I used to have one single solitary blog that I’d throw everything onto. Usually photos, but also sometimes a place where my political thoughts would spill over. For years these articles have lived on allmyfriendsarejpegs.com, but not really fitted in – so I’ve decided to slowly re-publish them here so they have a more suitable home. Note that these haven’t been edited since they were posted, and so may not necessarily reflect my current position.

Why I am opposed to ‘assumed consent’ for organ donation

First published: 25th October 2011

Today on the news there was a story around organ donation, highlighting that Scotland has the highest figure of people signed up in the UK at a reported 37% of the population.

As part of this, the question was again brought up as to whether or not we might move to an ‘opt-out’ system of registration rather than the current one, where people must actively state that they wish their organs to be used after their death where possible.

I posted on Twitter with my rather blunt opposition to such an idea (something along the lines of fuck that), and was surprised (in a way) to see that there were a number of responses that were in complete disagreement. Rather than reply in bursts of 140 characters, I thought I’d try articulate things a bit better on here.

What would the change mean?

The policy that is being advocated is one of ‘assumed consent’. Essentially what this means is that if you die and your organs are able to be used, then it will be presumed that you would agree to such a thing in the interests of saving another person’s life, and they will be taken unless you have specifically stated that you do not wish this to be the case prior to your death.

So what’s the problem?

Why should anybody object to such an approach? It seems fairly straightforward surely? What happens to your body upon passing away is of no consequence to you, and if such a move will help increase the number of organs available and in turn save lives, then we should make it happen. After all, if they do have problems with the idea, they can still opt-out.

However, it isn’t as simple as that, and there are subtle, but profound effects of such a decision. The utilitarian notion of the ‘greater good’ trumping the inconvenience of the few is as flawed here as it is in other ethical questions. To go into examples would be fruitless as it is debated at length elsewhere, and there are deeper questions involved that transcend any idea of accumulated communal wellbeing. In short, just because something may have a positive impact in one respect on a group of people as a whole, that does not mean that it is automatically the correct position to take; far from it.

Why are rates so low?

If the donor rates are so low, then why is this? Does that mean that people in society have some sort of moral deficiency? Does the act of not signing up not state exactly what opting out will do, but in a different way? If it is indeed true that people simply don’t have the knowledge, interest, or concern about the topic, then why should the State coerce them into a position that they have no desire to be involved in? By re-stating the question in a different way, do we not just twist the rules of morality to make them acceptable to our own standards, dominating the moral and political narratives that underpin our supposedly ‘free’ society, and ignoring any possible philisophical, ethical, theological or ideological differences?

Ideology

There is a massive ideological problem involved in the approach being proposed. There are a whole host of issues that we will set to one side for now, such as those involving how foreign nationals would be dealt with; those with a lack of mental capacity; basic human rights claims; the question of whether consent is really ‘informed’ or not; tensions and relationships with relatives in the event of a dispute… all of which are important, but there is a deeper question about the reach of the State itself.

By creating such legislation, the Government would in effect be stating that it had an automatic right to ownership of your body (over and above even your closest family), unless you explicitly protest against it. This is an incredibly dangerous road to travel down, and is something that they do not, and should never have the authority to claim. That in of itself is enough to reject the proposal completely.

We need to read behind the lines in decisions like this, and not just take things on an issue-by-issue basis. The precedent that this assertion would create would conceivably allow future Governments to make further claims on its back, with the steady erosion of control over our own being.

Implied consent is not a common default with regards to other legal questions, and especially when it comes to matters regarding the body. Interestingly enough, the act (or contract!) of sexual intercourse requires active consent. The exact definition of what that entails is open to legal debate, but there is never assumed consent to engaging in sex. Whilst the comparison may be specious, it’s worth noting our attitude to issues relating to the person as distinct from other contractual matters, and on this hangs the crux: There is something important about the rights of a human being to their own constitution actually belonging to them without having to explicitly make this clear. No person, State or other entity should ever have the arrogance to over-ride this.

Disclaimer: In the interests of full disclosure, it’s worth noting that I am a registered donor and have been since I was young. This isn’t a question about the value of organ donation in itself, but political interference in the process.