03/08/2011 Newsnight Scotland

could easily bring them victory in On Newsnight Scotland tonight. It

may be impractical to sell a kidney to someone who needs it, but is it

immoral? And if you can't make a legal

market, how do you supply the increasing need for transplant body

parts? Also tonight, has the Cadder ruling,

that suspects have a right to a lawyer, led to a rip-off of

innocent solicitors? Good evening. It is a classic

dilemma for a medical ethics text book or Radio 4's Moral Maze. The

demand for kidneys needed for transplant vastly outstrips the

supply. So should we pay people to donate a kidney and potentially

save a life? We'll discuss that in a moment, but first a short film

which contains some images perhaps not for the squeamish.

Every day three people in the UK die while waiting for a kidney

transplant. Thousands more are on dialysis, a process which is

growing for the patient and expensive for the NHS. For most,

the only option is a transplant. Each year, around 2000 kidneys are

transplanted but five times that number on the did. This research

fellow from Dundee University has suggested paying donors over

�20,000 for a kidney to increase the donors. We allow a stranger

donation, we are getting some altruistic donations, but we need

to ask the British public, not the doctors, not the charities, but the

British public, about whether they would entertain the possibility of

doing it for a reasonable sum. And I have set that reasonable sum as

the average annual income in Britain so it would appeal across

many strata. The British Medical Association has rejected the idea,

saying that the risk to the health of the donor makes the payment in

appropriate. Another potential problem is that the donor might be

tempted to lie about the state of their own health in order to get

the money. Or policing has been waiting for seven years for a

kidney but thinks there are better solutions. I think it is the wrong

idea. I think what they should do is look at other countries like

Spain, where you are automatically a donor and miss you opt out, which

makes sense. -- you opt in unless you opt out. It is not just kidneys,

it is other organs. The demand for donor kidneys is likely to rise

with increasing conditions like diabetes and high blood pressure.

Should we stop being so squeamish about introducing money into the

equation? I'm joined now by Professor Hugh

McLachlan, who teaches medical ethics at Glasgow Caledonian

University, and in Edinburgh Dr Calum MacKellar, who's director of

eesearch at the Scottish Centre for Human Bioethics. Thank you both

very much indeed for coming in. If we look at this basic principle,

should the NHS to regulate the market in which kidneys are bought

and sold? The fundamental question is, it is not whether the practice

is wise or whether it is even ethical, I think the question is,

should it be legal? I don't think we need to justify having actions

as illegal. The question is, is there a justification for making it

a criminal offence to buy or sell an organ? There might be such a

reason and if there is, I would be happy to make it illegal but I have

not come across such a reason. you a sympathetic to the proposal?

Yes. I am not an enthusiast but I have not heard justification for

making it a criminal offence. then you come up against questions

like how much we should pay. Whatever the market will bear.

Let's see what people are prepared to pay. Let's see what price people

would expect for their kidneys. Would you have to take in

calculations about what the cost of the Kip Meek transaction would be

as compared with Daedalus's for many years -- kidney transaction?

Yes. You would offer a price and see if the other person was

interested. What should be the age of consent? Let's say it 18th.

you have any reservations at all? - let's say a team. -- 18th. We are

quite happy to say that people should donate kidneys. You might

donate a kidney and find that the kidney you have got left doesn't

work. That could happen, with the you so you could mean all with the

you donate it. -- with their you sell your kidney or where they you

donate it. There is also concern about commotion, family members, if

a kid any is needed. -- about coercion. There can become Russian

on family members to provide that. That is to do with family members,

not whether it should be illegal to sell it. There could be more

coercion and emotional blackmail in terms of those that rely on their

relatives than selling to a stranger. So if it is not

absolutely illegal then don't rule it out. Doctor, what do you make of

that proposition that there is not really a sound argument at the

moment to say it should be illegal? I believe there are some very sound

arguments. Legislation is based on ethics. Ethics comes first, then

legislation. From the ethical perspective, there are three

reasons why the selling of organs is concerning. An organ is part of

a living person. It is part of his or her body. A person has no price

and therefore the body has no price and therefore the organ has their

price. The fact that bodies and people have no price is a reason

why we cannot seller sells into slavery. -- we cannot sell

ourselves into slavery. On their bases that we have this inherent

dignity to not have a price, to then put a price on skin and organs,

or where do you stop? Does the body then eventually have a price? Can

you put a monetary sum to a body? The second reason is that people

who will be tempted to sell their organs will usually be the people

who are vulnerable in society. The people who need this money and

needed very quickly. It will not be that rich people selling their

organs. There is already a lot of unfairness in society between rich

and poor and this proposal would compound the problem. The third

reason, in medical ethics the concept free, informed consent is

extremely important and putting undue pressure on people to sell

their organs does not make it a free decision, three, informed

consent. People will be encouraged and may be under pressure, they may

be desperate at one time and then regret their decision, as is

happening in India. This makes it extremely concerning for people to

even suggest the proposal of selling organs. I don't accept any

of these reasons for making it illegal. In terms of thinking it is

unethical. I don't think that is sufficient reason for prohibiting

other people from giving it. If that is the way you feel, don't do

it yourself. In terms of... Sorry. Carried on. In terms of compression

and people may be changing their mind and doing something against

their interest, that is people's own responsibility. Often we do

things that are mistakes but it does not mean it should be a

If it some body feels like they would rather have more money than

it two kidneys because they are driven to the wall, if they think

it will serve their interests to have one kidney and more money, who

are we to say they are wrong? It might turn out they made a mistake

but why should they not be allowed to take that chance?

I will let you answer that but first, it is already the situation

that people are paid to take part in medical trials which are

potentially risky. You have conceded there is our legal market

where people can go overseas to buy organs. So once you get into the

ethics of all that you see no advantage in a properly regulated

system in this country? When people get paid to take part

increment -- clinical trials, there being compensated. The risks being

taken and the money made provide no comparison. Secondly, people are

going abroad, are going abroad from the UK even, and I believe that is

exploitation. Exploitation of the poor. And I believe our society has

a responsibility to protect the vulnerable, make them think about

these issues, and even stop them. There is a law in the UK which says

you cannot sell yourself into slavery. That is because there is a

concept of inherent human dignity which everybody has and for

somebody to be able to sell themselves under minds this

inherent dignity. When you get to selling body parts, organs,

yourself, it is a step on the ladder, or down the stairs, to

denying the inherent to human dignity everybody has.

But the air would also be a legal concept of personal autonomy.

there would also be a regal concept. People believe they have inherent

human dignity. If you believe another person has no human dignity

then you do not respect their autonomy. One that does not trump

the other. Of course. But it is not against

human dignity to allow some body to sell a kidney, if they so wish. You

are respecting their autonomy whether you approve or not. You are

not going to prohibit them from doing it.

There is a difference between donating Academy - they are you

have autonomy and you do get out of sympathy and altruism - but that is

different from selling a kidney for financial gain which is prohibited

by international law and legislation in Scotland.

There are differences but not to the extent one should be illegal

and the other illegal. In terms of medical ethics and

social norms we're in such a quagmire that it will take a while

to reach a conclusion. Yes. Which is why it is important

to have programmes like this. There has been plenty debate over

the Supreme Court candour ruling which entitles you to a lawyer F

arrested by the police. But the other side of the coin is the

pressure put on solicitors. Today the Government and lawyers thrashed

out at degree of compromise. The start of a long and difficult

process. A suspect arrives at a police station to be questioned

about a crime. But a complex system is required it to insecure that

rates are fully protected. Won the Supreme Court ruling has made life

more complicated for police and lawyers.

The practice in Scotland of detaining a person for up to six

hours so that the police can question them as regards potential

criminal conduct is regulated by statute.

We in the judge ruled that the The judge rule that the system

needed it changed. A temporary scheme has been put in

place to make change happen but many lawyers are not happy with it.

Why not? We asked a former police officer what happens when a suspect

is brought into questioning. The accused requests a solicitor

and that solicitor -- if that solicitor is not available then a

help line will call back and present another along with fellow

estimated time of arrival. That way the person in custody gets legal

representation. The Duke team to find a lawyer falls on the Legal

Aid Board. -- the duty. Lawyers argue that the

new rules are far too restrictive and impinge on a suspect's right to

choose who represents them. If they want advice prior to

questioning and paid for out of government funding then only a

solicitor on the police station a duty a rota that can be funded.

And of very few lawyers are on this scheme. Just 10% of the total in

Scotland. State funded public defenders back up the slack. So why

eight the dismal reception? -- picked up the slack.

We are in a situation where a professional solicitors are being

given a stand-alone piece of work but if it is prosecuted then the

you will get no money for it. On an individual case they do not like

that. It is like a plumber on being called out in the middle of a night

when it that bathroom suite needs fixed but then afterwards not being

paid. It would not happen in any other profession.

The Government rejects claims that the lawyers are paying the price of

the Government. But they're hinting at change which may end the dispute.

We and the police are happy to put the individual solicitor who is

requested in touch with the detainee. We are happy to undertake

that. But what we are not prepared to insist upon as a government is

that the police should sit around phoning for a particular solicitor,

hour after hour, until they get them.

Is the arguing over? With lawyers and politicians involved, do not

bet on it. A quick look at Tomorrow's headlines. The Scotsman

has the exam blunder story line. In the Independent, the Chancellor's

watchdog sounds an alarm on the economy. That is all from me. A

Good evening. The daytime heat has peaked but we have one more muggy

night to deal with. Into the after noon brighter weather well

developed in the north-west of England but a wet afternoon in

store for eastern parts. In East Anglia we could see some mild

flooding. Dryer in the second half of the day. Many will see sunshine

in the afternoon. Not quite as humid as today but in the sunshine

it will still be strong enough to make you feel reasonably warm.

Northern Ireland, brightening sky is in the afternoon. For the

northern half of Scotland the rain will push its way up and it will

remain wet through Thursday night. You can see the changes across

Norburn areas - rain predominant on Thursday. -- more than areas. We