Tuesday, 15 January 2008

Coercing Corpses

As predicted by Polly Toynbee in her column in today's Guardian, commentators are up in arms about Gordon Brown's backing of a proposal to move to a 'presumed consent' model for organ donation (Link). For once, I am on her side.

Donation rates in the UK are much lower than in other Western countries, and the gap between people who state that they would be willing to donate organs in a survey (~90%) and those who actually sign up to the register (around 24%) is tremendous. In an opt-in system such as we have at present in the UK, only those 24% could possibly donate, and in fact because registration is not legally valid (i.e. relatives can veto it) a smaller proportion still of the medically fit recently-deceased actually do so.

Most of the arguments against moving to the opt-out model hang on the concept of presumed consent. Typical of the expressions of discontent at the proposal is this statement by Joyce Robin of Patient Concern (quoted in the Times):

"They call it presumed consent, but it is no consent at all...They are relying on inertia and ignorance to get the results that they want."
The antipathy to the opt-out model at several libertarian blogs run along slightly different lines, focusing on the issue of ownership (e.g. Perry de Havilland's furious 'statement' at Samizdata).

Generally, I would see Gordon Brown and Polly Toynbee backing something as a fairly reliable indicator that it's not a good idea. But in this case I have to beg to differ. I do not comprehend the reasoning behind the strength of opposition to this proposal that I'm seeing. As far as I am concerned, everything she's said today just makes sense.

Once you're dead, you're dead and you don't need your organs any more; they may be of use to another individual (not the State. The State here is just the mechanism - it's not like ID cards!); many potential life-saving transplants aren't happening most likely because of inertia (perhaps up to 70%, see above); and it is possible to opt-out under the proposed system if you (or your relatives) sufficiently disagree with donation to do so.

The costs are zero (because the donor is dead - unlike in other potentially comparable situations, such as participation in medical research or uploading of confidential medical data to a centralised database). The potential benefits to others (transplant recipients) are direct and of course highly significant in terms of their lifespan and quality of life. I do not see any reason to believe (as posited by Longrider) that abuse would be any greater than under the current system, particularly since relatives will still be consulted (Link)*.

Finally, the argument regarding 'presumption' is lost on me also. The way things work at present, we are presumed to want our organs to rot when we die. This is simply a pragmatic switching of presumptions.

* On the other hand, I suspect that a market solution as suggested by Tim Worstall would be unacceptably prone to abuse from several sets of interests.


Longrider said...

The way things work at present, we are presumed to want our organs to rot when we die.

Ian, that's a false dichotomy. There is no presumption at the moment. If someone has not specifically made their wishes known before death, then, should the right set of circumstances arise, the medical team must ask the next of kin, which is right ad proper.

It is the "presumption" that I find so deeply obnoxious. No one may presume anything about my wishes until such time as I or my next of kin advise them. My opting out will revert the situation back to the current arrangements - they will be forced to ask, which is what should happen in a civilised society.

And, yes, you can be sure that given the pressures proposed in this idea (targets of all things) there will be abuse.

QT said...

If someone has not specifically made their wishes known before death, then, should the right set of circumstances arise, the medical team must ask the next of kin, which is right ad proper.

It may be in principle right and proper - but in practice, because of the short window of time after brain stem death within which organs have to be removed in order for them to be suitable for transplantation, it just means organs going to waste.

The first part of Michele Hanson's piece on CiF today has more.

Lee Griffin said...

Interestingly the latest law on this issue, the Human Tissue Act 2004, states that if you have not given your express wishes one way or another, or haven't declared a person to act as your arbiter, then it can be deemed you have given your consent. And the families can't object to this.

This governments proposals actually set out clearly that you are allowing your organs to be used if you don't opt out, rather than hiding the same situation in plain sight, meaning you are more informed, and gives families the option of giving the choice once again where any ambiguity may lie.

All in all, despite what is being said, Brown is actually opening up the process and giving more rights and structure to individuals through these proposals compared to the more murky 2004 act that does, in fact, presume our consent if we've said nothing.

Lee Griffin said...

And longrider, targets already exist and there are less organs around. What makes you think that a better flow of organs into the system will make doctors more likely to abuse the system than they currently are given that targets will be met more easily in the future just through increased donors?

Dorothea said...

Given the repeated and egregious "incompetencies" of our ruling classes and their managerial minions, the likelihood is that even if one expresses the wish to opt out then some idiot, or computer error will mean that when it comes to it the record will have been lost.

A gentleman on Radio 4 this morning also raised another issue. He had received an organ positively and willingly donated, and said that he would feel psychologically very unhappy about glibly assuming consent from an unwilling party. This, he pointed out could compromise his body's acceptance of the organ.

Those who wish to see more organs being donated could put their energies into making donor cards actually available, something which they are not at present, apparently.