Hazel McHaffie

Questions & Challenges for “Over my Dead Body”

Literary questions for reading groups

For discussion

  • Q. What are the main characteristics you would attribute to Elvira, Carole, Guy and Willow? How far do you think these account for the tensions within the family?
  • Q. We hear a lot about Carole’s feelings and opinions. How accurate do you think her perceptions of a) herself, b) her husband and c) her daughter are? Did your opinion of Guy change by the end of the book?
  • Q. Why do you think Carole is so obsessed by what happened to Sally? Are her fears about a) Elvira, b) the organs, and c) Willow justified? What was your response to the revelation?
  • Q. The policeman, Lennox McRobert, has confidential information from the past. Was he justified in a) reassuring Carole, b) not sharing it with the Family Liaison Officer?
  • Q. Carole takes steps to protect Elvira’s memory (an isolated grave, a simple headstone, withdrawing her book of poems). Does this behaviour tally with your picture of her?
  • Q. How does it square with her replying to the letter of thanks Sam sent?
  • Q. In Chapter 18 Carole lists a number of reasons why she doesn’t want to donate Elvira’s organs. How far do you a) sympathise with her reservations, b) agree with her final decision, c) feel she was influenced by Oliver or the chaplain?
  • Q. Has this book changed your personal opinions about organ donation? Are there any circumstances which would make you say no to either receiving or donating an organ? Are there any organs or tissues you would personally not want used from a) yourself or b) your child?
  • Q. Oliver asks: ‘What’s the point of deciding for yourself, carrying a card, being on the register and everything, if they don’t take any notice when you’re dead?’ How would you answer him? Of all those connected to Elvira, whose opinions about the use of her organs should carry most weight? Why?
  • Q. Several people in this story are exercised by the ‘worthiness’ of potential recipients and their unhealthy lifestyles. The specialist nurses assure them that decisions are made on the basis of medical need, by impartial assessors and computers. What are your opinions on this? Does hearing the recipients’ stories influence your views about the use of Elvira and Madeline’s organs?
  • Q. Would you support the use of organs from a) impoverished foreigners, b) executed prisoners?
  • Q. Patty Ingram wanted to give her own kidney to her brother, Sam. He refused it. What do you think about live donation a) to a relative, b) to a stranger, and c) through a chain of patients and their relatives?
  • Q. There is a shortage of organs available for transplantation. Far more people agree with organ donation than sign the donor register. Which of the steps to encourage participation listed in Chapter 34 did you find most persuasive? Can you think of any others?
  • Q. Sometimes transplanted organs fail or are rejected. Sarah wonders if donor families should be told. Would you wish to know?


Moral and ethical questions

The central issues in Over my Dead Body are autonomy and confidentiality. Should a family be allowed to override the stated and documented wishes of a relative who is now deceased, when the lives and health of others are at stake?

Rights and interests

  • Q. Elvira had a right to state her wishes in respect of her own organs while she was alive. And as Oliver says: ‘It’s there in black and white. She signed the register. She told me that’s what she wanted.’ The medical staff, however, defer to the family’s preferences after her death. Whose rights and interests do you think should be paramount: those of Elvira herself, her mother, her father, her brothers, her daughters, her boyfriend?
  • Q. Carole has her own reasons for not wanting Elvira’s organs used. Should her personal domestic interests be permitted to outweigh the interests of other people for whom a transplant could be life-saving or transforming?
  • Q. Carole and Guy are equally Elvira’s parents. Should Carole’s wishes be allowed to override Guy’s?
  • Q. What rights does Oliver have as her ‘part-time’ partner? Would this change if he lived with her? Or was married to her?
  • Q. The teams involved in medical care, donation and transplantation go to great lengths to keep their roles and interests separate. Why do you think that is? Are there any circumstances where they might usefully collaborate?
  • Q. Oliver contrives an interview with Sarah without Elvira’s parents present (Chapter 12). Did he have the right to do so?
  • Q. Given the shortage of organs, should donors be able to select which organs they donate? Carole and Oliver hate the idea of Elvira’s corneas being taken. Do you share this reservation?

Autonomy and paternalism

  • Q. The medical staff know the benefits of a transplant to ill patients in their care. Should they ever be allowed to adopt a paternalistic stance in order to save life?
  • Q. In Chapter 28, twelve-year-old Finn Lincoln is caught between warring parents each trying to score points off the other. Now his life is in the balance: to what extent should a) Finn himself; b) his mother, c) his father or d) the medical team have the power to decide whether or not he gets a transplant? Should his absent father have the right to say it’s his live donation or nothing? How would you respond to his attempt to blackmail the authorities into acceding to his requests?
  • Q. Several parents in this book are exercised by the merits of the people who receive their children’s organs. Should their preferences be taken into account?
  • Q. If Drew had lived he’d have been the person to authorise the use of Elvira and Maddie’s organs. Who do you think should now Drew is no longer there?
  • Q. How ethical or otherwise did you feel the comments of Specialist Nurse, Sarah, to the family were when they were considering donation from Chapter 10 onwards? Was she giving both sides of the arguments fairly, or were her responses weighted in favour of donation?
  • Q. Was it right for Sarah and Ruaidhri to try to unearth the Beacham’s secrets? Did their aim justify the means?

Confidentiality and the right to know

  • Q. Elvira’s past haunts this story. Was Carole right to conceal it from Elvira herself?  Does anyone else have a right to know? Should Inspector Lennox McRobert have shared the information with his colleagues who were closely involved with the family after the accident?
  • Q. Carole is keen to keep her distance from the recipients of the organs … until Sam’s poem arrives. Then the boundaries set to safeguard the anonymity of all concerned were breached. Whose ‘fault’ was this?
  •  Q. In the sequence of events which led budding journalist, Patty Ingram, to discover the events of thirty years ago, should anyone have behaved differently?
  • Q. The chaplain fears that sharing his personal story might have unduly influenced Carole Beacham. Are his scruples justified? Are there any circumstances where staff’s personal opinions should be offered?
  • Q. Just how much information about the recipients do you think the donor family should be given?
  • Q. Carole doesn’t want to know if the recipient of the liver was an alcoholic who has reverted to drinking. Would you? Sarah doesn’t think she should tell the Beachams if any of the transplants were unsuccessful. Is she right?

Proxy decision making

  • Q. Do families have the right to choose what happens to their deceased relative’s organs? Should they have?
  • Q. Keeping a patient on a ventilator preserves a sense that they are still alive. To what extent do you think this fact influences the thinking of Elvira’s family in this story?

Balance of burdens and benefits

  • Q. When Oliver asks Sarah about an opt-out system she replies, ‘Ideally we’d all like people to give their organs freely and willingly. But there are those who argue that the desperate shortage of organs trumps finer feelings.’ What do you think?
  • Q. Lennox McRobert has just become a grandfather for the first time. He’s aware of the change in his thinking now. To what extent should personal experience and empathy be allowed to influence his professional conduct?

Ethical issues at the end of life

  • Q. Carole knows she is terminally ill. How much do you think this influences or explain her behaviour towards her husband, her sons, her granddaughter, the recipients of Elvira’s organs? Is this appropriate?

Ethical issues relating to organ donation and transplantation

  • Q. In Chapter 12, Sarah tells Guy, ‘Deciding when a patient’s actually dead, that’s medical. Deciding who should be a potential recipient, that is too. But deciding whether or not organs may be used for this purpose – well, it’s partly family and partly medical. The family say if they agree with donating organs, but the doctors decide if the organs are suitable for transplanting.’ Would you be happy with this allocation of responsibility?
  • Q. Has this book changed your own view about organ donation or transplantation? If so, in what way?
  • Q. Would you make a different choice in relation to giving your own heart from giving the heart of your child? If so, why?


  • Q. Guy suggests that if they would want to accept an organ to save the life of their granddaughter, they should be prepared to give the organs of their own daughter and granddaughter to save others. Do you agree with him?
  • Q. To what extent does the past influence Carole’s present? Is this fair?
  • Q. In Chapter 25, teenager Jade Connolly is offered the heart of an older man who smoked? He gets the heart and lungs of a healthy young woman, Elvira, although technically he only needs her lungs. Is this fair?
  • Q. Allocation of organs is based on medical priorities and availability. The relative merits or ‘worthiness’ of the potential recipients are not factored in. Several characters in this book question the justice of this. What do you think?

Resource allocation

  • Q. The age and expected life span of recipients could influence the value-for-money of a transplant, as this book illustrates. But each person is loved and valued by their own family and friends. Should their potential contribution to society be a factor in the allocation of organs?
  • Q. Huge sums of money are devoted to trying to save Elvira’s life even though the prognosis is poor. The thought crosses the surgeon’s mind that even Elvira herself ‘might be better served by inaction.’ Given that her organs could potentially save/transform the lives of many other ill people are these heroic efforts justified?
  • Q. Examples are given of a Chinese teenager selling his kidney to buy an iPhone and iPad, a farmer selling his wife’s kidney to buy a second-hand tractor, a businessman donating to his father, the organs being used from executed prisoners, a lucrative black market in organs. Which, if any, of these practices could you justify?