On presumed consent.

November 28, 2008

I am a big supporter of the idea of “presumed consent” when it comes to organ donation and I am frequently baffled when I hear the arguments of those people who are against the idea.  I can’t fathom it.  The two systems basically boil down to this: under the current “opt-in” system, a person who dies, and whose organs are suitable for donation, must have provided prior consent before the organs in his cadaver can be used for transplantation.  That consent can be challenged by relatives, and directly over-ruled even where clear consent has been given.  Under presumed consent, a person is presumed to have given consent, unless they explicitly register their lack of consent.  The family of the deceased may not overule the presumption of consent, but neither may they overall the explicit lack of consent.

Normally I expect the opposition to presumed consent to come from the more fundamental religious folk.  I would imagine that to most atheists, the idea that a cadaver has any intrinsic value would be self-evidently nonsense.  So I was suprised when I came across this letter (search for “Fairbairns”) in the National Secular Society Newsline e-mail, by one Zoë Fairbairns:

It’s not just religious people who are opposed to “presumed consent” on organ donation. There are good secular and humanist arguments for insisting that our bodies belong to us rather than to the government – the same arguments which are made for free choice on abortion and assisted suicide.

I am terribly confused by this statement, “our bodies belong to us ….”.  How can a body – a corpse – belong to itself.  A corpse is not a person.  A corpse has no legal rights. A corpse cannot own anything.  Forget about any arguments about free choice on abortion or assisted suicide, or any nonsense about the government owning human transplant organs, one thing is abundantly clear: a corpse does not belong to a dead person.  The arguments regarding abortion and assisted suicide in this case are utterly irrelevant: those are arguments being made by the living.

We’re told that two-thirds of British people support presumed consent. Fine. Let them carry donor cards, and their consent will be — quite correctly — presumed. No doubt they are all carrying cards already. If they are not, the sincerity of their support must surely be questioned. Perhaps they only support it for other people?

Presumed consent changes one thing, and one thing only: who is required to register a wish with respects to organ donation.  Under the present system, everyone who would like their organs to be donated after their death needs to inform people, and ideally needs to carry a card, or be on the NHS organ donor register.  Under presumed consent, only those who do not want to be donors need bother explain to anyone why, or to register this wish on a register. Ms Fairbanks seems to want to place the burden on the majority, rather than the minority.  And she accuses the medical practitioners of arrogance.

An article entitled Organ Donation – an Outline for General Practitioners, published in 2002 by the Royal College of General Practitioners (RCGP) makes clear that surgeons removing organs for donation frequently anaesthetise the “corpse” – suggesting that they are aware of the risk that it may not be a corpse at all. The article is available online.

This is a real clanger.  I mean this is beyond stupid.  From the quoted link:

Those members of the public who read media reports on medical matters will remember some controversy reported on this activity. It is more or less standard practice for anaesthetic agents to be used during organ retrieval.

The logic behind this will escape those who say ‘if the donor is dead, why is an anaesthetic needed – and if he’s not dead, you should not be doing this.’ The difficult truth, as stated by the anaesthetists and surgeons, is that the cadaver may retain some reflex movement that hinders the smooth retrieval of organs and makes the transplant surgeon’s work difficult. The use of muscle relaxants, for example, helps the process. The reasons have been well argued by the College of Anaesthetists, and, for the time being, have been generally accepted by the profession.

Does Zoë really believe that when people die, they just suddenly go limp like they do in the movies?  I’m only a lowly computer programmer, and I knew what I was about to read before I even clicked on the link.  So she lied.  She’s trying to make a secular case against presumed consent and she lied.  And I personally think she lies again:

I used to carry a donor card, but the RCGP article, coupled with the terrifying arrogance behind the notion of “presumed consent” has made me tear it up. As the sole proprietor of my body, I will certainly opt out of any “presumed consent” system. I hope I will not be required to fabricate a religious reason for this.

She used to carry a donor card, but read that anaesthetics are used during organ removal (and then failed to read the rest of the paragraph), and she didn’t like presumed consent being discussed (even though it wouldn’t have affected her personal choice in any way) and threw her card away.  Surely, though, if she was an ex-organ donor, mere discussion of other forms of providing consent wouldn’t change her mind that organ donation was a good thing. I hope she remembered to remove her name from the Organ Donor register…

Zoë is not going to be the sole proprietor of her corpse when she is dead.  She is entitled to every say over her body while she is still alive, but once she’s dead it’s game over. She will not be able to own anything, because she will be dead.  Just as I or you will not be able to own anything once we are dead.  Sure discussions can be made about who does own it (the deceased’s family would be a better – although far from ideal – choice), but arguing that the dead can own their bodies is ludicrous.

As a side-note.  If you are in the UK and would like to ensure your organs are donated after your death, please remember to add your details to the organ donor register.  Details here.

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