SECOND OPINION:Issue highlighted by proposed sale of Michael Collins's hair
THE RECENT hubbub over the proposed sale of a lock of Michael Collins’ hair reminds us that we care deeply about what happens to ourselves and our loved ones after death.
Our well-developed bereavement and funeral rituals are one aspect of this: the other is the due attention we pay to last wills and testaments, above and beyond the financial aspects. We also carry and respect a moral and emotional inheritance in terms of what we have learned from our deceased parents and wider family.
Yet in a modern and complex world, this respect can come under fire from many quarters and we need to be vigilant in defending the dignity of those who can no longer defend themselves.
The tolerance for the ongoing exhibition of the bodies of Chinese people in the Ambassador in Dublin remains a source of shame: it is troubling that a Minister for Education with a record of defending human rights has not formally advised schools to avoid this commercial venture.
The medical profession also had significant soul-searching after the retained organs episode, and significant improvements have followed in education, guidelines and practice. Some historical issues remain: in an otherwise superb exhibition in the Old Library in Trinity College Dublin celebrating the tercentenary of its medical school last year, one unhappy exhibit was the display of a skeleton of unhappy provenance.
Cornelius Magrath was an Irish giant whose body was snatched after his death in 1760 by Trinity medical students who had “befriended” him. It is hard to justify the retention of his remains on historical or ethical grounds, and certainly serves as an example that medical students are also bound by ethical codes.
A replica would serve equally well, samples for DNA have already been taken for international collaborative studies, and a respectful disposal of his remains in keeping with current protocol for donated bodies would seem to be the least that modern thinking in bioethics would demand.
His case is substantially different to respectful archeological displays, such as that mounted in a sensitive and educational way by the National Museum of Ireland in its Kingship and Sacrifice exhibition of Iron Age bog bodies. Indeed, there is a significant and thoughtful ethics literature on the subject of human remains from ancient civilisations.
But of most immediate relevance to you and I is increasing pressure to erode the confidentiality we take as a given in our medical notes.
Requests for copies of the notes of deceased patients are more and more common, and finding ways to deal sympathetically and effectively with the concerns of relatives without breaching faith in the confidentiality of the medical system is hugely important.
For issues such as disputes over wills, there are clearly defined routes through legal requests, where the notes are released under a legal privilege which maintains confidentiality.
For adequacy of care or genetic concerns, my own practice is to arrange a speedy meeting with the relatives, clarify and explain where possible, and to have a very low threshold to arrange for independent third-party review to ensure all involved that openness about quality of care is of paramount concern.
Why such protectiveness of your notes when you are no longer here? Because you may have told us sensitive facts about your family that you do not wish them to know. If you are one of the significant minority of older people who have memory problems, we will have collected information from some but inevitably not all of your family which may cause distress if released indiscriminately after your death. These also gave this information in the expectation of confidentiality.
In addition, elder abuse affects one in 20 older people, not to mention issues such as domestic and child abuse which can be entered appropriately in your notes in the context of preserved confidentiality, but which you would not wish to effectively be accessible on the bookshelf in the homes of one of your adult children. Indeed, to which family member might notes be released?
Our freedom of information regulations are faulty on this matter, as recognised by the Information Commissioner in 2006.
A fresh and sensitive review is needed urgently to ensure that our moral and human engagement with our doctors is as secure after death as during life, while ensuring mechanisms to address satisfactorily the concerns of those we leave behind.
Prof Des O’Neill is a consultant in geriatric and stroke medicine