Legal and ethical conflicts of the Transplantation and Anatomy Act 1979 (Qld) and the Coroners Act 2003 (Qld)
Scott Kitchener1, ACHLR Brisbane 1ACHLR, Brisbane, Queensland, Australia
Abstract
The Transplantation and Anatomy Act 1979 (Qld) (T&AA) specifically refers to consideration of the Coroners Act 2003 (Qld) (CA) prior to entering a patient into the organ donation pathway during end-of-life. Beyond this legal intersection of legislation, there are significant ethical considerations regarding the appropriate investigation of possible unnatural causes for death, consideration of family and friends’ grief during end-of-life care and the difficult decisions regarding posthumous organ donation. Finally, preparation of patients for donation requires pre-morbid clinical investigations outside those for end-of-life care. Such investigations consume limited resources otherwise available for clinical management of non-end-of-life patients.
Cases found with just this conflict were identified through the Clinical Incident System in a regional hospital and health service. These patients were actively assessed for donation before death despite progressing to Coronial referral and investigation upon death, precluding donation. Clinicians involved identified that a determination of Coronial investigation is not required under the CA until after death, therefore investigation and family conversations regarding donation may occur without contradicting the Act with a view to donation if the Coroner decides not to progress investigation.
It is argued that this is unethical and contrary to the intent of these legislation to prevent donation from patients who require Coronial investigation regarding the circumstances of their death.
This argument will be developed with a brief legal and ethical critique of the legislation and investigation of the appropriateness or referral for Coronial review of cases entering the donation pathway over a three year period in this service.
Biography
Scott Kitchener is a public health physician and medical administrator practicing as the Executive Director of Medical Service, responsible for the professional practice of all medical practitioners in the Wide Bay Hospital and Health Service. His doctoral studies have been in public health and medicine.