Presumed consent: nationalising our organs
There is a desperate need for organs for transplant, but taking them from the dead without consent is no solution.
The UK National Health Service (NHS) has recently considered what is being called ‘the biggest shake-up of the ethical, legal and professional rules governing transplants’. Most of what has been discussed has been uncontroversial, such as new technologies being introduced to store organs better and new ‘financial rewards for intensive-care units for every organ they provide’, raising rewards closer to that of other European nations. What does raise an eyebrow, however, is the possible introduction of an organ-donation system based on ‘presumed consent’.
Under the current system of organ donation, consent for organs to be taken for transplantation must have been given either prior to death or by the deceased’s family members after death. Changing to a ‘presumed consent’ system would mean that upon death, all would be presumed to consent to having their organs used for medical purposes. Families with objections to having their loved one’s organs used are given the chance to opt out, but they have to do so actively.
The idea of moving to a system of presumed consent is not a new one. It has been floated a few times in the past few years, notably by former UK prime minister Gordon Brown in 2008. There is clearly a shortage of organs available for transplant – and lives would be saved if more became available. Presumed consent, however, is not a justifiable system.
Presuming consent would essentially end the idea of organ donation. No longer will people decide that – due to compassion, personal duty to their fellow human beings, or generosity – they will leave a part of their body to help someone else after they die. Rather, people will become organ conscripts, with the opt-out option working in a similar way to conscientious objection. Just as wartime conscription does away with people’s right to decide whether to serve in battle on the basis of duty or to help others, organ conscription does something similar.
As Professor John Fabre from King’s College London, a former president of the British Transplantation Society, put it in 2008, when this idea was last floated: ‘Presumed consent would degrade the ethical framework of our society and change a system of organ donation based on generosity and compassion into one of the state taking back what it thinks is its, while intruding on one of the most personal and delicate moments of a family’s life.’
While it is arguably true that we all should have a sense of duty to help out our fellow human beings, including by allowing for our organs to be used to save lives after ours is over, this a purely moral argument. To assume that people do give consent takes away the ethical decision-making process. While the organs of dead people may be highly useful, to presume consent – or rather, to get no consent – treats people as nothing more than pieces of meat. Humans should be seen as ends-in-themselves, as autonomous beings with no inherent obligation to anyone else. The proposal for presumed consent assumes we have an obligation, just throwing in a conscientious-objector clause to suit the religious types who might kick up a bit of fuss.
In essence, our bodies would become the property of the state. No longer would we be free autonomous individuals, but rather we would become nationalised property that the state reclaims after our death. Any society that respects individual autonomy should not view an individual’s body as public property purely by default.
Over 200 years ago, the German philosopher Immanuel Kant argued that enlightenment was defined by humans having ‘the courage to use [their] own reason’. If we regard ours as an enlightened society, then we should be allowed to exercise our own reason and decide for ourselves whether or not our deceased bodies can be used by someone else.
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