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Main Findings

• The consensus amongst commentators was that the proposed expansion to the range of purposes for which bodies could be used to include training in surgical procedures was welcome.
• Some respondents called for greater public awareness of the issues of authorisation of bodies in order to facilitate more informed decision making.
• The overriding view was that written authorisation by the potential donor was preferable to authorisation given orally.
• Respondents in favour of Scotland sharing an inspectorate with the rest of GB outnumbered those recommending a separate Scottish inspectorate by around 2 to 1.
• Arguments in favour of sharing an inspectorate included maintaining a consistency in approach, sustaining standards, sharing best practice and achieving a national perspective.
• There was unanimous support for the proposed amendment to allow bodies of persons whose deaths have been properly registered anywhere in the UK to be donated under the Anatomy Act.
• A divergence of views emerged on whether applications for licences and reasons for refusal of licences should be publicly disclosed. Overall, a slight majority was in favour of maintaining the present restrictions on disclosure.
• Of the majority who commented, all but one were in favour of issuing Codes of Practice.

Context

As it stands, the 1984 Anatomy Act, whilst making an important contribution to the training of health professionals, is curtailed in its usefulness relating to comprehensive training in new techniques. In particular, whilst graduate surgical trainees and students can dissect a corpse, they cannot practise surgical procedures that fall outside the scope of anatomical examination as it is currently defined in the Act. In short, the definitions and parameters set out in the Act require an overhaul to bring them in-line with technological advances, and indeed, the expectations of many of those who wish to bequeath their bodies for anatomical examination.

Parallel considerations in England and Wales have resulted in proposals for a comprehensive new Human Tissue Act which would replace the previous Anatomy Act 1984 and the Human Tissue Act 1961, and a new inspectorial structure. The issues are devolved, and whilst the Anatomy Act 1984 could continue in Scotland, the current HMIA arrangements for inspection in Scotland could be affected by changes south of the border and were therefore included in the consultation for consideration.

The Consultation

The consultation on the Existing Provisions and Licensing Arrangements of the Anatomy Act 1984 took place between 28 January 2004 and 30 April 2004. To launch the consultation over 300 copies of the consultation paper were distributed to a wide range of people and organisations in the public, private and voluntary sectors. A separate consultation on the regulation within the Human Tissue Act 1961 of hospital post-mortem examinations has also taken place and a report of the analysis of its responses completed.

A press release helped publicise the consultation paper which was made available on the Scottish Executive website.

The consultation paper highlighted specific issues on which views were invited. These were:

• Changes to the definition of anatomical examination to include training in surgical procedures
• Modernising the framework for donation of bodies for examination
• Updating licensing arrangements of premises to ensure more effective regulation of premises by HMIA for Scotland

Forty-three responses were received from a range of professional organisations and individuals.

Aims and Objectives

The aim of the research was to analyse the comments contained in written responses to the consultation on the Existing Provisions and Licensing Arrangements of the Anatomy Act 1984, to present the findings of the analysis and to identify any gaps in respondent sector.

Methodology

Responses to the consultation were sent to the Scottish Executive consultation team either in hard copy or via e-mail. The consultation team sent copies of each response to The Research Shop for analysis. The consultation attracted relatively modest numbers of responses but represented a wide range of respondent categories with NHS Scotland bodies and other medical organisations comprising the largest group of respondents. One gap in respondent organisations emerged as that of representative minority ethnic groups.

An electronic Excel database was used to store and assist analysis of the responses. Most of the analysis was qualitative in nature although where scope for quantitative analysis existed, this was exploited.

Nature of Responses

The general mood of responses was one of support for bringing the legislation up to date in order to reflect modern day needs and expectations and to take account of concurrent changes south of the border.

Authorisation and Donation of Bodies

Some respondents saw the need for making the public more aware of the issues of authorisation in order that potential donors and their families could make more informed decisions. The vast majority considered written authorisation to be preferable to authorisation given orally with many respondents also calling for written authorisation to be witnessed by up to 2 people.

Amongst the few respondents who commented, there was disagreement over whether the views of surviving relatives should be able to supersede those of the potential donor.

The vast majority of respondents were in favour of deleting Section 4(3) of the Act which relates to use of a cadaver for anatomical examination where the deceased had expressed no wish or opinion in this regard.

Most respondents were in favour of making it clear that bodies donated under the Act should not give rise to financial gain.

Definitions of Anatomical Examination, Body and Body Parts

Respondents agreed with the proposed expansion to the range of purposes for which bodies could be used to include training in surgical procedures. Some respondents recommended that the expansion should also include practical and clinical procedures and other health disciplines such as dental training.

Many commentators considered that the Act should possibly encompass a wider range of personnel such as other health professionals, students and non-medically qualified practitioners amongst those permitted to use bodies or their parts for training in surgical procedures.

The majority view was that the definition of what is meant by "part of a body" should be dealt with by a Code of Practice. Many respondents considered the prescription of a specific body proportion to be fraught with difficulties. However, a minority suggested pragmatic approaches to prescribing appropriate proportions of bodies for retention.

Issues of Inspection

The majority view was in favour of Scotland sharing an inspectorate with the rest of GB. This was seen as maintaining consistency, sustaining standards, sharing best practice and helping to achieve a national perspective. The part-time role of an inspectorate in Scotland was not seen as problematic, with ideas suggested for combining the part-time inspectorate functions with other related tasks.

All but one respondent who commented supported the proposal to enable an authorised Inspector to have the power to enter premises, whether licensed or not, on the authority of a warrant, should they have reasonable cause to believe that an offence has been committed. Opinions were split on whether an Inspector undertaking a forced entry should be accompanied by a uniformed police officer, or simply the most appropriate official depending on the context.

Issues of Protocol for Deaths Outside Scotland

The proposed amendment to allow bodies of persons whose deaths have been properly registered anywhere in the UK to be donated under the Anatomy Act was supported. Although supported in principle, some practical problems were associated with moving bodies of donors who had died away from home: time and cost implications; awareness of the deceased's wishes; and needing to honour any bequest to the donor's local medical school.

All but one commentator supported the proposed amendment to enable licensing requirements to apply to the possession in Scotland of any dissected body or body part irrespective of where the dissection took place or any form of processing.

Respondents stressed the importance of systematic record keeping, with a variety of suggestions made for length of record maintenance.

Miscellaneous Issues

There was a mix of views on whether applications for licences and reasons for refusal of licences should be publicly disclosed with a slight majority in favour of maintaining the present restrictions on disclosure.

The vast majority of those who commented were in favour of issuing Codes of Practice. These were seen as facilitating consistency of good practice, providing accessible and readily amended guidance, helping to maintain a consistent practice with the rest of GB, providing help for licensed teachers and reassurance to the public.

A recurring view was that Codes of Practice should be informed by a variety of stakeholders including doctors, licensed teachers, professional bodies and practitioners.

Respondents were evenly split between those who considered the current arrangements regarding offences and penalties for breaching of regulations to be adequate and those who wished to see harsher penalties introduced.

Respondents raised a few additional issues for comment. These comprised, a) the need for a Code of Practice relating to final disposal of bodies; b) the need for separate licensing arrangements regarding the location of any procedure carried out on un-embalmed bodies; and c) the need for greater clarification of procedures relating to historical collections of bodies/parts