Organ Donation: Should we be ‘Opting in’ or ‘Opting out’?

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Okay, a short enough question to chew on for a bit. The core of this argument between JoAnne Dobson (UUP) and Alastair Ross (DUP) is that the former wants to change the law to make organ donation a default position which you and your relatives can opt out of, whilst Mr Ross’s proposed amendment would set it back to opt in system.

So, for the moment leaving aside all the politicking and looking at the core question, what is wrong with making organ donation the default? Mr Ross says its ethics, but doesn’t really go into any detail on that. There was also a rematch on Nolan yesterday morning:

Ms Dobson says her measure is needed to increase supply to meet a growing demand for organ replacements. What’s your view?

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  • The Slicer

    Increasing organ donation is important but JoAnne Dobson’s proposed legislation is misguided, in my opinion, and her claim of the degree of support she has is a misrepresentation. A number of expert groups have expressed opposition to presumed consent (i.e. are opposed to opt out). Welfare of all patients and relatives needs to be preserved, not just the potential recipients. There are also other important related issues linked to presumed consent. The potential negative consequences of such a move are not being given adequate public voice. For some of the missing facts and informed opinion, see this:
    http://t.co/XNJPus0B0v

  • http://fitzjameshorselooksattheworld.wordpress.com/ fitzjameshorse1745

    On this issue…I am frankly a hypocrite.
    I can afford to be detached and have no emotional attachment to the question.
    As a husband, father and grandfather, I have a different perspective.

    I frankly dont like the Medical Establishment and certainly not the administration of Health policy. The higher up the medical hierarchy, the less I like them.
    I dont think that when I am deceased I can claim ownership of my organs. The decision is entirely my next of kin. I do not carry a donor card and signing one will not be a factor in THEIR decision. Nor should any conversation with a nurse trained in the art of persuading grieving relatives.
    More influential should be that my body will be burned in Roselawn and it wont make any material difference to anyone that I am missing a heart, kidney or liver (Ive never had an alcoholic drink in my life so it should be in excellent condition) lungs ( never smoked) and eyes.

    I do NOT believe on opting out.
    Legislation is about the balance of RIGHTS and DUTIES.
    Changing the default position effectively changes that delicate balance.
    I dont think anyone would seriously suggest that relatives have no right of veto.
    Yet to me …its a thin end of a wedge.
    When I am in dead …my organs …are not “mine”
    Nor do I like the situation that they “default” to being the property of the “State” and can be disposed of at their discretion.
    If the Default position changed….I would certainly OPT OUT.

    Like it or not, the position we have now is the best one.
    Relatives make the decision,in difficult circumstances often informed by the EXPRESSED will of their deceased loved one.
    There clearly is a gap between the two positions.
    Maybe a card …drivers licence that had a “tick” to one of three boxes.
    1 YES…take them all. <Id like my next of kin to abide by this)
    2 NO…..no circumstances (Legally binding and I dont want anyone to decide other)
    3 NO PREFERENCE ….please defer to my relatives without any "pressure".

  • Tir Chonaill Gael

    I’d like to hear Ross’ thoughts on creationism before analysing his pontifications on other aspects of life science.

  • SK

    “If the Default position changed….I would certainly OPT OUT.”

    Those who are not inclined to offer their organs for donation should not be eligible to recieve a donation themselves.

    Quid pro quo.

  • David Crookes

    TCG, we may as well ask to hear his thoughts on motorbikes. Creationism is irrelevant, and so is biology, if that is what you mean by ‘life science’. FJH has addressed the matter magisterially.

    Of course there’s a demand for more organs. There’s also a demand for functional A&E departments, and there’s a long-standing demand for a second storey on the RVH car-park.

    Anyone is welcome to most of my bits and pieces when I die, but I hate the idea of the state becoming a kind of Hegelian absolute that says, “X is a civic duty unless you opt out of it.” And I tend to beware of legislators who want to make us all do more and more things.

    Maybe FJH’s three-box idea is the best way forward. By the way, is it possible for 21st century bureaucrats to create a single card which will incorporate driving license, medical card, and national insurance card? It certainly ought to be.

    The whole matter of what happens to you when you die is much bound up with holiness, by which I mean what people and their families regard as precious, important, private, and decorous. Some people hate the idea of cremation. They shouldn’t have to say why. It’s not the business of anyone else. Some people hate the idea of having their body parts removed.They shouldn’t have to say why. It’s not the business of anyone else. Questions of biology don’t come into it.

  • babyface finlayson

    I can see no good reason not to make it opt out, provided the proper safeguards are in place. Not only can any individual with strong objections make their wishes clear before they die, but there is the secondary safeguard of next of kin agreement.
    I agree with David Crookes about the state interfering in our lives but then I felt the same way about the seatbelt law which is somewhat analagous, and I now accept it without complaint.
    Furthermore if the DUP is agin it then surely all sane people must be for it.

  • http://fitzjameshorselooksattheworld.wordpress.com/ fitzjameshorse1745

    I take SKs point that a person who wont donate might be refused a donation. For the record, some years ago I had a moderately serious kidney problem.
    Ultimately thats a lifestyle choice.
    If people are denied a transplant because of lifestyle choice as a means of closing the gap between the numbers …then of course that brings up denying a liver to a lifelong drinker and a lung to a lifelong smoker.
    And more broadly denying (free) medical treatment to a motor cycle racer.

  • ForkHandles

    Opt in is the only decent way to go about organ gathering. I find it a bit medieval and gruesome to think that by default I would be sliced up and who knows what removed the second I die. To have a law that says this will happen to my body unless I fill in a form is a bit sick.
    Until we can grow organs in the lab, organ donation is a life saver for many people. It should be advertised and much more of an active effort made to sign people up in the street and so on. It should always be the persons choice to donate their own body.

  • http://fitzjameshorselooksattheworld.wordpress.com/ fitzjameshorse1745

    I dont think signing up the “Future Deceased” is relevant.
    The people who should be signed up are the “Future Bereaved”.
    Concentrate the Campaign on Relatives….thats the way forward.

  • sherdy

    I had a dream, no not like Martin Luther King, but it was many years ago, and I was in hospital dying needing major surgery to keep me alive.
    In the private ward next door a top politician was also dying, and in need of a heart transplant.
    I could hear the medics discussing who should be kept alive – to do their best for me or take my heart out and sacrifice me.
    Talk quickly came down to how much profit could be made in the private ward, how great the kudos for the medics, and the overall good publicity would accrue to the hospital.
    To tell the truth the prospects frightened me so much I jumped out of my sleep, but since then have had an aversion to having to opt out of such situations.
    But today the thought of me dying corpus intact and some young person dying because I hadn’t been a donor does not make me feel good either.
    But people should not be compelled to be voluntarily chopped up after they die.
    My thoughts are nothing to do with the DUP electioneering on this issue, which I find despicable,

  • The Slicer

    Can’t see how this is a DUP electioneering issue – the Health Minister would appear to have a different position than his DUP colleague.

  • iluvni

    And as the dying patient lies there, and the patient’s family is asked for consent…what happens when some members of the family agree, and other members of the family disagree?
    Is pressure to be brought, at that nightmare time, to change their mind….only to be regretted later?

    Ross’s proposal is the only way to go.

  • Charles_Gould

    A dead person cannot benefit from his organs but others can.

    I take Dobson’s position: it is the one that makes the most positive real difference to people.

  • babyface finlayson

    illuvni
    “some members of the family agree, and other members of the family disagree?”
    Not an insurmountable problem. A requirement could be put in place that full agreement of immediate next of kin (or those contactable at least) is required or nothing happens. So if a parent, child or spouse,say, were to object.then no pillaging would take place.
    Easily avoided by ticking the opt out box anyway.
    Sherdy
    You would probably have the onerous task of ticking the opt out box too.Then your extremely unlikely scenario would never happen.

  • cynic2

    I don’t own my dead body so I dont see why my relatives should.

    Having had a close friend die in his 40s while waiting for an organ that didn’t arrive quick enough I am all for a OPT OUT system That way I set my wishes out clearly and the state can follow them.

    Its always my right to change this at any point up to the one where I pop my clogs – at which pint i wont give a damn.

    The DUP Bill though is just another spoiler. There’s no show without punch and the religious right want to control everything. What next? Locking up the swings again? what about prohibition?

  • Alias

    The underlyning principle being established is the citizen is the property of the state, with its organs harvested to serve the common good or to serve the private corporate interests who operate with the state in its medical facilities. No doubt those of a statist mentality see nothing wrong with ownership of their bodies being claimed by the state but the rest of folks should be concerned at the transfer of ownership.

    Incidentally, some doctors prefer not to wait until the patient is actually dead and others prefer to kill the patient rather than wait.

  • Alias

    “Its always my right to change this at any point up to the one where I pop my clogs – at which pint i wont give a damn.”

    Good for you, but those who can’t exercise the supposed choice such as the mentally ill and the intellectually disabled don’t have the academic luxury.

  • The Slicer

    cynic2. “That way I set my wishes out clearly and the state can follow them” That’s not a coherent point. Opt out (which you seem to be championing) is designed to catch folk who DON’T set out their wishes clearly (one way or the other) and put them into the organ donor pool, presuming their wishes. You’re free to set out your wishes clearly with either opt out or opt in. The current opt in system, which Mr Ross’s proposal is in line with, is the way to prevent ‘the state’ presuming your wishes rather than following them.

  • cynic2

    “the citizen is the property of the state”

    Sorry Alias but this is just plain wrong. It is explained succinctly on the Liberty website at

    http://www.yourrights.org.uk/yourrights/rights-of-the-bereaved/the-rights-over-a-dead-body/possession-of-a-dead-body.html

    To sum it up:

    1 It is a well-established principle of law that ‘there is no property in a corpse.’

    2 This means that the law does not regard a corpse as property protected by rights. In other words there can be no ‘ownership’ of a dead body.

    3 The only exception is where body parts acquire different attributes by virtue of the application of skill, e.g. dissection and/or preservation techniques.

    4 However even if there is no legal ownership certain people have the right to possess the body.

    5 In the first place, anyone who has a duty to bury the deceased has the right to possess the body in order to bury it.

    6 In many cases this duty will fall upon the personal representatives of the deceased i.e. the administrator or executor of the deceased’s estate

    So nobody owns the body. We have seen a huge amount of twaddle on this over the last 10 years from relatives who claim ownership of every cell and have had weak and incompetent politicians in a spin

    What the proposed system authorizes is the state to operate on the body to remove organs to help others. Once harvested ownership in those organs is crystallized as they have become converted by the surgeon’s skill

    And how can this be , as you suggest, making the citizen the property of the state., It only applies when the citizen is dead. Deceased. Gone. And the property created in the tissue is then given away to help another human being in dire need.

    I can (just about) understand why some people want to opt out. I still think its selfish but that is their right and I respect it. But how is it any less an interference with my rights as a citizen to say that my next of kin owns me when i gone and i have no say in that?

  • son of sam

    By all accounts,Joe Brolly has made it clear he supports the Dobson Bill.I seem to remember that Peter and Martin had indicated that they were behind Joe when he was lobbying for legislative action.What has happened now if the First Minister is permitting one of his M L A s to initiate a rival Bill?

  • David Crookes

    Once a thing becomes legal, some people always want to go further. Alias makes a point whose subtext is that a living person may come to be seen as an organ resource. That takes us into a more frightening arena than the who-owns-a-corpse arena. A doctor waiting to harvest an organ may come to resent the patient who refuses to die obligingly on time. Such feelings may give rise to murder if they become the basis of actions.

    In the background the Nazi state is always there, wanting to take over. Be sensible. Be efficient. You’ve lived for long enough.

    A state that is allowed to harvest organs without any restriction will move on to euthanasia.

  • sherdy

    Babyface, – If only dreams were as logical as yourself!
    Slicer, – You don’t see how this can be en electioneering issue.
    Robbo will do anything to ensure complete domination over the UUP, and throwing Ross into a dogfight will not cost him a thought. Ross might even win, and then Robbo wins.
    As far as Edwin supporting the Dobson proposals, Edwin has been too far on the religious right for his boss and has come out of too many situations looking very inept.
    Would his demise be any loss to the party? Definitely not.

  • megatron

    I am sympathetic to those who question the opt out system.

    i think much more could be done on opt in – eg how much does it cost to have census people (or more recently electoral register people) call to every house in the country.

    A strong promotional / educational campaign plus an informed person calling at each house seeing who could be signed up is the way to go in my opinion. Opt in should be last resort.

  • The Slicer

    @megatron. I have sympathy with what you’ve posted and agree that more could be done in association with an opt in system. However, a census/referendum is only of value (in fact the same is true of democracy) if those voting are sufficiently informed on the issue they’re voting on. The electorate is currently insufficiently informed. Sadly it appears that so our some of our political ‘representatives.’

  • The Slicer

    ….so ‘are’ some of our political representatives…

  • Harry Flashman

    “So, for the moment leaving aside all the politicking and looking at the core question, what is wrong with making organ donation the default?”

    How can you leave out the “politicking” when politics and the relationship of the individual to the state is the absolute core issue in this debate?

    I currently carry a organ donation card and am happy to let anyone take what they want from my body once I am dead if it will help others. The day the state decides that my body is by default their property and they feel they can help themselves is the day I will tear up that card and tattoo across my abdomen “Keep your theiving statist hands off!”

    It’s this ornery objection to being told what to do and how to live their lives by an all-benevolent Nanny State, who knows better than you how your body should be treated, that is at the core of most Americans’ objections to universal healthcare provision by the state. Of course you wouldn’t understand this if you got your news solely from mainstream, pro-statist news sources where you would be led to believe that such objections are rooted in a simple know-nothing hatred of the poor.

    That is the fundamental slippery-slope argument against compulsory state healthcare, once you declare that the state must provide you and your family with healthcare you have utterly transformed the relationship between the citizen and the state. You are no longer a free citizen who pays taxes to have public servants provide essential public services that individually you cannot provide.

    Instead you become a supplicant of the state, like the inmate of a workhouse or charitable institution, dependent on the benevolence of your overseers who have the absolute right to tell you what you can eat, drink, activities you can indulge in, what body-shape your child should have, where if anywhere you can smoke, the amount of trans fats you can consume, how big your soft drink may be and how many aspirins you can buy.

    Ultimately they can decide whether your life is worth living and whether you’d be better off dead so the state can use your bits for someone else’s benefit.

    Hell no!

  • Seamuscamp

    I find it hard to see why a family should have any say in the consideration of organ donation. The body isn’t their’s. There have even been cases where people have “opted in” and the family has blocked the donation.

    To the dead, what happens isn’t an issue; to the living there may be an issue; to the recipient of a life-saving organ there is no down-side. If I were against organ-harvesting, I’d make sure my opposition was recorded. The record system , of course, must be robust.

  • Newman

    There are a number of competing issues here:
    1 Respect for the corpse which has been at the heart of our civilisation for thousands of years
    2.Recognising that defining the moment of death is a key issue and by no means agreed by all.
    3 Harvesting organs is best of the organs are still alive and operating.
    4 The proposal has the potential to be extremely distressing for next of kin, particularly if life support is not turned off and anaesthetics are being administered to avoid “pain”.
    5. Organ donation is wonderful gift of life but it should not be determined by the state in some utilitarian manner.
    6. Another great example of the law of unintended consequences.

    A plea for a little bit more informed comment on this complex issue.

  • http://fitzjameshorselooksattheworld.wordpress.com/ fitzjameshorse1745

    Rather obviously, the people to get “onside” are the next of kin.
    To some extent the Corpse is irrelevant.
    The Corpse feels nothing. The relatives dont.
    At the end of the day, the family is expected to pay the funeral bill. For SeamusCamp above to say that the body isnt “theirs”…that seems to suggest that they have no responsibility to the corpse and Society.
    What is the proper position for a family.
    “Nothing to do with us guv….the State should pay for a funeral”
    What is the proper position of the State?
    “Nothing to do with the family…the expense of a funeral falls on the State”

    How bizarre would it be that Healtth is privatised, railways etc but what Government thinks it a good idea to nationalise the most private situation?
    Of course some might say that there is some kind of partial Burial Grant for the poor? A civilised society might say that a family whose funeral is being paid for should have fewer rights….a bit like the poor in India have fewer rights in organ donation (they are actually alive) …but for me thats a depressing thought.

    Bridging the gap between organ donation and organ need should not be established by “opt in”legislation…Where there is legislation, there are court cases….adverse publicity, public and private resentment.
    Go down a legislation route and inevitably someone will get a heart or kidney that they are not “entitled” to.
    Cue Portia and Shylock and the rest.
    And a surgeon turning up at a. Hospital bed to take it back….

  • http://fitzjameshorselooksattheworld.wordpress.com/ fitzjameshorse1745

    Oops…the Relatives DO feel.

  • The Slicer

    Newman. I agree it’s important that utilitarianism isn’t given free reign. Note ‘though that the time of death is not in doubt, regardless of whether donation occurs following brain stem death (when circulation to the vital organs continues up to retrieval of organs) or cardiac death (when circulation has stopped for a short period prior to retrieval). Re informed comment, did you follow the link from my first comment (at the top)?
    FJH, you make an important point about the family. This is explored in the same post via the above link. Shylock gets a mention there too. (From your earlier comment I presume that there’s a typo in your last comment i.e. ‘should not be established by “opt in” legislation” is a typo and you mean should not be established by opt out).

  • http://fitzjameshorselooksattheworld.wordpress.com/ fitzjameshorse1745

    Yes…sorry.

  • Harry Flashman

    Singapore is the classic example of the Nanny State where individuals are not free-born citizens but merely wards of the all-powerful state whose well-being the state works hard to ensure but who must be reminded that they ultimately are not their own masters.

    If you’re comfortable with a government that will provide for you from cradle to grave and keep the streets clean and free from crime at a cost of your own liberty and individual freedom then Singapore is the place to live. I personally like a visit there every so often just to enjoy the sensation of no litter and free-flowing traffic but give me the freedom and mess of Indonesia any day, it’s a personal political thing for me.

    It therefore comes as no surprise that Singapore has the opt-out option. And it comes as no further surprise that when the rubber hits the road family’s feelings, the rights of a still breathing human being are trumped by the power of the state.

    http://www.geraldtan.com/medaffairs/hota.html#optsgh1

    “Brain-dead man’s kin in scuffle over op to remove organs
    Relatives, hoping for miracle, wanted doctors to delay surgery for another day”

    The money quote for me:

    “Lianhe Wanbao reported that around 20 members of Mr Sim’s family intervened when his body was being wheeled into the operating theatre at about 10.15pm on Tuesday. His mother and five other relatives went down on their knees to beg doctors to delay the operation for one more day.”

    Nanny is such a nice lady when she’s handing out the sweeties, not so nice when she wants to give you the castor oil.

  • babyface finlayson

    Newman
    On your 4th point the Spanish model seems worth copying.They have a trained clinician ready to talk to the next of kin at the appropriate time. A process they seem to think contributes much to the high rate of donation.
    I would be in favour of an opt out possibly with this kind of safeguard in place

  • cynic2

    “the rights of a still breathing human being”

    He was dead. Stone dead. Any breathing was machines pumping air into a corpse. He had the choice to opt out and decided not to.

    There is no property in a corpse.
    .
    I am sorry too but families hoping for miracles are common but not rational. I listened recently to a lady on radio berating the NHS for failing to save her father in A&E where he was taken with a massive stroke. She would sue she said as they had ‘stolen years of life from him’ It turned out he was 87 years old and (reading between the lines) brain dead on arrival .

    I am sorry for her and other like her but death is a reality that has to be faced and accepted and I see no reason why the ability to help others should lie in the hands of grieving relatives when the deceased themselves had a choice.

  • cynic2

    The DUPs attitude to death seems odd.

    Two years ago some senior members of the DUP looked forward to almost a state funeral for the Big Man when he was critically ill.

    Yet we now know this seems more than anything to have been to get him nailed down where he could cause no trouble

    Aint politics wonderful

  • Harry Flashman

    “There is no property in a corpse.”

    Balderdash.

  • FuturePhysicist

    How’s about a system where you keep opt in, but those who don’t opt in are lower down the organ donation list? How’s that for incentive?

  • Coll Ciotach

    FP – how about an opt in for all health services? or would that cause too many problems regarding those who can least afford the opt in being left out?

  • FuturePhysicist

    My point is that there are healthy people who’d rather take organs than give them, when you think about the opponents of the opt out system, it’s tough to defend their position as being anything but selfish. We assume everyone has the right to organs, why can’t we assume everyone has the responsibility to provide them if they die?

    Vast majority of us will die with un-transplantable damaged organs anyway.

  • FuturePhysicist

    At the very least someone should have the responsibility to make the effort to register that choice.

  • Harry Flashman

    I stated above that I currently hold an organ donation card and am happy to have any organs of mine used after my death.

    I went on to explain the logical and perfectly rational objection on the basis of political philosophy to state control of healthcare (and by extension “opt-out” organ donation) on the grounds that it leads to a transformation of the relationship between a citizen and the state.

    I pointed out that many people have difficulty understanding this political standpoint because of brainwashing by statist media.

    FuturePhysicist then pipes up all rosy-cheeked and good little boy-scoutish.

    “it’s tough to defend their position as being anything but selfish”

    The future of physics is indeed bleak if the practitioners of that science can’t even grasp rather basic philosophical concepts.

  • FuturePhysicist

    Let me take you back to the past of physics when the word meant medicine, you didn’t have transplants in that physics because individual surgeries didn’t have the facility to store them. Hospitals became a statist intervention, then national donor registers. If you want to go completely anti-state then people would have to pay for personalised donors, organ donation becomes mere prostitution, literally the selling of bodies. Indeed you verge out of libertarianism to plain elitism, someone else’s body belongs to you, simply because that way imposes market sense.

    My philosophy is basically altruism and empathy

    Why shouldn’t the greater need prevail?
    What fear justifies the denial of organs that can compare to the fear of being denied organs?
    On what basis would I if I ever had the need feel that it is justified for me to receive organs without donating them?

    “Because I am selfish” fits better than some “I’m defending my body from some statist conspiracy and I want the chance to social engineer after I’m dead”. I’m sorry I wasn’t able to morally ethically reform my opinion that letting someone die is the most noblest thing we can possibly do in the name of our personal freedom.

    What I am talking about is mutualism as opposed to exploitation, any system which prioritises the taking of organs over the giving of organs is formulaically exploitative. It’s not statist propaganda, it’s rationalism at its best, if you want to have some poor person’s organs you should be prepared to reciprocate in his or her need.

  • IrelandNorth

    Moving from opting-in to opting-out represents a further erosion of ctizenry and/or subjectivity. Every time this organ ‘donation’ (sic) topic presents itself, I think of that Monty Pythonesque sketch from their feature film: “The Meaning of Life”, where John Cleese and another come calling to a Hilda Ogden type character in a Coronation Street setting to collect a liver for a client from an inconveniently undeceased ‘doner’. Or, of the 19th century infamous bodysnatchers Burke and Hare, and how failing to opt-out amounts to a form of constructive organ snatching.

  • babyface finlayson

    IrelandNorth
    I presume then you are in favour of scrapping the current organ donor card system, since anyone carrying a card is vulnerable to the same kind of exploitation you are concerned about.
    Into hospital for toe surgery and bobs your uncle out comes a kidney.
    Or maybe we shouldn’t believe everything those wacky Python boys told us.

  • IrelandNorth

    babyface finlayson! Opting-in is my favoured option, since it’s elective and non-presumptious unlike its opting-out contrary. A bit like an invitation to a cocktail party where one is obliged to RSVP regrets only, thereby oobliging correspondence. I appreciate a Monty Pythonesque logic is somewhat zany. But many a true word spoken in jest. I’m long enough around the block to fear the tyranny of the law of demand on supply. If spleens were in short supply, I’d stand well back from my local railway platform as the train came in. You never know if a latter Burke or Hare is breathing down your neck. In more improvished climes like Turkey and China, people have been known to sell a spare kidney to feed the family. I”m uncomfortable with the enroachment on personal autonomy by Europan federalism.

  • babyface finlayson

    IrelandNorth
    Surely the opt-out option would increase the legitimate supply of spleens and organs of that kidney, thereby reducing the danger of someone pinching one out of your belly before you have joined the choir invisible?
    The more there are available legitimately the less likelihood of a black market.