Sunday, 18 November 2007

SELLING A KIDNEY: LET’S HAVE A GROWN-UP DEBATE

This morning the Sunday Times reports that in the Netherlands a proposal is being considered to pay – or, more accurately, to bribe – citizens to encourage them to donate one of their kidneys for transplantation. The plan, being considered by the Dutch health minister, is to ‘reward’ donors by giving them free-for-life health insurance – calculated by the Dutch Health Council to be worth around €50,000 – say £35,000.

The background to this proposal is that there is in the Netherlands, as in the UK, a chronic shortage of healthy kidneys for transplantation, partly because advances in medical science mean that there are fewer cadaver-derived kidneys from – for example – road accident victims. Meanwhile, patients suffering from kidney failure are dying while on dialysis.

Currently, in the Netherlands as in Britain, the sale (as opposed to the simple donation) of organs is illegal. The British legislation was rushed through parliament in 1989 without any public debate (there was, it is true, a hysterical media campaign, but that is not quite the same thing, is it?) by a Tory government that had no mandate for such an enactment but which knew it could rely on the unthinking support of the Socialist opposition. On the Socialist side the argument was suddenly heard that unless the sale of organs was criminalised the poor might be exploited. And on the Tory side Mrs Thatcher declared that the sale of organs was “utterly repugnant.” So that was that.

But – of course – the sale of organs, and specifically of kidneys, has not ceased. The ‘trade’ has simply moved to India and elsewhere.

Meanwhile, last May, we had the bleak privilege of witnessing the first conviction in this country of someone who wished to sell a kidney. Mr Daniel Tuck was convicted of contravening the Human Tissue Act by offering to sell one of his kidneys to a reporter apparently working for a Birmingham newspaper. Mr Tuck (a young man who had gambling debts) subsequently hanged himself. What possible good did his prosecution serve? All those involved in the prosecution of Mr Tuck need to reflect on the fact that a kidney sufferer may have been denied the right to treatment, and that the ill-considered prosecution of Mr Tuck may have contributed to his tragic death. These are not things I would wish to have on my conscience.

Since appearing as an expert witness before the Professional Conduct Committee of the General Medical Council in 1990 I have written on this subject several times – notably in the journal (Verdict) of the Oxford University Law Society (1996) and in the Guardian earlier this year.[1] But I have to say that there appears to be a determined reluctance amongst politicians to have a serious debate on the subject. When I asked my own MP to sponsor such a debate in the House of Commons, he told me that he was not prepared to do this because he had “a list of other things I think are of higher priority.”

But what could be a higher priority than the saving of lives?

If I wish to sell one of my kidneys I should be free to do so. As for the poor, none of us has any moral right to prevent them selling something that is theirs. If there is felt to be a risk of exploitation, then regulation, not prohibition, is the answer.

I very much welcome the Dutch initiative, therefore. Let’s hope that it will stimulate a calm, rational, ‘grown up’ discussion in this country with a view to decriminalising the sale of organs for transplant, and establishing a regulated market for such life-saving procedures.

[1] http://commentisfree.guardian.co.uk/geoffrey_alderman/2007/07/body_politic.html

Tuesday, 13 November 2007

Power to the People

The Conservative party – of which I am neither a member nor supporter – will today unveil a plan to give local-government electors the right to vote down large council-tax rises. Apparently, a threshold will be set, and any rise above this threshold will automatically trigger a local referendum.

Of course the devil will lie in the detail, but no-one concerned with the present moribund state of local democracy in England can do other than welcome this idea – as I do.

In response to the Tory proposal, the Local Government Association has said that “Local authorities should have the power to determine, without interference, the appropriate levels of council tax for their areas."

Presumably, however, the words “without interference” do not include local electors.

Of course it seems unlikely that local councillors will welcome these proposals, because the power of these councillors will – in effect – be usurped by the voters whose interests they are supposed to represent – but rarely do.

But if the local-referendum proposal is implemented, permitting local electors to veto local council budgets, local councillors will only have themselves to blame. For decades, a game of poker has been played between Whitehall and the town halls. Whitehall has shifted more and more of the tax burden to local councils, but local councillors have, for the most part, accepted and implemented these increases, and have shrunk from a policy of confrontation.

The Labour government's financial settlement for local authorities seems likely to trigger council-tax increases well above inflation in 2008. There is no justification for this, nor is there any mandate. But local councils do have a choice.

Whatever the culpability of the government, the political parties at local level can remedy the situation by announcing, now, that under no circumstances whatever will they propose or support above-inflation council-tax increases (inclusive of public-service precepts) next year.

Could they all please make such announcements, now?

Sunday, 11 November 2007

REPRESENTATION WITHOUT TAXATION

Lord Ashcroft is a multi-millionaire, whose fortune is said to amount to some £800 millions. He is a major donor to the Conservative party (of which I am neither a member nor a supporter). He is said to reside in Belize. It is not clear whether he pays any UK income tax.

The Guardian of 9 November 2007 ran a front-page story on him, alleging that prior to the conferment of his life peerage pledges were made by the Conservative party that he would return to the UK and pay UK income tax. The Guardian quoted David Heath, Liberal-Democrat spokesperson on constitutional affairs, as declaring that “No one should take a place in the legislature of this country who doesn’t pay taxes in this country.”

Why not? There are plenty of people living in this country who don’t pay any taxes. Are they, for that reason, to be barred from sitting in either House of Parliament? And what about voting? You don’t have to pay taxes in order to exercise the right to vote. The linkage between voting and payment of taxes was broken when the Representation of the People Act was passed in 1918. Indeed, until 1918 you couldn’t vote if you received poor relief – the dole.

In some ways this particular 1918 reform was retrograde. It has meant, and means, that citizens without any wealth, and who pay no taxes, are able to influence the tax burden on those who do have wealth, and are able to have a say in the manner in which these tax revenues (to which they have contributed nothing) are spent.

Be that as it may, the 1918 reform has stood the test of time. You can vote in local elections – and sit on your local council - whether or not you pay council tax, and in national elections – and be elected to the Commons - whether or not you pay income tax. So why, simply because you are a non-taxpayer, should you not be able to sit in the House of Lords?

I hold no particular brief for Lord Ashcroft. I do believe that he has rights, and is entitled to exercise them.