Chief doctor calls for organ donation by default
By Sarah Boseley for The Guardian
Tuesday July 17, 2007
Doctors should be able to assume that patients who die will donate their heart, lungs and other organs, unless they specifically opt out during their lifetime, the government's chief medical officer recommended today. Sir Liam Donaldson's proposal is aimed at cutting the number of people who die while on the waiting list for a transplant. "We have something of a crisis in this country," he said at a briefing today. "Every day at least one patient dies while on the transplant waiting list. There are something like 7,000 people on the waiting list at any one time. There is a shortage of organs in this country and the situation is getting worse."
Sir Liam said he hoped the measure would be as successful as in Spain, which introduced an "opt-out" system for organ donation at the same time as appointing dedicated transplant coordinators in hospitals, leading to soaring donations and a shorter waiting list for transplants. All those who did not wish to donate, on religious or other grounds, would be able to register their refusal, said Sir Liam. Whether they would carry a card confirming this was a matter for later discussion. The British Medical Association backs an opt-out scheme, but the House of Commons recently rejected the idea during extensive debate over the passage of the Human Tissue Act. Sir Liam is an authoritative voice in the medical establishment, and claims the public would support the change, but it is unclear whether he would get political backing.
[How is it possible to have ‘presumed’ consent for organ removal? Isn’t consent supposed to be a voluntary – and informed – act? If the justification for such presumption is that the majority of people wish to donate their organs then why don’t the majority sign the relevant bits of paper (or make a Will expressing their consent) to make it happen? Why must everyone have presumed to have consented unless we take the effort to opt out?
I actually find the concept of presumed consent to be both immoral and deeply disturbing. How is this concept meant to be any less than viewing the general population as mere cattle to be harvested when the need arises? Should we also presume that people will consent to donations of blood while they are still alive? Maybe we should just set up local ‘blood databases’ so that hospitals can just arrive at your house or place of work take as much blood as they need and be on their way?
Presumed consent in these cases views humanity as a resource to be used as required. This is a very dangerous idea indeed. Once you stop treating people as people and start treating them as ‘happy meals on legs’ its difficult to know where or when to stop. Maybe we don’t need any kind of consent, presumed or otherwise. After all if important people are dying because of the lack of an organ and you happen to be compatible enough to donate one of your kidneys how could you possibly refuse? Happen to have a rare blood type – expect to be fitted with a GPS tracking device so you can have a pint or so siphoned off if someone needs it. Isn’t such an act part of your civic duty after all? Surely we all need to do what we can in these difficult times.
This is lazy bureaucratic nonsense. Rather then take the effort to get more people to actually consent to an action it appears to be far easier to create universal consent by fiat. If those in positions of power stopped treating us like idiots or children maybe they would get a great deal more respect from us and maybe also they would get our consent along with it.]
5 comments:
I'm not with you at all on this one. The reason for "presumed consent" is that people are lazy. Most won't opt in or opt out of anything that they don't care about. For the good of society, presumed consent will greatly increase the availability of donor organs.
Currently, only those who feel strongly about donating will opt in. With the proposed change, only those who feel strongly about not donating will opt out. Those who don't care either way won't opt in/out, no matter what the policy. Why not reap the societal benefits from them, if they don't care either way?
I have no problem with viewing the *deceased* population as livestock. When someone's dead, they have no more use for their body, unless in life they had some religious superstition that caused them to believe otherwise. They have every right to their beliefs, and they should be respected.
Now, your objections seem to cross over into forced donation during life. That's quite a leap IMHO. When someone is alive, they still generally have the ability to express or withhold consent. Where I do see ethical issues arising is in cases such as a brain dead vegetable. Great care would have to be taken to ensure that undue pressure isn't put on family members in a difficult time.
Provided that proper safeguards are written into the policy, I think the proposed approach is quite sensible.
Welcome back e-dogg.
e-dogg said: I'm not with you at all on this one.
Oh, it happens from time to time. [grin]
e-dogg said: The reason for "presumed consent" is that people are lazy.
Indeed they are (in general) but that's hardly a valid reason to bring in this kind of legislation.
e-dogg said: For the good of society, presumed consent will greatly increase the availability of donor organs.
For the 'good of society' many things can be done. But is it the function of the State to enforce that 'good' if the population (who make up that society/state) have not consented to it?
e-dogg said: With the proposed change, only those who feel strongly about not donating will opt out. Those who don't care either way won't opt in/out, no matter what the policy.
As people are lazy I suggest that the opt-out option will hardly be used. This would mean that the Government have (in their own minds) made a good case for not wasting time/money on the Opt-out database and just make it standard practice that organs will be removed on death.
Also I can see it becoming a matter of 'anti-social' behaviour if you *do* choose to Opt-out.
Of course those who die of old age won't make particularly good organ donors - presumably the 18-35 age group would be most prefered. This is also the age group that drinks heavily, smokes and takes part in dangerous activity. So, after the removal of organs has become the accepted norm - will it be seen as irresponsible not to take good care of your organs so that you can pass them on (being a good citizen and all that). Can we therefore expect a Reckless Endangerment of Transplantable Organs (RETO) Act to prevent people from damaging such a valuable resource? Once 'presumed consent' is recognised there will inevitably be function creep and futher legalisation of the process and all predicated on the idea that our organs, our very bodies, are nothing more than resources to be used for the 'good of society'. In other words we become property of the State rather than free individual human beings.
e-dogg said: I have no problem with viewing the *deceased* population as livestock. When someone's dead, they have no more use for their body, unless in life they had some religious superstition that caused them to believe otherwise. They have every right to their beliefs, and they should be respected.
It's true that once we're dead that's it. We're dead and no longer really care what happens to our bodies - because we're dead and are no longer in a position to care. BUT... that's not the point I'm trying to make here. The point that *really* disturbs me is the idea of human beings being viewed as the property of the State. The idea of 'presumed consent' is a move in this direction and I am opposed to it. If people want to donate their organs that's fine. If the State wants to encourage people to donate that's fine too. When the State tells or expects people to donate their organs - that's something *quite* different.
e-dogg said: Now, your objections seem to cross over into forced donation during life. That's quite a leap IMHO.
Yes it is a leap - which I used to illustrate my point that functions creep and, rather inevitably, one thing leads to another. What you rightly point out is the difference between those who are able to consent (the living) and those who cannot (the dead). Normally in medical ethics those who cannot, for various reasons, consent to an act, are presumed to have *not* consented to that act rather than the other way around. You can imagine the argument put forward to increase the range of 'presumed consent' beyond harvested the dead. It is a *very* dangerous precedent.
Ah, the evil deeds that are done for the good of society.
The better solution here is to allow people to be compensated for allowing their body to be used. Like all government price fixing adventures the ban on allowing people to be paid for their organs is what causes shortages. Lift the ban and watch the "good of society" really improve.
I might add people are not at all "lazy". Quite to the contrary humans act, and they act based on incentives and reason. Just because they don't act in the way YOU want them to does not make them lazy.
Hi Scott...
I have no problem with people being compensated for their organs - though I don't know how the buyer could get any refund if the organs were not in the required condition... A risk they have to take no doubt.
The authorities would also have to make sure that the organs actually came from bodies that died naturally [grin].
Rather than lazy maybe 'the people' are just unconcerned.... I think it was in reference to the statement that apparently 90% of people *want* to donate but never get around to it.
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