‘What if?’ is a question many novelists ask themselves – ‘What if that man across the street is a murderer?’, ‘What if that woman is having an affair?’

Hazel McHaffie had been asking ‘What if?’ all her working life, but in a very different context.  As an academic researching medical ethics it was her job to look at some of the most difficult questions society has to face – ‘What if we allow people the right to die? What if we don’t?’ ‘What if we refuse to treat people with problems caused by smoking or alcohol abuse?’  The field is, she says, wonderfully rich and challenging; as medicine continues to push the boundaries of what is scientifically possible, more and more questions arise as to where – if at all – a line should be drawn and choices made.

Hazel was involved in research about the ethics of keeping very sick babies alive when she first turned to fiction.  Writing proposals to attract funding, she realised that whilst this was an excellent subject for a novel, she was going to have to write that novel before she started interviewing parents and doctors for her academic project – otherwise she might well be accused of using confidential information.  A publisher accepted the book immediately, and Hazel’s career as a novelist had begun.  On Tuesday at Fountainbridge Library Hazel discussed her eighth fiction book, Over My Dead Body.

The subject of organ donation has been in and out of the headlines for years.  Many people now carry donor cards and have joined the NHS Register of Donors; many others have not, whether for religious or moral reasons, or simply because they don’t like the idea or ‘haven’t got round to it.’ An aspect that most of us give little thought to, though, is what we would say if we were asked to consent to the donation of someone else’s organs – our partner, parent or child, or indeed anyone for whom we are classified as ‘next of kin.’ How many of us have discussed this difficult subject with our families?  And even if we have, would we still think the same way in the middle of a crisis?

In Over My Dead Body, Hazel poses all of these questions and more.  Elvira, a 35 year old widow, is driving her two young daughters to ballet when they are involved in a head-on crash.  Elvira is able to tell the police that her parents are her next of kin, but she quickly deteriorates and soon Carol and Guy are being asked if they will consent to the use of their daughter’s organs after her death. Carol has more than one reason for saying no to this request: whilst it’s true that she can’t bear the thought of anything else happening to Elvira’s body, she also harbours a very dark secret about the family’s past – a secret that led to them moving from the Highlands to Edinburgh .  Carol fears that the use of Elvira’s organs will reveal this secret, and she also believes that any recipient of those organs may take on some of Elvira’s characteristics.  She doesn’t want that to happen – but why?

The theory of cellular memory – the idea that organs can bring with them parts of the donor’s personality – has been used as the basis for many novels, especially in the US.  Hazel did not want to write a novel based entirely around it, although she does have her own opinions on the subject.  She interviewed many organ donors and donees who believe that cellular memory exists, but as in all her books Hazel has been careful to keep her views out of the story – she aims to present many different aspects of any ethical issue she is covering, to encourage people to stop and think and to realise that there is always more than one side to any argument.

over my dead body

In the story, Carol and Guy are further discomfited when they find a stranger at Elvira’s bedside. Oliver claims to be her boyfriend but Elvira has ever mentioned him; he says they were very close and planned to marry.  Moreover he says that he and Elvira had discussed organ donation, Elvira wished to participate and had signed up to the donor register.  Carol can’t believe that Oliver is who he claims to be. Who is telling the truth? The organ register is not conclusive: next of kin consent is still required before a transplant can proceed; should Oliver be discounted as Elvira’s next of kin just because their marriage hadn’t taken place?

When the police call at Carol and Guy’s home to inform them of the accident, Carol is painting a picture that she plans to give to Elvira to reveal the family secret to her.  What did the painting mean? Why could Carol not tell Elvira herself? And what is going on between Carol and Guy?  Guy is at first a shadowy figure who says little; he has his reasons for keeping quiet, although he does eventually express some opinions.

The other side of the story is of course that of the potential recipients of the organs, and they too bring with them moral dilemmas, especially for the people who have to decide who gets what.  Hazel explains that the organs from one person can save the lives of up to nine people, but nine to ten thousand people in the UK alone are waiting for transplants and three die every day still waiting; there are far fewer organs available than people needing them.  In the book Hazel describes some of the possible recipients of Elvira’s heart and kidneys; is a middle-aged man with dependants more worthy than a young girl with her life ahead of her?  Who should get a kidney, a twelve year old boy or a teenager?  And what happens when a child’s parent refuses to allow him to have any kidney except the parent’s own – which comes with conditions attached?  Again Hazel stresses that she tries to present characters whose claims have equal weight, to show the readers how difficult these issues are, and to encourage them to talk to their own families about them before they are thrust into the situation themselves.

The longer Hazel has worked in medical ethics, the more she has come to realise that there are many valid opinions on any subject, even if some of those opinions are not hers.  Each of her novels includes someone who holds strong religious views  – usually a chaplain or priest, someone who might stand between the medical experts and the families involved.  In Over My Dead Body, the chaplain also has personal experience of organ transplant, adding another layer to the complexities of the story. Hazel points out that religion is a huge part of medical ethics, ‘one of the hardest things to change with medical logic is a religious scruple.’

Hazel has no trouble in finding ideas for her books; whenever she sees or hears something interesting, whether in a newspaper, a medical journal or on the bus, she makes notes and keeps them in folders, one for each ‘issue.’  She currently has twenty-seven folders on the go, and when she’s deciding what to write about next the size of the folder tells her where to start.  She explains that she could have tackled the topic of organ donation in many ways but that some of the true stories she has come across simply would not be believed by her readers: a teenager found in a field with his internal organs replaced by newspapers, an Indian farmer who sold his wife’s kidney to finance a new tractor, a child found with no eyes – all of these things happened.  The World Health Organisation estimates that seven thousand kidneys are illegally trafficked every year.

Hazel’s novels are still fundamentally family sagas about people and how those people think and act – although she would like readers to think about the dilemmas those people face and how they themselves would approach them, it is just as possible to read the stories as stories, and she points out that there is plenty of humour and romance in them too – ‘it’s not all doom and gloom.’  When she used to attend academic conferences Hazel noticed that most of the professors’ lectures were boring, stuffed full of dry facts and figures.  Young registrars, by contrast, would talk about real life dramas – about people – and their sessions were much more popular and interesting.  She soon realised that fiction would be a great way to discuss the issues that interested her, and to share them with people who did not have any background in the subject.  She wants to make it clear though that all of her characters are made up:

‘I don’t write about people I know, I write about what I know about people.’

One of the many things that Hazel relishes about writing fiction is that she no longer has to add all those academic references at the end of every chapter – but this does not mean that she is slack about her facts. She always carries out a great deal of research: to write Saving Sebastian, her novel about ‘saviour siblings’ she spent days with embryologists and in clinics.  She’s now onto her ninth book, which she originally intended to be about eating disorders, but her plans soon changed  She always reads lots of ‘the competition’ first, and having struggled through numerous dull stories about anorexia she decided that she needed to widen her remit.  The novel will now also focus on gender identity, our celebrity culture, and the pressures of social media.

Asked if her novels would make good films Hazel replies that she would much prefer to see a television series addressing various ethical dilemmas, each illustrated by one of her books.  Hazel’s first novel was used as a set text for medical students, who were required to argue the case for a viewpoint they did not necessarily hold.

Hazel is frequently asked to take part in consultation exercises to encourage healthy debate based on fact and to allow many different voices to be heard.  This can sometimes be very difficult, and she cites the example of a discussion about the withdrawal of treatment from very premature, sick or disabled babies. One committee member was herself a disabled person, and felt that people were saying that her own life had not been worth saving.  Other members spent a long time explaining that they wanted to talk about whether it was right to impose a high level of disability on a new baby, and Hazel was very pleased that everyone waited until this member felt able to join the discussion, ‘The more you look into anything, the more you see that everything is shades of grey; there are no black and white answers.’

Provocative, unsettling, fascinating, challenging: the world of medical ethics can be described as all of these. Hazel McHaffie hopes that her novels will persuade her readers to think about life’s big questions: to ask ‘What if?’

Over My Dead Body by Hazel McHaffie is published by VelvetEthics Press and is available in bookshops, online, and in Edinburgh libraries.