Presumed Consent Again

I see that the issue of presumed consent for organ donation rumbles on. An article in CiF tells us about the process of “soft” opt-out being proposed in Wales.

The argument about organ donation and whether it is ethical to “presume consent” is not a new one, but its relevance has returned since Wales recently made steps towards adopting a “soft” opt-out system. The plan will mean that organ donations no longer require confirmed consent by an individual, though it being “soft” means relatives will continue to be consulted on and subsequently will have the final word on the matter. Welsh ministers insist that it has popular appeal, but plans in England to adopt the same were shelved, even after Gordon Brown and about 90 other MPs across the political spectrum gave their support to it in 2008.

I don’t care how many MPs support the idea. They have no place deciding a matter that is a personal one. I’ve made my position plain on this one before, but I’ll make it again; what happens to our organs is nothing whatsoever to do with the state. If people wish to give their organs, that is their choice. If they choose not to, that, too, is their choice. Presumed consent is no consent and is therefore immoral and deeply repugnant. I’ll also make a brief comment about the right to life. There is no such thing. The gift of an organ is just that, a gift. It is not a right.

The article goes on to cover religious objections to donation. I don’t care what people believe and this, too, is no business of the state. The matter of why people choose not to donate is a matter for them and them alone, not the state. They should not have to give a reason or justify themselves, nor should they suffer a guilt trip because they choose not to donate.

Presumed consent is presumptuous. It is not the place of the state to presume anything, nor should people be forced to opt-out. The only ethical position is opt-in and encourage people to do so.


  1. Obviously I agree that the state should have nothing to do with anything like this (preferably nothing at all), but I do take issue with this being an issue of ethics. Humour me. Whose freedoms are being infringed upon if you take organs from a dead body? The body was previously the property of ‘you’, but since ‘you’ no longer exist, the body has no rightful moral owner – there is no you, therefore no freedom, therefore no inherent ownership. Legally there might be some ownership, e.g. people who donate their bodies to science, but beyond the cultural attachment to dead bodies, and the historical incidence of ritualistic burials, I can’t really see a moral case to answer.

  2. “Whose freedoms are being infringed upon if you take organs from a dead body? The body was previously the property of ‘you’, but since ‘you’ no longer exist, the body has no rightful moral owner”

    Well put. The mindset of someone who’d put the rights of a corpse above those of a living person in desperate need is something I simply cannot comprehend.

  3. The decision to give or not is made while we are alive. To usurp that, or to make a presumption about our wishes, is to infringe the freedom of the living, not the dead. This is very much a matter of ethics. If you want something from someone that does not belong to you, the ethical thing to do is to ask politely. To do otherwise is deeply immoral. Presumed consent is taking without specifically asking. This is not and never was about the rights of the dead; it is about the behaviour of the living.

    The argument about opt-in and opt-out is no different here to any other attempt by those who choose to presume consent and sneak in opt-out rather than the more open and ethical opt-in approach.

  4. ‘Presumed consent’ is an ugly concept. Try applying it to sexual intercourse and see where you end up. Increasing the opportunities and occasions where people are asked to consent to donation is sound and legitimate. Taking silence, deliberate or otherwise, to stand for consent or a lack of refusal leads us into dangerous byways. How about presumed consent for donating one’s body to medical science? I personally am on the donor register, but that’s my choice. I do not demand everyone be on it for some ‘greater good’.

  5. Longrider: If everyone who did not have a problem with donation opted in under the current system then this discussion wouldn’t be necessary. Fact is in the real world people don’t opt in because they don’t think about it or it never gets to the top of their list of things to do (probably in a lot of cases simply because they assume they’re not going to die anytime soon!).

    I couldn’t care less about “taking without specifically asking” when people are suffering and dying basically because of inertia, and there’s a simple change to the way things work that would improve matters greatly. You’re putting abstract principles ahead of real people, and you have no substantive argument against what I’ve said other than these.

    PT Barnum: There is no comparison to sexual intercourse, as rape causes great suffering to another living person. Organ donation does not – indeed quite the opposite. I have no opinion either way on donation to medical science as once again I will be dead by the time it becomes an issue, although my relatives might. Don’t forget that under the proposed changes to the organ donation arrangements relatives will still be consulted.

    I posted on this at my new blog (I used to be Question That):

  6. H&M You are treading a very dangerous path here. The abstract principle is very important. You are doing as others have done in this argument, you are allowing the suffering of those awaiting transplants to cloud that principle. Without the option of transplant, these people would die anyway – transplant is a gift and a gift is exactly what it should remain. It is not a right. It is never moral or ethical to take anything that does not belong to you without previously asking. If we make an exception here, what will the next exception be?

    Also, you are making an assumption – a popular one, I admit, but an assumption nevertheless – that those who do not opt in are okay with it, but are too lazy to opt-in. Unless you ask each and every one of them, you cannot know.

    This really is a simple matter of ethics. A blindingly obvious one at the core of a civilised society, frankly. Our bodies do not belong to the state to dish out as they see fit. It is up to us while alive to make a decision about donation. If people choose not to, or don’t get around to it, that is the way it is; their choice and making no choice should also be up to them.

    It is up to those who want the organs to make their case more robustly in order to encourage donation, not take the easy option and assume that people consent. It is not their place to do that.

    I used to be Question That

    I thought that argument sounded familiar…

  7. ‘I couldn’t care less about “taking without specifically asking” when people are suffering and dying basically because of inertia, and there’s a simple change to the way things work that would improve matters greatly.’

    This is utterly chilling, hand&mouse. I, like you, have decided that I’d rather my corpse did benefit someone rather than be burned or buried inviolate, but that is my choice as it is your choice. All wedges have thin ends, however.

    The existence of suffering and dying people does not justify state-sanctioned theft. We thereby enter a world where relatives of the dead will be shamed into agreeing that there was presumed consent and who are they to refuse, where the opt-outs will reside on a database, segregated, set apart from those who support this ‘greater good’ of other people’s health.

    Some folk are dealt a bad hand at birth. Some acquire illnesses that destroy their organs. Some pursue behaviours that destroy their organs. The only ‘right to life’ we have is that the state does not actively pursue our deaths. The rest is just life.

  8. I am a dialysis patient, currently awaiting what will be my third kidney transplant, and I agree with you completely Longrider.

    There is a decision to be made while alive, and failure to make that decision does not give the state the right to go around extracting organs.

    Indeed, if nothing else, it places the risk of error on the wrong side. At the moment there is the risk that someone’s wishes may not be known/communicated to the doctors until it is too late to use the organ. But better that than the flip scenario where someone has explicitly not wanted their organs used, but surgeons have gone ahead assuming consent, after failing to find an opt-out card, or whatever alternative is used.

  9. I’m sorry to hear that you previous transplants haven’t worked. I think there’s an underlying assumption that they do. An erstwhile colleague of mine has had her life transformed by a kidney transplant, so I am in favour of transplant and I am not – as seems to be suggested – worried about dead bodies remaining intact.

    My objections are consistent with everything else I’ve said about the state encroaching into the personal. I merely do not make an exception based upon the issue at hand. The end does not justify the means.

  10. You’re right that people seem to think that once transplanted, that’s it, you’re cured. In fact, the average kidney transplant lasts 7-8 years. As always with averages, plenty make it way beyond that, many nowhere near.

    For what it’s worth my first actually did ‘work’, and lasted 14 trouble-free years, before eventually failing due to being poisoned by the immunosuppresant drugs. By comparison, the second only lasted 18 months, but I knew it was a gamble as it was damaged to begin with.

    In the end, I’ve had over 15 years away from dialysis for which I’m grateful. But I agree that even if I hadn’t had dialysis to fall back on, and that the situation had been life or death, it wouldn’t have given me, or the state, the right to take the sort of action that some respondents are proposing. As you say, the end simply does not justify the means.

    The added irony is that you can bet that the likes of the Mouse would be opposed to trade in human organs as ‘immoral’. At least, it has been my experience that most supporters of ‘presumed consent’ take the rather twisted view that it is immoral for a person to freely sell an organ whether alive or as part of an arrangement to add funds to his estate post-death, but perfectly acceptable for the State to forcibly extract tissue.

  11. Tim Worstall is a proponent of organs trading. Personally, I have no ethical objections to it providing that there is no duress involved.

  12. ‘The decision to give or not is made while we are alive.’ Of course, hence why we have wills. Your body is your property, and contracting it to someone else’s possession while alive s of course your business. If you don’t do that, however, it ought to revert to the status of any unowned possession. Again, I’m unsure there’s any real moral case to answer, unless an explicit agreement has been broken.

  13. The default would be to revert to the ownership of the next of kin. The only time the state would be in a moral position to presume ownership would be if someone died intestate and without any known next of kin. Anything else is theft, once dead and presumptuousness in the extreme while the individual was alive. This is simply something the state has no business being involved in. It’s the presumptuousness that is immoral.

    I’m not convinced that the lack of organs is through pure apathy. The contradiction in poll results and organs made available for donation is just as likely to be a consequence of people lying about their intentions because they do not wish to appear callous.

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