Department of Health and Children responds to comments raised in relation to the Post Mortem Inquiry Report
In response to an Freedom of Information request from Parents for Justice some sections of the report of Ms Anne Dunne SC into post mortem practice were released on 18 July last.
When Ms Dunne presented her report and appendices to the Tánaiste in March 2005 the legal advice was that the full report was unpublishable for legal and natural justice reasons. Dr Deirdre Madden, a distinguished expert on medical law was appointed by Government to provide the Tánaiste with a report on key issues relating to post mortem practice and procedures. Dr Madden presented her Report to the Tánaiste on 21 December last and following its examination by Government it was published on 18 January.
The Post Mortem Inquiry process was initiated by Ms Dunne, and the work carried out Ms Dunne was taken into account by Dr Madden, who had access to all of Ms Dunne’s documentation. It should be clear to those reading the information that was released under FOI that the material content of both reports was similar.
The Tánaiste and Government agreed that Dr Madden’s report was a robust one which provided findings on post mortem practice and procedures in relation to children born alive and under 12 years between 1970 and 2000. While it answers the questions for many parents and next of kin it is acknowledged that this will never erase the lifelong sorrow and loss.
The key findings in the Madden Report are:
Post-mortem examinations were carried out according to best professional and international standards and no intentional disrespect was shown to deceased children or their families.
Communication between hospital staff and parents and next of kin was poor, with people not being told that organs might be retained at a post-mortem. This was often done for parternalistic reasons, where doctors did not wish to upset next of kin when they were already distressed and vulnerable.
There was no legislative framework in place and no consistent national policy relating to these practices. However, the lack of a national policy on post mortem practice until 2002 is not unique to Ireland, nor was it the usual practice in other countries to provide information about organ retention to relatives of a deceased person.
In some cases it may have been necessary to send samples of organs or tissues to hospitals in other countries for specialist examination.
The system of disposal of organs and tissues by hospitals was not intentionally disrespectful to children or their families. Hospitals were constrained by health and safety regulations and were obliged to consider organs and tissues as clinical waste. In this context, because there were no appropriate facilities in Ireland this material had to be sent to other countries for appropriate disposal in accordance with health and safety legislation.
Action being taken
Departmental officials and the Health Service Executive are working on the implementation of the 50 recommendations in the report in consultation with relevant bodies and a report will be provided to the Tánaiste at the end of the year on progress made. All recommendations, including the running of awareness and information campaigns will be implemented.
The Tánaiste set up a Working Group, as recommended by Dr Madden, to examine issues not covered under the terms of reference of the Report, dealing with babies who died before or during birth, minors over 12 years and adults. PFJ are active members of this Group, which is expected to produce its findings in the next few months.
Another recommendation in the Report was that there would be a national audit and public information campaign in relation to organs that may be retained in hospitals. The Tánaiste did not tell PFJ that this audit would not be undertaken. On the contrary, an internal audit has been carried out in one major hospital since the publication of Dr Madden’s report and it is expected that this will form the framework for the national audit which will be independently validated.
In April this year the Tánaiste signed regulations (SI 158 of 2006) on quality and safety of tissues and cells for human application, which provide that consent must be obtained before tissues and cells are procured. Work is underway on the drafting of other legislation as recommended.
PFJ has been supported by the Department of Health and Children and the HSE to provide advice and support to members affected by post mortems. From 2000 to the end of December, 2005 the Group had received just over €1.3 million and funding continues to be provided, mainly for counselling services.