Monday, 17 November 2008

Presumed Consent Redux

I originally wrote this in January, but it has become topical again so I am re-posting it.

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 that will help overcome inertia.

People who disagree:


John B said...

Completely agreed. I understand right/conservative/religious-type objections to this (bodily integrity and all that), but from a libertarian POV it just seems utterly bizarre.

Mark Wadsworth said...

I tend to agree with you. What the relatives say is the most important bit. If somebody has clearly ruled himself in or out, most relatives would respect this.

Macx Stirner said...

I think it's the sheer, breathtaking arrogance of the presumption that the State owns your dead body and can do what it likes with it. The presumption should be, in the absence of statements to the contrary, that the organs belong to the next of kin.

Longrider said...

Oh, wow! I get a tag all to myself...

Seriously, while this is a thoughtful piece, like Free born John's, it hasn't changed my opinion, sorry.

Ultimately, the decision to give is a personal one and has nothing to do with the state. Much less one that should involve any form of legislation.