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Organ Transplantation, the Criminal Law, and the Health Tourist: A Case for Extraterritorial Jurisdiction?

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1. R (on the application of Watts) v. Bedford Primary Care Trust, Secretary of State for Health [2006] ECR I-4325; du Bois-Pedain A.Seeking healthcare elsewhere. Cambridge Law Journal 2007;66:44–7; Davies G.The effect of Mrs Watts trip to France on the National Health Service. Kings Law Journal 2007;18:158–67; McHale JV.The right to medical treatment in EU law. Medical Law Review 2007;15:99108.

2. Fenton R.Catholic doctrine versus reproductive rights: The new Italian law on assisted reproduction. Medical Law Review 2006;14:73107.

3. See further s. 2 (1) Suicide Act 1961; A Local Authority v. Z [2005] 1 FLR 740; R (Purdy) v. DPP [2009] UKHL 45; Hirst M. Assisted suicide after Purdy: The unresolved issue. Criminal Law Review 2009;12:870–6; Nobles R, Schiff D.Disobedience to law—Debbie Purdy’s case. Modern Law Review 2010;73:295304; Greasley K.R(Purdy) v DPP and the case for wilful blindness. Oxford Journal of Legal Studies 2010:301–26.

4. See, e.g., Coggon J.Assisted dying and the context of the debate: Medical law versus end of life law. Medical Law Review 2010;18:541–63.

5. See the two principal reports into organ retention: the Bristol Inquiry Report’s Removal and Retention of Human Material; 2001; and The Royal Liverpool Children’s Inquiry Report . London: Stationery Office; 2001.

6. Warning over UK’s “organ tourists”; available at http://www.politics.co.uk/news/2008/08/15/warning-over-uk-s-organ-tourists (last accessed 20 Sept 2011).

7. Human Tissue Authority statement, June 2008.

8. Shimazono Y. The State of the International Organ Trade: A Provisional Picture Based on Integration of Available Information (2009). WHO; available at http://www.who.int/bulletin/volumes/85/12/06-039370/en/#R28#R28 (last accessed 16 Sep 2012).

9. See note 8, Shimazono 2009.

10. “Transplant tourist” defends trip. BBC News; available at http://news.bbc.co.uk/1/hi/wales/7123747.stm (last accessed 20 Sept 2011).

11. Japanese flock to China for organ transplants. Asia Times Online 2006 Apr 4; available at http://www.atimes.com/atimes/China/HD04Ad01.html (last accessed 16 Sep 2012); see also discussion in the Joint Council of Europe/United Nations study Trafficking in Organs, Tissues and Cells and Trafficking in Human Beings for the Purpose of the Removal of Organs. Directorate General of Human Rights and Legal Affairs, Council of Europe; 2009.

12. Branigan T. Executed prisoners are main source of Chinese organ donations. Guardian 2009 Aug 26.

13. Lamb D.Organ Transplants and Ethics. London: Routledge; 1990, at 133–40; Taylor JS.Stakes and Kidneys: Why Markets in Human Body Parts Are Morally Imperative. Dartmouth: Ashgate; 2005; Price D.Organ Transplants and Ethics. Cambridge: Cambridge University Press; 2000; Wilkinson S.Bodies for Sale: Ethics and Exploitation in the Human Body Trade. London: Routledge; 2003.

14. Savulescu J.Is the sale of body parts wrong? Journal of Medical Ethics 2003;29:138–9.

15. Re T (Adult Refusal of Treatment) [1992] 4 All ER 649.

16. Radcliffe-Richards J, Daar AS, Guttman RD, Hoffenberg R, Kennedy I, Lord M, et al. . The case for allowing kidney sales. Lancet 1998;351:1950–2.

17. CETS No. 186. See also Parliamentary Assembly Recommendation 1611 (2003) on trafficking in organs in Europe and Committee of Ministers Recommendation 2004 (7) to member states on organ trafficking.

18. Asian Task Force on Organ Trafficking Recommendation on the Prohibition, Prevention and Elimination of Organ Trafficking in Asia, cited in Joint Council of Europe/United Nations 2009 (see note 11).

19. Resolution WHA 40.13 on the development of guiding principles for human organ transplants adopted by the 40th World Health Assembly in May 1987. See also WHO Guiding Principles of Human Organs for Transplantation, endorsed by the World Health Assembly in 1991.

20. Resolution adopted by the 57th World Health Assembly, 22 May 2004, WHA57/18.

21. See generally discussion in Wilkinson 2003 (note 13), chap. 6, at 126–32.

22. In 2003 a report of the Council of Europe Parliamentary Assembly noted that trafficking networks targeted poorer European countries such as Estonia, Bulgaria, Georgia, Russia, Moldavia, Romania, and the Ukraine and pressured people into selling kidneys; see further Council of Europe. Trafficking in Organs in Europe; 2003; see also discussion in Wilkinson 2003 (note 13), 105.

23. Steering Committee of the Istanbul Summit. Organ trafficking and transplant tourism and commercialism: The Declaration of Istanbul. Lancet 2008;372:5.

24. See note 23, Steering Committee of the Istanbul Summit 2008.

25. See generally discussion in Wilkinson 2003 (note 13).

26. Veatch R.Why liberals should accept financial incentives for organ procurement. Kennedy Institute of Ethics Journal 2003;13:1936.

27. See discussion in Dickenson D.Body Shopping: Converting Body Parts to Profit One World. Oxford: Oxford University Press; 2008, at 154.

28. Erin C, Harris J.A monopsonistic market; Or how to buy and sell human organs, tissues and cells ethically. In: Robinson I, ed. Life and Death Under High Technology Medicine. Geneva: Manchester University Press; 1994.

29. See further discussion of this issue and ultimate rejection of this argument in Duxbury N. Do markets degrade? Modern Law Review 1996;59:331–48.

30. See Watson R.European Parliament tries to stamp out trafficking in human organs. British Medical Journal 2003;327:1009; Communication from the Commission to the European Parliament and Council. Organ Donation and Transplantation: Policy Action at EU Level. COM (2007) 275 final, 30 May 2007; Resolution of the European Parliament of 22 April 2008, Resolution 2007/2210 on organ donation and transplantation. Action Plan on Organ Donation and Transplantation: Strategic Co-Operation between Member States. SEC 2008- 2956, Brussels, 8 Dec 2008 (COM 2008, 819/3); Directive 2010/45/EC of the European Parliament and of the Council of 7 July 2010 on Standards of Quality and Safety of Human Organs Intended for Transplantation OJ L 2007, 6 Sept 2010.

31. See further discussion in McHale JV.Fundamental rights and health care. In: Mossialos E, Hervey TK, Permanand G, Baeten R, eds. Health Systems Governance in the EU. Cambridge: Cambridge University Press; 2010.

32. See Brahams D.Kidneys for sale by living donors. Lancet 1989;285:1441–3.

33. Report of the Inquiry into the Royal Liverpool Children’s Hospital (Alder Hey) (2001); available at http://www.rclinquiry.org.uk (Alder Hey Report) (last accessed 16 Sep 2012). Bristol Inquiry Interim Report. The Inquiry into the Management and Care of Children Receiving Complex Heart Surgery at Bristol Royal Infirmary: Removal and Retention of Human Material. 2000 May. Crown Copyright.

34. The Investigation into Retained Organs, Chief Medical Officer’s Report on Organ Retention. London: Department of Health and Social Services; 2001.

35. See generally the discussion in Price D.From Cosmos and Damien to Van Velzen: The human tissue saga continues. Medical Law Review 2003;11:147.

36. See further Hardcastle R.Law and the Human Body: Property Rights, Ownership and Control. Oxford: Hart; 2007, at chap. 4.

37. Liddell K, Hall A.Beyond Bristol and Alder Hey: The future regulation of human tissue. Medical Law Review 2005;13:170223.

38. House of Commons Hansard Debates 28 June 2004, column 115.

39. Human Tissue Act 2004, s. 32(8), (9).

40. Human Tissue Act 2004, s. 32(8).

41. Human Tissue Act 2004, s. 32(9).

42. Human Tissue Act 2004, s. 32(2)(b).

43. See note 36, Hardcastle 2007, 118.

44. Human Tissue Act 2004, s. 32(6).

45. See note 36, Hardcastle 2007, 118.

46. See further Dworkin G, Kennedy I.Human tissue: Rights in the body and its parts. Medical Law Review 1993;1:291319; note 36, Hardcastle 2007; Matthews P.Whose body? People as property. Current Legal Problems 1983;36:193239.

47. See further R v. Luff, The Times, 13 December, 1960; R v. Herbert, The Times, 22 December 1960; R v. Kelly [1999] QB 621; Yearworth v. North Bristol NHS Trust [2009] EWCA Civ 37; Quigley M. Property: The future of human tissue. Medical Law Review 2009;17:457–66.

48. R. v. Tuck [2007] O.J. 2988 and see Body parts sale man avoids jail. BBC News; available at http:///news.bbc.co.uk/1/hiu/england/west_midlands/6646467.stm (last accessed 16 Sep 2012).

49. See further Lowe V.International Law. Oxford: Clarendon Law Series; 2007, at chap. 5.

50. Hurst M.Jurisdiction and the Ambit of the Criminal Law. Oxford: Oxford University Press; 2003, at 55.

51. R v. Harden [1963] 1 QB 8.

52. [1963] AC 48, at 67.

53. [1957] AC 602 HL.

54. [1971] AC 537, at 552–3.

55. See note 3, Hirst 2009, 55.

56. E.g., Criminal Justice Act 1993 s. 1 made special rules in relation to certain designated offenses, e.g., theft/false accounting/blackmail.

57. S. 9, Offences Against the Person Act 1861.

58. S. 4, Offences Against the Person Act 1861.

59. S. 7, Bribery Act 2010, and see further Sullivan G.The Bribery Act 2010: Part 1 an overview. Criminal Law Review 2010:87100.

60. R v. Harden [1963] 1 QB 8 and Treacy v. DPP [1971] AC 537.

61. Blackstone’s Criminal Practice. Oxford: Oxford University Press; 2009, at 155–6.

62. In Smith (Wallace Duncan) [1996] 2 Cr App R 1 and Smith (Wallace Duncan) (No. 4) [2004] QB 418.

63. [1999] QB 980.

64. [1963] 1 QB 8.

65. [2004] QB 418.

66. See note 65.

67. See note 65.

68. See note 61, Blackstone’s Criminal Practice 2009, 156.

69. EWHL 95, 2008.

70. See, e.g., X v. Y [1988] 2 All ER 648; General Medical Council. Confidentiality. London: GMC; 2009; NMC. The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. London: NMC; 2008.

71. Campbell v. Mirror Group Newspapers [2004] 2 All ER 99.

72. See, e.g., W v. Egdell [1990] 1 All ER 835; McHale JV.Confidentiality: An absolute obligation? Modern Law Review 1989;52:715–21; Mason JK.The legal aspects and the implications of risk assessment. Medical Law Review 2000;7:6984.

73. S. 19, Terrorism Act 2000; also see s. 172 of Road Traffic Act, in which on request a doctor must provide any evidence that may lead to the identification of a car driver involved in an accident.

74. R v. Cambridge DHA, ex p B [1995] 1 WLR 898; Re J (a minor) (wardship: medical treatment) [1992] 4 All ER 614. See also generally Syrett K.Law, Legitimacy and the Rationing of Health Care. Cambridge: Cambridge University Press; 2007, at chap. 1–6.

75. Shoham S, Hinestrosa F, Moore J, O'Donnell S, Ruiz M, Light J. Invasive filimentious fungal infections associated with renal transplant tourism. Transplant Infectious Diseases 2010;123:71–6.

76. Shimazono Y. The state of the international organ trade: A provisional picture based on an integration of available information. Bulletin of the World Health Organization; available at http://www.who.int/bulletin/volumes/85/12/06-039370/en/#R33#R33 (last accessed 13 Nov 2011).

77. See generally, in relation to rationing, Newdick C.Who Should We Treat. Oxford: Oxford University Press; 2005.

78. See further, e.g., Bloor K, Grubb J.Head to head: Should patients be able to pay top-up fees to receive the treatment they want? British Medical Journal 2008;336:1104; Richards M.Improving Access to Medicines: Report by the Secretary of State by Professor Mike Richards. London: DOH; 2008; Jackson E.Top up payments for expensive cancer drugs: Rationing fairness and the NHS. Modern Law Review 2010;73:399; and Sikora K.Paying for cancer care—a new dilemma. Journal of the Royal Society of Medicine 2007;100(4):166.

79. GMC. Good Medical Practice: Decisions about Access to Medical Care. London: General Medical Council; 2007.

The author would like to express her thanks to Sheelagh McGuinness, Tom Walker, and Stephen Wilkinson, the organizers of the Organ Donation and Consent Wellcome Trust Workshop at the University of Keele, where an early version of this article was first presented; the editors of this special edition; and the anonymous reviewers of this piece. All opinions expressed and indeed any errors that remain are of course solely of the responsibility of the author.

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Cambridge Quarterly of Healthcare Ethics
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