Presumed Consent and the BMA

I’ve discussed the idea of presumed consent for organ donation a number of times over at my place ever since the idea raised its ugly head. The debate inevitably polarises into two distinct camps. There are the utilitarians who argue –  with some justification –  that a dead body is just that, so using the bits is okay even if the erstwhile owner never actually gave permission while alive. The other camp argues that there is only one type of consent; informed consent granted while the donor is still alive and sufficiently compos mentis to make such a decision.

The BMA are very much in the former camp.

Doctors have reiterated their support for overhauling the organ donation system.

The British Medical Association has been campaigning for presumed consent – where all people are assumed to be willing to donate organs unless they opt out – since 1999.

This is about as surprising as a sunrise in the eastern skies. Not all agree that it is a good idea, though.

But some medics at the union’s annual conference challenged the stance on grounds it could damage patient trust.

It would. It would damage mine greatly. If I was fighting for my life, there would be that niggling doubt that maybe the medics have half an eye on the harvestable bits ready for packaging and recycling. Unfair? Maybe, but trust is a funny thing. And it isn’t something that bothers the BMA overmuch.

Delegates rejected the challenge, arguing it would save lives.

Maybe it will, maybe it won’t. That doesn’t alter the ethical considerations, though. Presumed consent is not consent. It is taking without consent. It is, above all, presumptuous. It is not up to anyone outside the immediate family of the deceased to make any presumptions about what was wanted while the individual was still alive.

Sure, it’s a difficult time for all involved and I am certain that it is a minefield for the person charged with asking the delicate question in the midst of the raw grief, but that is how things should be. It should not be easy. A donation is just that; a gift given freely. It is not something for the medical profession or the state to sequester irrespective of their professed egalitarian motives.

There are all sorts of reasons why someone might not want to donate –  or make their wishes on the matter clear before their death. The usual one assumed is apathy. Well, if anyone is apathetic, that’s just too bad. Yes, someone, somewhere might have benefited from organs that will now either rot in the ground or be incinerated. That’s life. People die. Before organ transplant technology, they would have died anyway. Just because medical science has made such treatment available, it does not place an obligation on anyone else to get involved and provide the spare parts necessary. If people choose not to, then that is their business and presumed consent seeks to undermine that decision – or at least, to undermine the decision not to make a decision and not to communicate it. If someone puts off making their wishes known because they do not wish to face their own mortality, that is their business, not the state’s and not the BMA’s. It is up to the donor and no one else to decide and using the blackmail of saving lives is unethical. The end does not justify the means. The lives saved by donation are something to be thankful for, but they are not a right, it is not something to be demanded or presumed. There is no right to life. Some people are dealt a shitty hand in life and die young. That is life. There is no obligation on the part of others to provide the spare parts to save the life of another –  merely generosity should they decide to be philanthropic. It is not a decision in which the state should play any part whatsoever. And it’s none of the BMA’s business, either.

29 comments for “Presumed Consent and the BMA

  1. June 29, 2011 at 7:37 pm

    The hospital has no more right to a dead person’s body parts than they do to the contents of his pockets. It’s not their property.

    • June 30, 2011 at 5:35 am

      Spot on!

  2. June 29, 2011 at 7:54 pm

    The debate inevitably polarises into two distinct camps. There are the utilitarians who argue – with some justification – that a dead body is just that, so using the bits is okay even if the erstwhile owner never actually gave permission while alive.

    Is not their argument weakened, when the state controls both the medical profession and the hospitals (such as in the NHS) and when parliamentary democracy has been deliberately destroyed?

  3. June 29, 2011 at 7:59 pm

    The BMA should learn the basics, such as the difference between meum and tuum before venturing into ethical debates.

  4. June 29, 2011 at 8:02 pm

    To back up Trooper Thompson, we understand that the (common?) law says that the body of the deceased belongs to the family. This presumed consent is a proposed change that is in effect a dispossession of the family. F in outrageous.

    • Jonathan Miller
      June 30, 2011 at 8:01 am

      Under common law a dead body is not property, so it does not belong to anyone (not even the estate of the deceased) and cannot be stolen. Control of the corpse is in the hands of the current custodian. Bits of you that are chopped off may, or may not still belong to you, according to statute.

      The Alderhay child organs scandal highlighted this issue – nothing was stolen, no law was broken, when the organs of dead children were taken and stored by the hospital (the public, though, found the situation extremely distasteful, showing that common law and the opinion of the common man can be at odds).

      • June 30, 2011 at 9:25 am

        This is one of those issues where law isn’t relevant. It is an ethical one and the only ethical solution is opt in. Alderhay is an excellent example of how public opinion stands. On the face of it, what was the problem. People, whether rationally or not, have an attachment to the bodies of their loved ones. It’s a human thing. We are not a collection of spare parts like an old car.

  5. June 29, 2011 at 8:07 pm

    Very well put. Rather than presumed consent, what about handing out donor cards to tick the boxes and log your name/address at voting polls, leaving a box to drop in your wishes. While we’re at it, they could do it in pubs, doctors surgeries, and anywhere else where someone is static for a period of time.

    An Organ donation box if you like – at least that way it gives people a choice and will probably increase the numbers of donors 10-fold from where we are today. Apathy, as you suggest, is the reason I haven’t bothered to fill one out, but they can take what they like from my shell when I’m gone.

    • June 30, 2011 at 5:38 am

      The thing is, donor cards aren’t presently held in a castle guarded by flesh-eating piranhas in the moat and fire-breathing dragons and animated skeletal warriors. They’re already easily available, should you want one.

      What they don’t like is that not enough people for their liking are using them.

      • June 30, 2011 at 9:28 am

        Indeed so. it may be that we have reached a saturation point. And if people choose not to make a decision because of the uck factor, well, that is their business, not the state’s.

    • June 30, 2011 at 9:27 am

      I’m all in favour of making donation more simple and publicising it. Indeed, I am in favour of the whole thing as it helps people live who would otherwise have died. It must, however, be ethical and presumed consent is not ethical.

  6. nisakiman
    June 29, 2011 at 8:30 pm

    “If I was fighting for my life, there would be that niggling doubt that maybe the medics have half an eye on the harvestable bits ready for packaging and recycling”

    I hadn’t considered that aspect, but given the cavalier attitude of the state to people’s personal freedoms these days, it’s a very valid point. We seem to be moving towards an “end justifies the means” approach to state intervention / control. (In fact we’ve already arrived where some things are concerned – smoking, drinking and food spring to mind). Yes, a little disconcerting.

    Not that I’d have anything to worry about personally, being a smoking drinker with malaria and hep B running through my veins. 😈 Pity really, since my vital organs seem to be doing a sterling job, and would probably go for several more decades for somebody were I to suffer an early, accidental demise.

  7. ivan
    June 29, 2011 at 9:10 pm

    This sort of thing leads to what is best described as ‘organ-legging’ where people are likely to disappear and their organs appear in the underworld for sale.

    I’m trying to think of the title of a SF story from the 60s about this very thing.

    • June 29, 2011 at 10:15 pm

      I’m trying to think of the title of a SF story from the 60s about this very thing.

      I know the one you mean. Can’t recall the title either…

    • Voice of Reason
      June 30, 2011 at 12:19 am

      There were a whole bunch of short stories on ‘Gil the ARM’, and at least one novel (‘A Gift from Earth’) using the idea, all by Larry Niven

  8. pendlewitch
    June 29, 2011 at 10:19 pm

    Organs rotting in the ground is precisely why I wish my body, in it’s entirety, to be interned – I would prefer to feed the soil and help to give something back to it, than possibly save the life of a couple of people. That is my prerogative and the BMA are arrogant so and so’s to presume to make a choice like that on my behalf.

    • June 30, 2011 at 9:29 am

      And that is your decision. You have no need to justify it. I recall one discussion on CiF where someone made this point because he was religious. The subsequent vilification was fairly predictable.

  9. LJ Hills
    June 30, 2011 at 12:00 am

    It’s a logical progression of a nationalised health service : they spend our taxes on keeping us going and feel thereby that our useable parts are owed to the system. As far as the NHS is concerned, we are differentiated by our diseases not our desires for our final disposal. The socialization of the individual will be complete when our dead bodies belong to the state.

  10. Livewire
    June 30, 2011 at 5:13 am

    Easy solution, tattoos near the appropriate bits.
    Biohazard,toxic waste and the radiation symbol (in glowing ink) should dissuade them.
    It’s actually illegal to misuse the symbols so the state would probably impose a fine and gaol the corpse for non-payment, bureaucrats’ procedures must be always be followed to the letter.

  11. Maaarrghk!
    June 30, 2011 at 6:42 am

    I’ve had a donor card since being 18 – a long time ago.

    Although presumed consent wouldn’t particularly bother me I am certain that our muslim brethren would soon put an end to any serious attempt at it.

    Can’t let any of their faithful organs end up inside a Jew. Nope.

  12. June 30, 2011 at 8:30 am

    In order to understand that organs for transplants already have a value, one need not resort to fiction, but try to obtain a copy of the book by Carla Del Ponte, Chief Prosecutor for two UN International Criminal Law tribunals who “conducted an investigation on the allegations of organ trafficking by the KLA of Serbs and other non-Albanians in Kosovo and Albania for the Parliament of Europe

    She wrote the book subsequently, in Italian, and became an obscure Swiss Diplomat somewhere in South America. Early in her career she had taken on the Italian mafia in her native and Italian speaking canton of Ticino. Brave woman!

    Good Luck in your search. Some facts can be found on the web:

    http://thebloodyellowhouse.wordpress.com/

  13. filthy smoker
    June 30, 2011 at 2:20 pm

    I cut my blood and organ donor cards up and sent them back in 2007.I designed my own anti-donor card based on the real thing and carry it in my wallet.They turned me and a quarter of britain into social outcasts.They can whistle for my bits.I wrote it into my will and told my family that on no account were my organs to be donated to anyone for any reason.
    Apologies to anyone who was benefiting from my blood and plasma.Given that anyone with serious health issues is forced to quit smoking before treatment is granted,you were probably a rabid anti-smoker anyway – so fuck you and your fucked up body.Dont blame me ‘cos you cant clean your blood – blame deborah arnott and the BMA.
    Spite in,spite out.

  14. filthy smoker
    June 30, 2011 at 2:52 pm

    damnit -I forgot theres a blogger called Flithy Smoker – that is not me..I’m just a peasant in the big shitty.

  15. Andrew Duffin
    June 30, 2011 at 2:54 pm

    “maybe the medics have half an eye on the harvestable bits”

    Yes, exactly.

    If they know the bits aren’t harvestable, I’ll bet they try harder.

    When it’s me, they can just try harder.

  16. Monty
    June 30, 2011 at 5:40 pm

    The usual preferrence for people who know they are approaching the end of life, is to be allowed to die in their own home, surrounded by all that they love. But if their organs are earmarked for transplantation, the medical profession have an immediate vested interest in getting the patient into hospital, and putting him onto a medical regime designed to maximise the viability of his organs, and not the comfort of the patient.
    That is a significant conflict of interest. And in the case of a dying patient, who has no future anyway, the temptation to railroad him into hospital and treat him as a resource, rather than a human being, would be very worrying.

    If presumed consent is brought in, I will opt out.

    • June 30, 2011 at 5:52 pm

      On balance, I think it unlikely in the short term. This government doesn’t seem to have the same desire as its predecessor. Still, if it did come in, I would do likewise and opt out.

  17. June 30, 2011 at 7:05 pm

    Why do these people always think they know better than everyone else?

    Instead, why don’t they campaign for people to have the OPTION of being a donor by, say, putting an opt in box on some kind of regularly used form – the census or the annual voter registration forms?

    Would that not be better?

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