I missed this one the other day when discussing the government’s new law to seize organs without our explicit consent, so I’m drawing attention to it now. I like the way that Max Marlowe has framed the debate. I have always said that presumed consent is not consent and it is taking without asking first – i.e theft. Calling it the Organ Seizure Act encapsulates neatly the whole matter of what is so wrong with this law.
On Wednesday the Organ Donation Act came into force: “force” (the government’s words, not ours). This means that, based on a consultation of 17,000 individuals, the government has chosen to nationalise the organs of its citizens rather than gain their explicit consent.
The nationalisation is clear. On death, the person, after consulting with family, will be presumed to have consented to have their organs harvested:
Again, the wording is spot on – the state has effectively nationalised our bodies. Supporters of this vile idea claim that once dead, what does it matter to us? Convenience is more important than principle or ethics. They miss the point by a country mile. The decision to give or not is one that we make when alive. If we have not made that decision known, then no such assumption can be made and we default to the norm – that is, the usual disposal of the body via burial or cremation. I see nothing wrong with the next of kin making a different decision as they will have known the deceased and are likely to have a view about how the person felt on the matter. But it is not for the state to make a blanket decision.
Another factor this article picks up on that is important is this:
This act will not even be guaranteed to increase the rate of organ transfers. Presumed consent, as it is officially known, has not been statistically demonstrated to increase transfer rates (Hitchen, 2008). This has been demonstrated in Wales, Sweden, Singapore, Chile, and Brazil (Arshad et al, 2019).
In order for organs to be suitable for harvest, the person needs to die in a specific circumstance – in hospital following brain death, but an otherwise intact body. Outside of this, the organs will have deteriorated by the time they can be harvested, so merely switching to presumed consent will not increase the rate at which people will die in the right circumstances.
They also remind us of this:
A lot of this revolves around Nudge Theory (Thaler and Sunstein) and resolving policy problems through the manipulation of choice architecture.
I realise of course, that once politicians got hold of the idea, it ceased to be what Thaler and Sunstein intended, but the whole concept is one I find deeply abhorrent. Indeed, when they manipulate the choice architecture to try and nudge me, they merely make me dig my heels in and become even more obstinate. I will not be nudged, cajoled or bullied. And I will not have my consent presumed. Instead, I have actively taken that consent away. And, no, it does not mean that I am condemning anyone to die. Again, the article puts it very well:
Thirdly, the sick do not have the right to the organs of the dead. There is no obligation to transfer ownership of organs from one individual to the other just because they are not in usage anymore. This may sound heartless, but there are two parties to this, and a Burkean conception of presence post-mortem is still important. Why else is there the veneration of the dead in British Culture?
Precisely and my own approach all along:
No sane individual would baulk at seeing less people on waiting lists and more people living happy, fruitful lives. Yet, the method of getting here must be ethically sound.
This, then is what it is all about. By deliberately opting out, I am in my own small way reminding the powers that be of their ethical obligations. If they will not behave ethically, I will withdraw my consent. No exchange should take place if the process is not entirely ethical. Ever.
For years I carried an organ donor card with explicit instructions that my organs could only be used if the recipient was personally known to me. My reasoning for this was that there are a lot of people around who don’t deserve my organs. I’d rather they died than help prolong their life. Would you like to help a child molester live longer, for example? Thankfully I don’t personally know anyone like that, so if I knew them, they were welcome to have my organs.
As soon as I heard about the presumed consent I opted out and have told my relatives.
or like George Best, the footballer that needed a liver transplant due to his severe and persistent alcoholism.
As soon as the new liver was installed, he went back to his alcoholism and drinking himself to death. OK, the official cause was kidney failure because of the immuno suppressant drugs he was on but it was (in my opinion) only a matter of time before he needed a second liver transplant.
Wikipedis covers it:
https://en.wikipedia.org/wiki/George_Best#Personal_life
Another concern to old gits like me is – does a withdrawal of consent put a none too secret black spot on your medical records which will be the working equivalent of DNR? In other words, doctor, he doesn’t want to fit in so let him out . . .
I suspect that as we grow older, our organs aren’t much use anyway.
Not for transplant perhaps but does the small print preclude research or more general useage?
I’ve not overly concerned what happens to my bits when I’m dead as they would only burn (I would always opt for cremation) or rot anyway.
The attitude of the state towards people when they are alive is bad enough, just wait until you are – literally – dead meat.
I’m pretty sure that’s a different matter. People specifically opt in to donate their bodies for research. I’m not aware that has changed. I could be wrong, of course.
The new Act specifically covers donation for transplant. It has no bearing on donation for research.
https://www.hta.gov.uk/donating-your-body
Also, I object to the obscene new usage (not introduced by you, of course) of the word ‘harvest’, a sickening mealymouthedness like the phrase ’tissue samples’ that was used by hospitals to con grieving parents into unwittingly allowing their dead children’s organs to be snatched.
I rather like the term. It has the right Orwellian overtones.
Despite having been a blood donor for the best part of 50 years, and having carried a donor card for many years, I have opted out. The state does not own my organs and I am appalled that the state thinks it has any right to claim any part of my body. Whilst it may seem illogical to some, I will happily carry a donor card if it is my decision, but the state should be my servant not my master.
I just opted out. For the very same reason.
Some years ago, a lady with kidney failure was waiting for a transplant, and her young adult daughter registered to be a donor, should she ever be at death’s door, so at least her mother could benefit from her kidneys. Few years later the daughter was in a road accident, and declared brain dead. Her organs were harvested, but the mother was not entitled to a kidney because “It’s not our policy…”
I’ve opted out, and if they want any bits of me they will have to prioritise according to my criteria, not their own. Any needs of my family come first, or they get nowt.
What is the process of opting out ? If it involves a central register that is obviously open to bureaucratic “error”.
Consultant to patient “sorry we made a mistake and we have to remove your new kidney “. Don’t think so.