Coroners and Justice Bill

My Lords, I shall speak also to Amendment 33. Amendment 32 is in keeping with the Government’s desire to make investigations at post-mortem more relevant and helpful to the family of the deceased, as in paragraph 37 of the draft charter for the bereaved. At post-mortem, it is often possible to go beyond the needs of the coroner and to get information relevant to relatives’ future health. Currently, it is a criminal offence for a pathologist to undertake work to further examine tissues if the wishes of the relatives are not known at the time of the post-mortem. Indeed, it is illegal for the pathologist to remove small samples of tissue for further examination, irrespective of what he finds, even if the coroner is no longer involved. It is also important to remember that if the wishes of the relatives are known, such as that they want a post-mortem which is to the absolute minimum, a pathologist can satisfy the needs of the state and still meet some of the wishes of the relatives by modifying the way in which the post-mortem is undertaken. A clear example of that is if, in the body cavities, it is quite obvious that the cause of death is natural and what the cause of death is, it may not be necessary to undertake a full examination, including slicing the brain. The first report from the Human Tissue Authority revealed that post-mortems are being undertaken in complete ignorance of the wishes of the relatives, and it made recommendations. However, the second report shows that problems still persist and that the wishes of the relatives are still not known by the pathologist. Sadly, that is probably because the Human Tissue Authority cannot influence how coroners work. Some coroners try to get round that before a post-mortem by trying to gain permission from the relatives for the blocks and slides to be retained so that they form part of the medical record. One would think that that would be good, humane and ethical practice. Sadly, some coroners do not go to the effort of obtaining that additional consent. Amendment 33 is designed as an enabling provision so that the Human Tissue Act can have flexibility without any possibility of return to the post-mortem practices which led to the 2004 Act. It will allow it to be brought closer to the Human Tissue (Scotland) Act 2006. The present problems fall into two categories: first, the inability to provide work for the benefit of the state; and, secondly, the inability to provide work for the benefit of the deceased’s relatives. For the benefit of the state there are three broad groups: the first is forensic research. Research into shaken baby syndrome currently demands consent from the person accused of murder. There is no alternative. Research intended to prevent severe miscarriages of justice is in fact prohibited by law. Secondly, when the cause of death of an infant is not ascertained, the death is classified as being due to sudden infant death syndrome. A small proportion of those are unnatural deaths, but the vast majority are likely to be due to infections or other processes which are not yet identified. If there is a second death in that family, it could be essential to be able to go back and refer to tissues because you may then show that there was an inadequate immune response, for instance, to infection, which had not previously been detected because some highly sophisticated techniques would need to be used to stain the tissues. The third area where the needs of the state are not being met at the moment is public health. The classic example is research into hidden infections. There was a recent important investigation into new variant Creutzfeldt–Jakob disease which planned to take a tiny sample from the spleen of each deceased person at post-mortem. The coroners perceived that obtaining consent was outside their remit so that important Department of Health-funded research folded and we have no idea what the true instance is of new variant CJD. The other area is work for the benefit of the relatives. That is best illustrated by sudden cardiac death in young adults, which is usually caused by a variety of cardiomyopathies, some of which are inherited. To sample the heart requires appropriate consent. Qualified consent, as in the Human Tissue Act, would cover only the DNA analysis, so to take a piece of tissue requires appropriate consent. The trouble is that if one person refuses consent, and they may well do in the trauma and turmoil of being immediately bereaved, all other relatives are denied the benefit as the heart cannot be examined further. When another family member dies suddenly, the tragedy is more than doubled. It is important to remember that some of these conditions are inherited as autosomal dominants, not autosomal recessives. I am sure that the Government will say that consent is at the heart of the Human Tissue Act, and I am completely in agreement with the principle of consent, but it must be truly informed consent so relatives who have done no wrong are better served and miscarriages of justice can be more easily detected in future. Consent and well-being are at the heart of these amendments. I beg to move.