The announcement from Gordon Brown, that he supports the principle of 'Deemed Consent' to organ donation has brought out the predictable set of responses, ranging from the demented (New Labour New Cannibalism), through the only slightly less barking (although the discussion remains surprisingly thoughtful in the main) to the surprisingly unthinking.
Starting with the mad we have this amazing outburst:
When the law allows organs to be harvested from the bodies of the dead without the explicit prior consent of the dead, or the explicit consent of the next of kin, the State becomes effectively a cannibal.
and:
...presumed consent really is only the beginning. Let this through, and it is only a matter of time before blood donation becomes compulsory. After cannibalism, after all, vampirism is very little.
The trouble with this absurd hyperbole is that no one will listen when you make a serious point and there is a serious point to be made, even from this rather crazy perspective. Do you really trust NHS bureaucrats to get it right? After all one of the reasons for the decline in donors is the Alder Hey and associated scandals, the roots of which go back to 1948.
As Chris Dillow points out, one reason for making the change is the assumption that many people will fail to do so through simple inertia. It is not proposed on the grounds of being more rational but simple expediency.
...the way in which choices are presented to us can affect what we choose - a fact which is awkward for conventional conceptions of rationality.
This outburst from Sean Gabb is totally irrational. It is playing directly and explicitly to the 'yuk' factor and is as nonsensical as the tabloid garbage on which it is modeled.
Moving on to the slightly barking, we have an argument based in part on property rights but also implicitly on the concept that any action is permissible so long as it causes no harm to others.
...the State's plan to assume default ownership of my mortal remains is wholly and monstrously unacceptable. I reject the claim of the State to own my body just as I reject the legitimacy of its various claims to own my person whilst I am alive.
The second aspect is easier to dismiss.
- Are you harmed by the State removing your organs after death in order to transplant them into another person? Of course not - you are bloody well dead.
- Is anyone else harmed by this action? It could be argued that relatives suffer distress but I don't see much sympathy for that from Perry de Havilland and the other denizens of Samizdata if offense or distress is claimed as a reason for legal prohibition of an action.
- Harm might exist in circumstances where a free trade in bodies or body organs is allowed, since these proposals effectively nationalise your corpse (not for the first time of course).
- Harm is caused of course but indirectly. If your organs are incinerated or composted rather than being used to keep someone alive, then they will die. There is a strong case that by your inaction you have caused death or at least severe suffering.
Despite 3, I don't think an argument against opt-out based on harm to others can be made.
The issue of ownership is harder to deal with. We accept the disposition of property after death, although of course unless you are an anarchist or minarchist, the state will often set limits on that, for example through taxation. We do not generally accept that people can be owned even by mutual consent, (although there are some who argue otherwise). Can the body therefore be owned after death and on what terms?
It seems to me that this is easier to deal with from the atheist perspective. To an atheist, the body after death is just a collection of bones and tissue and has no intrinsic worth. Even atheists however recognise that to their friends and value their body does have meaning, if nothing else as a symbol of the person they were. This is of itself an important aspect in deciding on the disposition of one's body after death. In the extreme case of leaving one's body to medical research, you have to make specific provision. You apparently cannot simply write it into your will. Even here of course the 'yuk factor' comes into play, both for the owner of the body when making provision and of course for relatives.
For those of a religious bent, there will be other considerations. They are not considerations I accept, or even really understand, but it is your body and your beliefs and neither the state nor anyone else should be able to override those beliefs, even though it appears that the proposals will allow for opt-out.
On that basis, the proposals boil down to the state dictating how you should dispose of your body after death. The third posting I have picked out (cross posted from here) ignores this aspect almost entirely (although it is picked up in the comments) in favour of a rant about the right. It largely ignores the impact of death on the family and those around them - an attitude to a degree retracted in the comments. It simply assumes that there is no acceptable objection to the proposals.
Libby Purves puts it a little more rationally in The Times:
In any legal change, it must be acknowledged and accepted that some of our compatriots have powerfully superstitious beliefs about bodily parts: we are not historically far from the age of relics, and some of the Alder Hey parents held repeated funerals for recovered microscope slides. You may not think that way, I certainly don't; but nobody has the right to gainsay those who do. Not in the “public interest”, not using state authority. Your body is your own.
She also deals with the issue of implied consent:
My main caveat is that with presumed consent the opt-out should be staringly visible. It should be offered in a way nobody could fail to notice, and cost no time, stamps, visits or call centres. Perhaps a tickbox at 16 when you get your national insurance card; then every year a renewable consent box, maybe on your tax form (though given the Revenue & Customs' inability to handle data responsibly, perhaps not). But the opt-out must be unavoidable, universal, not in the small print.
There is no doubt but that people die every week because of the lack of a suitable donor and almost always that lack arises because the person who could have helped didn't get round to it and because no one had the nerve to ask the bereaved. Opinion polls actually show a high level of support for organ transplantation, much higher than for xenotransplants, held out by many as the ultimate solution.
The problem as ever is complex. There is no point in behaving as if there is one answer and ranting about the stupid behaviour of those who don't agree with you. At its centre are multiple moral and philosophical questions to do with our sense of who and what we are and about our place in the universe. Of course it would be nice to have a neat simple solution - but it isn't going to happen. We will have to carry on muddling through, making decisions that please no one.
Take the universe and grind it down to the finest powder and sieve it through the finest sieve and then show me one atom of justice, one molecule of mercy. And yet you act as if there is some rightness in the universe by which it may be judged.
Terry Pratchett Hogfather
