Monday, January 14, 2008

"I have to believe that when my eyes are closed, the world's still there."

There are some massive and flawed assumptions underlying Justin McKeating's angry post about those opposing opt-out organ donation. This section is a prime example:

"‘It strikes at our relationship with the state,’ they say. Well get this: You can’t have a relationship with the state when you’re dead. You can’t assert ownership over your own corpse. Why? Because. You. Are. Dead. What other freedoms would you like to exercise after you’ve shuffled off? I take it you’ll be putting your favourite songs on your iPod to take with you as well? It’ll be as much use to you as your liver."


You clearly can and do have a relationship with the state when you are dead. It doesn't take very long to think of some examples:

  1. There is both a criminal penalty (I assume) and a massive social sanction to necrophilia.
  2. People frequently refight criminal trials after the person convicted has died in order to establish their innocence.
  3. A will has legal force.
  4. Even under Brown's proposed reforms we will legally respect explicit opt-outs.

We clearly believe that people are entitled to maintain some kind of dignity after they have gone. This requires that we respect their wishes. Assuming that they would be okay with us removing their organs, rather than leaving them be if we don't know, is a fairly major change in how the state treats the dead. If you assume some kind of continuity between a dead person's identity and a live person's - which you should if you support the use of wills - then it most certainly does strike at our relationship with the state.

Balancing the dignity of the dead against the interests of the living is the philosophical question at the heart of any reasoned consideration of this problem. Plenty of people get very angry at the idea that their autonomy over the final fate of their bodies is being limited. Justin's rant isn't going to win them over. It isn't designed to. Those who die for lack of organs are never really used as anything but a rhetorical stick with which to beat assorted enemies.

Such a debate would look at alternatives like reforming how the health services treats grieving families. The Department of Health reckon they could increase organ donations by 50 per cent by better managing that process. That isn't enough but throw in some inventive new ways to get people to consent before death and I think you'd be fine. Beyond that, there's always commoditisation. Wat Tyler has more on the various alternatives to Brown's initiative.

I find the idea of an opt-out system for organ donation alarming for the same reason I found the idea - floated a while ago - that the HMRC should be able to take money straight out of our bank accounts alarming. It will mean that when inevitable screw-ups take place it will be far more likely that someone will wind up having their organs removed against their wishes. Bureaucratic procedure tends to err on the side of the default position; it seems almost certain that scandals thanks to overlooked opt-outs would become commonplace very quickly.

I don't actually feel outraged myself - I'm blessed with a rather moderate temperament - but I absolutely understand those who just feel very affronted at the idea anyone would presume consent to take their organs. As Justin says, even many of those who will quite happily take a donor card are angry at the presumption. Just the way plenty of people will give to charity but wouldn't like to find the RNLI lifting their wallet. Our bodies are our own, even after our death our wishes over how our corpses should be disposed of are quite rightly respected, and having them stolen grates even if it is for a good cause.

10 comments:

Alex said...

What about presumed consent with a next of kin veto? To me, that seems to solve most of the problems. And surely it's better to have a corpse's organs pillaged against the person's will (which would be a worst case schenario) than it is for a single person to ever die due to organ shortage?

Justin said...

Those who know me would tell you that I have never used a dying person as a 'rhetorical stick'. If you find my line offensive, I find yours equally so. My argument arises from a bleeding heart not a stone one.

My first concern in this issue is the welfare of people wanting to live not the thin skins of middle class libertarians and their perceived 'oppression'.

And if the cap doesn't fit, don't wear it.

Matthew Sinclair said...

Look at your post.

It has paragraph after paragraph lambasting attitudes you perceive as irrational but little more than an occasional mention of those suffering for lack of organs. You do nothing to illustrate, describe or quantify their suffering. Or to make the argument that this measure is essential to alleviate it.

Look at your first paragraph:

"The complaining about Gordon Brown proposing an opt-out organ donation system is great. Selfish, pig-headed and self-contradictory whining is always a joy."

You set the tone of your post as an ad hominem attack rather than an argument on behalf of those who might suffer for lack of organs.

I'm sorry if I've offended you but if you're going to launch a high strung attack accusing people of every intellectual crime going you best make sure your own house in order.

Do you actually have anything to say on the substantive argument in my post?

Anonymous said...

As a Healthcare professional working within the NHS, Having read your blog on the "Opt Out Organ Donation Scheme" I felt I needed to comment.
In your post you state:
"Such a debate would look at alternatives like reforming how the health services treats grieving families. The Department of Health reckon they could increase organ donations by 50 per cent by better managing that process. That isn't enough but throw in some inventive new ways to get people to consent before death and I think you'd be fine"
. I am initially wondering what you mean by reforming the way in which the health service treats grieving families? It annoys and frustrates me that organisations and politicians who have never been involved first hand in dealing with grieving families, or for that matter had to broach the subject of organ donation with a family following the death of a loved one are continually stating the obvious that the process needs to be managed better.
Having been in that situation in a professional capacity, most families are too overcome with grief to even contemplate whether donating their loved ones organs is: A) Something they would have wanted or B) the right thing to do. No matter how well the situation is broached the high emotions and overwhelming grief of the family member would always have to be considered and can often compromise/ completely remove the option of donation due to their uncertainty or inability to rationally make a decision in time. By implementing the "Opt out Scheme" the onus of such a decision is removed from the family. In studies such as the one conducted by the BMA over two thirds of people surveyed felt that the scheme was a good idea, yet only a quarter were on the register. You state that the estimated 50% increase would not be enough, but in the grand scheme of things it would be a damn sight better than the current statistics.
As for people being outraged, those who are should do as the scheme states and "Opt out" is it not better that those who choose not to are forced to state so instead of hoping and trying to encourage those who are indifferent or would in fact happily donate to register? It has already been shown that the majority would be happy to do so but are not on the register.

Matthew Sinclair said...

Anon,

The reference to reforming the way grieving families are handled wasn't of my own invention. It is based on this DH finding in the post of Wat Tyler's that I linked:
http://observer.guardian.co.uk/politics/story/0,,2240069,00.html

"The taskforce, set up by Health Secretary Alan Johnson to look at how to improve donation rates, is now considering the proposals for presumed consent. Their report out this week will say that the first step must be for the NHS to provide highly skilled organ co-ordinators who would be able to talk with sensitivity to relatives at the bedside of their loved ones.

They believe that there could be a 50 per cent increase in donated organs if hospitals became better at dealing with the highly sensitive conversations that take place when a patient has been confirmed braindead. At present, around one-third of families refuse to give consent for organ retrieval, and even when a patient carries a donor card, many families still refuse."


Sorry if I didn't make that clear enough. It isn't a claim I would make out of the blue.

Anonymous said...

Having seen your extract from the report further fuels my enthusiasm for the "opt out scheme". If a person carries a donor card and their wishes are not complied with then it strikes me that the policy is just what we need. Everyone has the right to decide whether or not to donate,it should be no one else's decision to make.

Anonymous said...

Also as an afterthought, where is the funding going to come from to :
"provide highly skilled organ co-ordinators who would be able to talk with sensitivity to relatives at the bedside of their loved ones", when most hospitals are terribly understaffed and therefore existing staff are overworked with little time and resources to provide the high standard of care needed for patients that are alive?!
Seems to me that all the government seem to do is generate reports but no actual soloutions..sorry, I shall get off my soapbox now.

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