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In Narnia we call it "going bad"

"But that would be putting the clock back," gasped the governor. "Have you no idea of progress, of development?"

"I have seen them both in an egg," said Caspian. "We call it 'Going Bad' in Narnia...."

C.S. Lewis, The Voyage of the Dawn Treader

Wales is going to presumed consent on organ donation. That means that the legal default position is that you have consented to be an organ donor.

Probably I have an unduly romantic view of the Welsh, fostered by my repeated reading (to the point almost of memorization) of Edith Pargeter's pro-Welsh historical novels set in the border country in the 1200's. But the thought that the distant relations of Llewellyn ap Griffith and the many others who fought and died for Wales have, apparently, some measure of political independence now and use it for this is something I find repugnant and depressing.

Yes, I understand it's a "soft" presumed consent system. This apparently means that they "consult" family members about organ donation. What they do if the family members say a resounding, "No!" remains to be seen. I hope I'm not just a cynic, but I think "consult" is a weasel word. It seems to me entirely plausible that the "soft" presumed consent will become "hard" presumed consent if family members refuse. I would be willing to go so far as to bet that if there is disagreement among family members, that will be enough to allow donation.

But even if we take the most charitable view and suppose that any immediate family member will have veto power over organ donation, what about the people who have no family, or whose family members are all far away and difficult to locate? It's hard to see any outcome there other than that the person will be seen as an organ donor. Indeed, if this change doesn't mean that, it isn't a change. Family members now, as far as I know, can consent to organ donation even if the patient has not filled out a donor card. For "presumed consent" to mean anything, there must be some group of people for whom consent can, in fact, be presumed.

What's almost as depressing as the outcome is the level of political discourse used in favor of the move:

A spokesperson said: "We believe we should be progressive on this issue and follow the example of those countries with excellent records on organ donation, where an opt-out system is a key element. Introducing a soft opt-out system will mean people are more likely to make decisions about donation during their lifetime and to have discussed their wishes with their family."

Oh, well, hey, if it's progressive, who could fault it? We've gotta be progressive!

Roy Thomas, chairman of the Kidney Wales Foundation, claims it will increase the number of organs available for donation by up to 30 percent.

"[It] will solve a lot of issues for people who are waiting for a transplant," he added.

"We are losing one person each week here in Wales and that's a huge amount of people who are dying and we need to give them hope.

"I believe the Welsh government has got this absolutely right and are progressive. Indeed I think the rest of the UK will follow."

Yep, that's all there is to it. If we believe the Welsh government is progressive, then that settles it.

And then there is the not-so-subtle coercion in one alleged selling point: "Introducing a soft opt-out system will mean people are more likely to make decisions about donation during their lifetime and to have discussed their wishes with their family." See that? What it amounts to is, "Speak now, or forever hold your peace. If you don't want to be a donor, you'd better get a move on and make that official." It's a deliberate attempt to force the issue.

If that's progress, I say the heck with it. In Narnia, we call it "going bad."

Comments (15)

On the other hand, if there were a place where I could go to fill out a form in triplicate so that every single time I go to the grocery store I do not have to grunt No to the constant question whether I want to give a dollar to that Komen woman and her Planned Parenthood pals I would happily go and fill that form out. I can take the social pressure of not being an organ donor. It's the constant nagging at my local food utility that sandpapers my eyes. Give us a Do Not Call registry for grocery checkout lines as well as organ donation and I'll be somewhat less dyspeptic on shopping and dying days.

Welll. I know you're being semi-humorous, David, but this is a little more serious than that. Presumed consent is a big legal move. It involves treating everyone as prima facie a source of spare parts. It involves treating our bodies as if they belonged prima facie to the state to be used "for the common good." This isn't just social pressure.

If some homeless man in Wales without relatives who didn't happen to be "plugged in" enough to fill out the special form to opt out gets hit by a car, suffers massive head injuries but doesn't quite die, and they have him in hospital, they can time it just right, do all the special stuff to make his kidneys suitable for donating, turn off the ventilator, wait for his heart to stop, wait two minutes (if that), "declare" him dead, start sending blood through his vital organs again (with special blockages in place so the blood doesn't go to his brain and resuscitate him), open his torso, and take out his kidneys for donation.

Hey, he's just a bum without any family. At least he can finally be useful to somebody.

and that's a huge amount of people who are dying...

Did he weigh them or something?

Yes, I was semi-kidding. The empire that produced Swift and Orwell and a Monty Python sketch about forced organ donation is increasingly hard to parody; and we, her heirs & assigns, are just an Oregon half-skip behind the growth of presumed-wanting-to-be-killed-if-it's-cloudy (because clouds are sad, and sadness is a senseless tragedy no one should be forced to endure) over there. At least opting out of this newest wrinkle is a possibility. Which probably puts one on a Suspected Terrorist list, and which de-opting will probably be eliminated if more than about two percent decide they'd rather keep themselves all in one piece.

I do worry that if I am out walking the dog, sans my Not A Donor driving license, when I'm mowed down, I will be harvested because there is a presumption that all decent people are organ donors, and this poor fellow, killed with his cocker spaniel, was obviously a decent man, and we keep the ice chest right here for the odd kidney or heart, so it would be indecent of us not to pick him clean before dumping him off at the coroner's. And what redress does my estate have, anyway, if I am caught dead with my license and my non-donor intentions are, uh, accidentally overlooked, by the zealous young EMTs?

And what redress does my estate have, anyway, if I am caught dead with my license and my non-donor intentions are, uh, accidentally overlooked, by the zealous young EMTs?

Especially since at that point they'll bring out some sick little kid and wax on about how you've given her "hope." Never mind that YOU are very dead, she can hope to live....

Generally, the British media justifies this sort of decision with a scientistic shrug - "at the end of the day, we're all spare parts". Or we defer to the "experts" - the British Medical Association, or whoever.
For the record, I'm with you on this Lydia. It's not just that I don't like this decision, or that I disagree with it. It's wicked. Fully informed consent from donors should be essential.

A bit of good news -
Organ Donation is recognised as an ethical problem in GCSE Religious Studies courses even though it rarely comes up in Undergraduate Medical Ethics textbooks. Maybe the next generation will at least be aware of the debate.


Wow, Graham, fascinating links. For people who have followed my writing on this subject, what David Hill, the interviewed anesthetist in one of the links Graham gives, says in the following quotation puts in a nutshell something I've been saying for a while. See whether this corresponds to what most people think goes on in transplant:

Moving on from there, please take us through the transplant procedure. The donor is taken down to theatre, the ventilator is turned off, respiration stops, the heartbeat stops, circulation stops, they're dead by anybody's criteria, and the operation begins. Is that right?
That's completely wrong. That is certainly the impression which is given, whether deliberately or not, but that is not the situation. It used to be the situation when we were transplanting only kidneys because the kidneys will survive a period after the person has died. Other organs - heart, lung, liver, pancreas -will not function under those circumstances. The earliest liver transplants were from patients who were treated in the way you describe but they failed, so it became necessary - it was seen to be necessary - to take organs at an earlier stage. It was at that time that the Royal Colleges changed their opinion so that fulfilment of the brainstem tests would diagnose death rather than say that it will happen eventually.
Let's be quite clear. At what point is the ventilator turned off?
The ventilator is not turned off until all the organs that are needed have been removed. The patient comes to the operating theatre with sometimes even more intensive treatment going on than they were receiving in the ICU, they may need blood transfusion, they are treated intensively and they look like any other patient. As I've said, at the beginning of surgery they respond physiologically like any other patient.

Notice that he's talking here about what one might call "traditional" transplant, where the patient has been declared "dead" by neurological criteria--i.e., "brain-dead." Above, I was discussing the Pittsburgh Protocol, which if anything is even looser.

Given these practices, is it any wonder that those who are dead-set committed to organ donation are now wanting to throw out the dead donor rule altogether, in the name of "honesty"? As with the connection between abortion and infanticide, it is a terrifying fact of modern life that, presented with an ethical reductio ad absurdam, the modern "ethicist" always simply bites the bullet and accepts the absurd conclusion. Hence, if we argue that, if abortion is moral, infanticide should be also, the modern ethicist concludes that infanticide is moral. If we argue that there are real, empirical worries as to whether patients used for organ transplant are actually dead, the modern ethicist concludes that it is moral to take vital organs from living patients.

Thanks Lydia. Hill makes a powerful case that, at the very least, deserves a considered answer. Instead he has simply been ignored. We don't stone prophets anymore - we just put them in perspective...
Incredibly, I would not have been aware of the ethical issues if I did not teach GCSE RE, despite covering medical ethics at University. (GCSE exams are taken by 16 year olds! This means that 16 year old students are more aware of the issues than most pastors!)

We're not allowed to talk about this issue. What the British Medical Association wants, the BMA gets. It's very, very worrying.


Odd, isn't it, that in modern Britain we would never "redistribute" a person's property without their consent. But we will "redistribute" their body parts....

Odd, isn't it, that in modern Britain we would never "redistribute" a person's property without their consent.

Welll. Aren't taxes rather high precisely for redistributionist purposes in modern Britain? Not entirely a joke. I would say that statism and collectivism take many forms and that once you train people's minds to think in collectivist ways, you weaken their resistance to more radical redistributions--e.g., of body parts.

You obviously have no understanding of the debate that has been ongoing in Wales for decades surrounding the subject of organ donation. The people who are supporting this are Welsh and support their devolved government. That is what devolution is all about - having the right to govern ourselves on certain issues. This is one of those issues.

Opt Out does exactly what it says on the tin - If you do not want to be a donor you opt out. As for the family that says "no" the that is end ex; no further action would be taken. That is the current system as there is not a doctor or transplant specialist nurse who would go against a families wishes. By the way did you know that legally if you carry a donor card a doctor does not have to seek the families permission, no thought not. So have you heard of a family that has not been asked once they know the person wants to be a donor? I never have. If you want to know the true facts here are a few:

People are believed to be willing to become donors unless:
o they have opted out
o they cannot be identified
o their place of residence cannot be identified
o the wishes of the deceased can be proven to be contrary after relatives have been contacted
o Immediate relatives object.

So as for the comment about the homeless man who no one knows then he would be buried or cremated with all his organs (at the expense of the tax payer).

Melanie, I don't give two pennies for the glories of devolved government in this context. What the government is doing is _wrong_. In fact, that was my whole point about Welsh independence--it's sickening to see it used for this purpose. The fact that "the people want it" doesn't make it right.

I said nothing in my scenario about whether the homeless man's name could be given. Presumably, _if_ your accouhnt is correct, the fact that he has no place of residence would scotch it. Whoop-de-doo. Feel free to change my scenario to a lonely man who has a "place of residence" but no immediate relatives and gets hit by a car, etc., etc. That make it better? No, it doesn't.

As for no transplant specialist's going against family wishes, forgive me if my skepticism arises concerning the meaning of "family." There have been cases in the UK in which people have been dehydrated to death against the wishes of at least some of their family, and there are always in such situations going to be family members whose wishes take priority. If, say, a wife is fine with it but, say, a sister (and only a sister) objects, I find it exceedingly hard to believe that the wife's consent would not be trumps. Legally, that would usually be true of most medical decisions, including life or death ones.

The difference between us is that you think presumed consent is fine and I think it's evil. I doubt there's going to be much rapprochement on that issue. I wrote the post to inform people of what is happening.

No you wrote this item to give your opinion. There is nothing wrong with that but at least be honest about it and do your home work and read the White paper that has been produced. I can understand anyone holding a different opinion to me but please refrain from passing a moral judgement on my opinions. By calling Opt Out evil means you think that I am because I believe in it. I am sorry that you wreak cynical and have such little faith in doctors.

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