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.