating Academy - they are you
:12:13. > :12:19.have autonomy and you do get out of sympathy and altruism - but that is
:12:19. > :12:24.different from selling a kidney for financial gain which is prohibited
:12:24. > :12:29.by international law and legislation in Scotland.
:12:29. > :12:35.There are differences but not to the extent one should be illegal
:12:35. > :12:39.and the other illegal. In terms of medical ethics and
:12:39. > :12:47.social norms we're in such a quagmire that it will take a while
:12:47. > :12:54.to reach a conclusion. Yes. Which is why it is important
:12:54. > :13:02.to have programmes like this. There has been plenty debate over
:13:02. > :13:08.the Supreme Court candour ruling which entitles you to a lawyer F
:13:08. > :13:15.arrested by the police. But the other side of the coin is the
:13:15. > :13:23.pressure put on solicitors. Today the Government and lawyers thrashed
:13:24. > :13:29.out at degree of compromise. The start of a long and difficult
:13:29. > :13:35.process. A suspect arrives at a police station to be questioned
:13:35. > :13:40.about a crime. But a complex system is required it to insecure that
:13:40. > :13:47.rates are fully protected. Won the Supreme Court ruling has made life
:13:47. > :13:51.more complicated for police and lawyers.
:13:51. > :13:56.The practice in Scotland of detaining a person for up to six
:13:56. > :14:01.hours so that the police can question them as regards potential
:14:01. > :14:11.criminal conduct is regulated by statute.
:14:11. > :14:14.
:14:14. > :14:22.We in the judge ruled that the The judge rule that the system
:14:22. > :14:28.needed it changed. A temporary scheme has been put in
:14:28. > :14:34.place to make change happen but many lawyers are not happy with it.
:14:34. > :14:41.Why not? We asked a former police officer what happens when a suspect
:14:41. > :14:49.is brought into questioning. The accused requests a solicitor
:14:49. > :14:55.and that solicitor -- if that solicitor is not available then a
:14:55. > :15:02.help line will call back and present another along with fellow
:15:02. > :15:09.estimated time of arrival. That way the person in custody gets legal
:15:09. > :15:14.representation. The Duke team to find a lawyer falls on the Legal
:15:14. > :15:20.Aid Board. -- the duty. Lawyers argue that the
:15:20. > :15:30.new rules are far too restrictive and impinge on a suspect's right to
:15:30. > :15:31.
:15:31. > :15:35.choose who represents them. If they want advice prior to
:15:35. > :15:43.questioning and paid for out of government funding then only a
:15:43. > :15:50.solicitor on the police station a duty a rota that can be funded.
:15:50. > :15:58.And of very few lawyers are on this scheme. Just 10% of the total in
:15:58. > :16:08.Scotland. State funded public defenders back up the slack. So why
:16:08. > :16:10.
:16:10. > :16:14.eight the dismal reception? -- picked up the slack.
:16:14. > :16:19.We are in a situation where a professional solicitors are being
:16:19. > :16:25.given a stand-alone piece of work but if it is prosecuted then the
:16:25. > :16:29.you will get no money for it. On an individual case they do not like
:16:29. > :16:36.that. It is like a plumber on being called out in the middle of a night
:16:36. > :16:45.when it that bathroom suite needs fixed but then afterwards not being
:16:45. > :16:49.paid. It would not happen in any other profession.
:16:49. > :16:56.The Government rejects claims that the lawyers are paying the price of
:16:57. > :17:01.the Government. But they're hinting at change which may end the dispute.
:17:01. > :17:05.We and the police are happy to put the individual solicitor who is
:17:05. > :17:11.requested in touch with the detainee. We are happy to undertake
:17:11. > :17:17.that. But what we are not prepared to insist upon as a government is
:17:17. > :17:25.that the police should sit around phoning for a particular solicitor,
:17:25. > :17:29.hour after hour, until they get them.
:17:29. > :17:37.Is the arguing over? With lawyers and politicians involved, do not
:17:37. > :17:47.bet on it. A quick look at Tomorrow's headlines. The Scotsman
:17:47. > :17:47.
:17:47. > :17:53.has the exam blunder story line. In the Independent, the Chancellor's
:17:53. > :18:03.watchdog sounds an alarm on the economy. That is all from me. A
:18:03. > :18:05.
:18:05. > :18:15.Good evening. The daytime heat has peaked but we have one more muggy
:18:15. > :18:15.
:18:16. > :18:20.night to deal with. Into the after noon brighter weather well
:18:21. > :18:24.developed in the north-west of England but a wet afternoon in
:18:24. > :18:33.store for eastern parts. In East Anglia we could see some mild
:18:33. > :18:38.flooding. Dryer in the second half of the day. Many will see sunshine
:18:38. > :18:45.in the afternoon. Not quite as humid as today but in the sunshine
:18:45. > :18:51.it will still be strong enough to make you feel reasonably warm.
:18:51. > :18:56.Northern Ireland, brightening sky is in the afternoon. For the
:18:56. > :19:02.northern half of Scotland the rain will push its way up and it will
:19:02. > :19:11.remain wet through Thursday night. You can see the changes across
:19:11. > :19:16.Norburn areas - rain predominant on Thursday. -- more than areas. We