The Thunderer on Presumed Consent

Minnette Marrin in the Sunday Times reflects on Gordon Brown’s failings (and there are plenty to choose from):

History, if it has any sense, will come to judge Gordon Brown with deep moral disapproval. Somehow the man has managed to blind most of us to his obvious faults, but I will take only one – his obstinacy in clinging, with all the force of his moral authority, such as it is, to morally dubious policies, against all advice and in defiance of the evidence.

I’d have thought his obvious faults were… well… obvious. A brooding, sullen man who lurked in the background sulking for a decade because he wasn’t the party leader and when he was, promptly proved that he is an utter, utter incompetent. Not that the level of his incompetence was necessarily obvious and nor for that matter were his authoritarian instincts. There was a brief period when I hoped that he might, just might, reject some of Blair’s illiberal agenda. It was a brief spark of hope rapidly extinguished.

Still, Marrin considers his attitude to presumed consent, a policy that I find deeply repugnant. Not because I have any particular issue about my body once it is dead, but for all the reasons that Marrin mentions:

However, the real objection to the scheme is more serious than the practical one. It is an objection in principle and it would apply even if a system of assumed consent might save more patients. The idea lets in an evil and dangerous political principle – the assumption that the state owns our bodies. Brown and Labour governments before him have tried to nationalise our private lives; now he wants to nationalise our private parts.

Yes, absolutely. When I’ve discussed this issue before, there have been those who tried to argue that we do not own our bodies and that there is the greater good to consider. Sorry, but that’s piffle. If we do not own our own bodies, who does? Certainly I expect absolute autonomy over my body. It does not belong to the state and I will never consent to the state assuming ownership to dispose of as it pleases. The state has taken enough from me in life, I will decide – and I alone – what is to happen to my body on death.

The thinking behind this is pure socialism. You and all your assets belong to the state to tax, teach, reeducate, redistribute and, generally speaking, harvest as it sees fit. It is an attitude that was tested to destruction in the bitter miseries of the 20th century but, like Dracula, it is mysteriously undead.

Indeed. There was a time when I was a socialist, believed in the ideals, in things like redistribution and social justice and equality. I don’t any more. I grew up. I saw the world as it is. I watched the evidence of socialism in action and was appalled. Socialism does not work and can never work. It is a morally bankrupt ideology. I can understand why the young are attracted to it, but life experience (and a little reading of history) should cure them.

And, as Minnette Marrin points out, it is not the lack of donors that is at the heart of this issue, it is the inability of the NHS to cope with the demand for the surgery. The NHS, a beacon of socialist ideology, is crumbling before us, as is our state education system.

Frankly, everything the state touches is tarnished by that touch. The less we allow politicians and their servants to poke about in the better all our lives would be. And, no, never will I have my consent presumed by anyone. You want something, you ask politely and I’ll think about it.


  1. I still strongly disagree (as in my post of January). Presumed consent isn’t about “the state owning your body”. It’s about pragmatism, about overcoming inertia, and its about saving lives. If you feel so strongly about it, opt out (but if it were up to me people who opted out would be ineligible to receive donor organs should they find themselves in the predicament of needing one).

    QuestionThats last blog post..Seen Elsewhere (25)

  2. Indeed, we had this discussion before. It is my body and therefore its disposal is for me to decide – and no one else. Pragmatism is not a justifiable excuse for unethical behaviour and presumed consent is deeply unethical. It presumes that what belongs to us is for the state or its agencies to take without asking first – and in a civilised society, if you want something then you ask the owner first. Anything else its theft.

    As I’ve mentioned before, I have no particular objection to my organs being used – I do have a strong objection to them being taken on an assumption – just as I object to anything else being taken without express, informed consent.

    The findings of the inquiry are the right, appropriate and ethical ones. As a pragmatist, I am happy to see that others take the same view; pragmatism has its place, but ethics must come first.

  3. Perhaps at the root of this disagreement (which I find intriguing, because this is one of very few issues on which I disagree with you and several other libertarians) is that, in my way of thinking about death, once I am dead I no longer exist in any meaningful sense, with the consequence as regards to ownership of my body that this implies (specifically, that said ownership becomes meaningless).

    I see the situation as more akin to that of a Will, hence my referring to a pragmatic switching of presumptions.

  4. If the state has carte blanche to use your cadaver post mortem, what is to stop the servants of the state moving the goalposts a little while you are still using your body? A little overdose here, a little mis-applied treatment there. On the cusp of life we are all too fragile. How about those people in Permanent Vegetative State who sometimes recover? Is ‘harvesting’ their organs to be allowed? Will the families of politicians and ‘celebrities’ be exempt as from certain proposed databases?

    My view? It doesn’t matter one whit whether you are ‘using’ your organs or not. Unless kept to find out why you have come to a possible untimely end, there is no justification for ‘presumed consent’ of organ donation as the NHS simply doesn’t seem to have the capacity to perform the surgeries anyway.

    If sitting on a jury, I personally would not convict an outraged relative who went completely postal if their nearest and dearest were ‘harvested’ without consent. Forensic yes, donor no. It’s simply a question of who owns what.

    Mister Joness last blog post..Standing in the rain

  5. “I see the situation as more akin to that of a Will” One owns the assets that are disposed of in a Will in the manner of one’s own choosing. Presumed consent implies you do not own your body and it, or leastways bits of it, is to be disposed of in the manner the state chooses.

    “If you feel so strongly about it, opt out (but if it were up to me people who opted out would be ineligible to receive donor organs should they find themselves in the predicament of needing one).”

    My family knows full well that I am happy to donate my organs, however, I would opt out if presumed consent was introduced because I do feel strongly about it. It would still be my intention to donate my organs through the permission of my next of kin provided the government did not introduce a system that meant if you opted out your next of kin could not overrule your decision.

    The bottom line is that presumed consent is no consent. The pragmatic argument could lead down some very terrifying avenues, particular in the fields of health and justice (as it is already doing with presumed guilt in areas such as drugs, family courts and terrorism).

  6. Ian, the reason we disagree is because you have been beguiled by the appeal to emotion. Take away the emotive issues surrounding death and dying and you have a simple principle – the state seeks to sequester that which it does not own.

    When I made my will I decided how my worldly goods are to be disposed of, not the state.

    Ultimately, as a libertarian I am being consistent. Presumed consent is, as DocBud points out no consent. It violates both property rights and the non aggression principle.

  7. “Ian, the reason we disagree is because you have been beguiled by the appeal to emotion.”

    You mean I’d rather people whose lives could be saved were saved?

    This whole debate is really starting to get me annoyed – to me its obvious what needs to be done and the arguments against it come across to me as really self-centred and often irrational.

    Vivienne Nathanson has an interesting article on the subject on CiF.

    QuestionThats last blog post..Seen Elsewhere (25)

  8. You mean I’d rather people whose lives could be saved were saved?

    No, that is not what I mean. You are attempting to apply situational ethics, hence my reference to logical fallacy. In any other situation taking without first obtaining informed consent would cause uproar and quite rightly so.

    Taking without informed consent is always wrong, no matter what the situation. You may try, after the event, to justify your actions and sometimes people may accept the greater good, but; taking without asking is still theft. It is not obvious that this needs to be done and it is certainly something that the state has no business being involved in.

    From the article that you cite:

    Transplant co-ordinators liaise with recently bereaved families, talk them through the process, make the arrangements with the hospital in which the patient dies, work to identify the right recipients and with the various units that will receive organs, and ultimately transplant them in to the recipients.

    Given that a donor might give two kidneys, a liver, a heart, their lungs, eyes, skin, bone and other tissues, this is an enormous task. They need time to deal with the process, and to be sensitive to the families – to answer questions, to give information and help distressed people make decisions.

    This is quite right and proper. To attempt to short circuit this for the sake of pragmatism would be immoral.

    Ethics are not irrational nor are they self-centred, they are the basis of a civilised society. I repeat – if you want my organs for someone else after my death, you ask me first. It really is a very simple principle.

  9. We’re clearly going to have to agree to disagree (I knew that to start with, really).

    I’m not going to be able to convince you that this is a unique situation in which the usual ethical considerations should take a back seat to pragmatism, and you’re not going to convince me that people whose lives could potentially be saved through the application of a little pragmatism in order to overcome inertia shouldn’t be given that chance.

    QuestionThats last blog post..Seen Elsewhere (25)

  10. Indeed. But that is because it isn’t a unique situation that requires ethics to be put aside. It’s actually fairly straightforward.

    If you read the comments on the CiF article you quote, there are plenty of alternatives to be tried long before we get into the state taking without asking. Incidentally, the majority are thinking as I do. Interesting, that.

    Also bear in mind that after a decade of this government, I will never trust it on anything. Why should I trust it to get this one right? Why should refusniks be forced to register on yet another database?

    Improved organ donation will be best served by a programme of accurate information and encouraging people to register. Personally, I’m not sure I want my life artificially extended by someone else’s spare parts, but that’s just me. We all die sooner or later.

  11. “this is a unique situation in which the usual ethical considerations should take a back seat to pragmatism”

    Accept this idea once and then sit back and be amazed at how many other unique situations the state can dream up.

  12. Indeed. What has surprised me is that during the various debates going on, I am in the majority, which is somewhat unique. I wonder how much that opposition is reflected in the wider world? If it is, then Brown is making a huge error of judgement if he pushes for it.

  13. Its not always easy to tell what the majority view actually is from internet discussions, because libertarians tend to be over-represented.

    However, I think you are probably right to suspect that in this case you are in the majority. Brown isn’t very good at accepting when he’s on a loser, however…

    QuestionThats last blog post..Seen Elsewhere (25)

  14. LR

    I agree with you 100%. But will it make any difference? Call me Mr Cynical – and call “QuestionThat” Mr Naive – but within a short time after this practice is adopted the NHS hospital where you die will rip out your organs anyway. Your relatives can protest as much as they want that your final request was to be buried/cremated with everything in place but they’ll be asked to “prove” it there and then.

    The next step is that the dying (or presumed dying) will be “nudged” over the edge. Consider: there might be a government minister requiring your kidneys sharpish. But, you know, this would be a situation where “ethics take a back seat to pragmatism”. After all, the minister’s life is so much more valuable than yours.

  15. If there is any possibility of my organs going into a politician, I’ll take up drinking to excess, eat myself silly and get my heart well and truly clogged with fat. if the bastards are going to steal my bits, I might as well engage in a little scorched earth…

  16. If you die without making any preparations for the disposal of your body, and you don’t have any relatives to deal with it, then the evil socialist state will already take charge of your corpse. It will bury it or burn it.

    The alternative is for the country to be strewn with rotting cadavers – presumably this is what a libertarian utopia would look like.

    So, given that the state will, and must, take charge of the corpses of people who haven’t left instructions and who don’t have relatives to decide on their behalf, the only question is what the state should be allowed to do with them.

    I think that the idea of using them to save lives wherever possible is eminently sensible and civilised, and your suggestion that they should just all be dumped on principle is bizarre to the point of being incomprehensible.

    In fact, I’d go further – I think it is actively insulting to the memory of the deceased. It is saying “We will proceed on the assumption that you were a stupid selfish arsehole who wants to let other people die needlessly, and who held dear your precious Right to Rot.”

    Larry Teabags last blog post..What’s the difference…

  17. LR

    The quality of your opponents’ arguments speaks volumes for your position and, besides, provides some innocent amusement. I particularly enjoyed the brilliant reasoning from “Larry Teabag” to the effect that “if it weren’t for our wonderful government we’d have cadavers stretching from London to Newcastle, therefore all our corpses belongs to the state”.

  18. The quality of your opponents’ arguments speaks volumes for your position and, besides, provides some innocent amusement.

    Glad to have returned the favour. I particularly enjoyed your argument that people in need of organ donations must be abandoned to die on principle, even though there are perfectly good organs available which the state is already necessarily de facto in possession of, because otherwise blah socialism blah fascism blah blah Stalinism Kim Jong Il blah blah ZaNuLab

    Larry Teabags last blog post..What’s the difference…

  19. Larry, what a wonderful strawman you have constructed – you really should apply for a CAP subsidy. I’ve no intention of dignifying it with a response, because it deserves none. Suffice to say; I did not say what you accuse me of saying – not even close.

  20. Agh, bollocks. I apologise for that last arsey comment… I’d failed to notice that I was talking to Umbongo not you.

    But I stand by my first comment. Libertarian rage at the state taking control of people’s bodies is conspicuous by its absence when those bodies are being buried or burnt, and only kicks in when they’re being used to save lives. Any idea why that should be? Cos it’s a mystery to me.

    And Umbongo can piss off to the Congo.

    Larry Teabags last blog post..What’s the difference…

  21. I have no problem with the state taking responsibility for disposal in the event of bodies being unclaimed because someone has to, due to public health concerns. There is, however, a difference between disposal of a body because no one else will and assuming ownership to the point of harvesting organs. The former has no ethical implications, the latter does. That said, the likelihood of an unclaimed body being suitable for harvesting is moot. Although, if it’s a wino who’s keeled over from an excess of meths, Gordon should have that liver, he deserves it.

  22. The former has no ethical implications, the latter does.

    Because you say so? Unnecessarily burning organs which could save someone’s life strikes me as having a distinctly ethical dimension.

    It just comes down to a question of what the default method of “disposal” should be. I don’t see why harvesting organs for transplant requires any more “ownership” than shoving the same organs in a furnace.

    Larry Teabags last blog post..What’s the difference…

  23. Because you say so?

    No, not because I say so.

    There is a clear difference between the two situations. Disposing of an “unclaimed” body for public health reasons is necessary and is doing no more than the next of kin would anyway. Therefore there are no ethics involved. Presuming to have sufficient ownership to give bits of it away crosses a line – even if the recipients have a need for it. While the state may, in the circumstances described, take responsibility for disposal, that responsibility does not infer ownership. That has a huge ethical dimension.

    As has been pointed out elsewhere in this argument, there are other ways of increasing available organs.

    The only ethical way to harvest a body is to obtain informed consent prior to the harvesting. If that means that is just a little bit difficult, well so be it.

  24. Presuming to have sufficient ownership to give bits of it away crosses a line

    Because you say so.

    I see no reason why you invoke supposed “ownership” at this point, rather than any other. It’s ad hoc.

    Why not agree that the state does not own the body, but may (and must) dispose of it. But how that disposal happens does unarguably have an ethical dimension: chucking it on the local tip, or turning it into dog-food would be unethical, for example.

    Harvesting organs to save lives (or “for public health reasons” if you prefer) can and should be a normal part of the disposal process, with no more implication of ownership than cremation already has.

    You say it’s unethical. I say burning the corpse without doing it is unethical.

    Larry Teabags last blog post..What’s the difference…

  25. No, not because I say so; because this is the default position. Disposal of an unclaimed body via burial or cremation will minimise the possibility of violation of the deceased’s wishes. Disposal is merely taking responsibility, giving bits away does, indeed confer ownership. To give away something that you do not own is not only unethical, it is theft.

    You may regard the deceased’s wishes as irrational or superstitious as has been maintained elsewhere in this debate, but, frankly, that is not your call to make; it is one for the individual being asked to make the donation. Subordinating the sensitivities and conscience of the individual to the will of the collective is, indeed, a socialist concept and it is an ugly, abhorrent, immoral, unethical one and one I will never subscribe to.

    This is tending to get silly, so with one final comment, I’m going to draw a line under it.

    You are splitting hairs here. For a body to be harvested, it needs to be alive in that there is oxygenated blood flowing to the organs. Just how many unclaimed coma patients are there kicking about in British hospitals? Not enough, I suggest, to make this an issue worth pursuing.

    I would have thought that Alder Hay had taught the presumed consent lobby a valuable lesson. But, no, clearly not. Personally, I had some difficulty comprehending the need for second funerals and such, but I do understand fully why those families felt so violated – it was because the hospital presumed consent. As a general rule, we tend to dislike being taken for granted – it’s a human thing. To ignore this is to display a callous lack of basic humanity (not to mention good manners).

    Donation is a gift freely given. Extended life as a consequence of that gift is not a right, nor should it be.

  26. burial or cremation will minimise the possibility of violation of the deceased’s wishes

    So you are proceeding on the assumption that the deceased would actively have wished not to use their organs to save someone else’s life. So my first comment wasn’t a straw man at all, but an accurate precis of your position.

    Maybe the deceased would have wanted to use their body to save lives. In fact polls suggest that that is more likely. In which case you’re the one violating their wishes, and you’re the one subordinating the sensitivities and conscience of the individual to the will of the collective (except that it isn’t, even). Socialist!

    The only possible for reason for your still unexplained insistence that cremation rather than organ harvesting has to be the default (other than because it just does ok) is that the possibility that the deceased held irrational or superstitious beliefs must automatically trump the (greater) possibility that they held moral and altruistic ones. Why?

    On hair-splitting, if it’s not theft to take something and burn it, then I fail to see why it’s theft to take it and use it. You’re the one with hairs to split if you want to defend that position.

    Larry Teabags last blog post..What’s the difference…

  27. So you are proceeding on the assumption that the deceased would actively have wished not to use their organs to save someone else’s life. So my first comment wasn’t a straw man at all, but an accurate precis of your position.


    No, I am not. If transplants were not available, we would not be having this discussion. Therefore clean disposal is the default position. I make no assumptions at all. I used the phrase “minimise the possibility” quite deliberately, because it is entirely possible that someone might want to donate but the person making the decision does not know – simple clean disposal takes the course of minimum risk. it makes no assumptions whatsoever. If someone wants to donate, they usually make a point of letting people know about it one way or another. That is how the default position works and it is how it should work.

    I would take polls with a huge pinch of salt. people lie to pollsters, so don’t bother wasting any effort in an attempt to use them to convince me. If your poll is to believed, more people would carry donor cards, wouldn’t they? That they do not suggests that they say one thing to the pollster and do another. Quelle surprise.

    As for your final paragraph, please…. Disposal is a necessity if we are not have a rotting body cluttering up the place. Burying it or burning it is not theft, it’s what the relatives would do anyway.

    Giving something away that has not been given to you or where you have not been given express permission most definitely is theft. There is nothing unexplained about my positron; it is the only ethical one to take and has been explained in great detail. If you still find it inexpiable, then the problem rests with you.

    As I said, organ transplants are a gift, they are not a right and neither is life itself. It’s a tough world and people die. Get used to the idea.

    Now that, frankly is the end of the matter.

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