Organ Donation Should NOT be Opt-Out – Conservative Article
England, Scotland and Wales have all now adopted an opt-out system for organ donation. Under such systems, everyone is assumed to have consented to organ donation unless they have explicitly opted out through official channels. It should be noted that this is a soft opt-out system. This is where families are consulted in an attempt to ensure religious and personal sensitivities are respected, even when a person has not opted out. When families are unable to be consulted, other people will be contacted to ensure organs are safe for transplant. Donation will then proceed on the basis of presumed consent. While a hard opt-out system, when the person’s consent has no chance of being overturned by their family, would certainly breach the ECHR, it should not be taken for granted that the soft approach is entirely unproblematic.
This may appear as a simple inconvenience for those who do not wish to be organ donors. However, such analysis of the situation misses several points. On a matter of principle, the default position must be that every individual has control over their bodies. By extension, control of the way their remains are disposed of after death. The approach taken in the UK and parts of Europe creates a markedly different situation whereby “presumed consent” is summoned from thin air. There is zero input or cognition from the person whose organs could be mistakenly donated. Where objections are clear the presumption is weak, but in less clear-cut cases this presumed consent has the potential to overturn the wishes of the deceased.
Many may be unaware that they have now been presumed to consent to be an organ donor. This policy has been implemented without any material opposition and only passing coverage by the media. When opt-out systems are implemented a huge awareness campaign must follow, yet this has been lacking. Many will be confused about the changes, entirely unaware of them, or simply unsure of what decision to make. Before, when you had to opt-in, people could do the research and discuss their options and make an informed choice regarding organ donation. However, now they must now do this research on something they are already presumed to have consented to. Those who are unsure of their decision and how they wish to engage with the bureaucracy erected by the NHS to manage this system, will find themselves covered by presumed consent until such a decision is made.
The use of family as a way to safeguard the interests of the deceased under a soft opt-out system is also not as universally robust as legislators may have thought. The person’s views may be vastly different from their families. They may not have has a close relationship. Furthermore, discussions of this nature may not have been had. Can we really be certain that the wishes of the deceased and their family match in every circumstance and that the decision made is one that the deceased would have wanted? Where objections are personal rather than religious there is a great potential for intimate wishes to be ignored by this scheme.
Equally, someone perfectly content with organ donation could have families that object and prevent donation. Indeed, 35% of Scottish and English families in a position to authorise donation, refused consent between 2018 and 2019. Some religious people wish to enter the afterlife as a whole, have specific interests surrounding funeral arrangements, or object to participating in organ donation as a medical procedure more broadly. Other people may object due to grief, discomfort, confusion, or private concerns not identifiable to others. The specific organ/organs in question may also be considered differently by families and individuals. This is one reason that the benefits in relation to the increased supply of transplants are highly questionable. The opt-out system discourages active organ donation registration where people are happy with the presumption made by doctors and lawmakers. The lack of an effective awareness campaign following the passing of these laws compounds this problem.
What happens if people have no next of kin or family available to make the decision? Will this leave presumed consent as the only indicator? The NHS states that it will attempt to approach a hierarchy of other people ranging from friends to care professionals to ensure the donation is safe. It appears as if the NHS is more concerned with seeking out medical history, rather than seeking out any potential objection to acting on presumed consent when attempts to find a family member have failed.
There is also a lack of evidence that such opt-out approaches increase organs donated. Many countries across Europe that have introduced such schemes have not seen a significant increase. Others have seen marginal increases. Some others have seen large increases that can be attributed to other elements of their overall approach to organ donation policy.
For example, Spain saw no material impact from the introduction of its opt-out system for almost 10 years. However, the connection between high organ donation rates and the opt-out system is accepted regardless of this fact. Active promotion campaigns and focussed and well-staffed referral systems have all been shown to provide more reliable results. Both of these factors are usually found at play behind the scenes where an opt-out policy takes the credit.
Marginal results must also be qualified by noting the potential counterproductive nature of the scheme. Not only does the system discourage active registering but, as noted by the UK Taskforce on Organ Donation, there could be backlash and an undermining of broader donation efforts after any perceived overreaching into private affairs.
Opposition to the opt-out system should not be equated to opposition to organ donation. It is more an opposition to the means by which it is being “promoted” by the state. The fact that civil servants and politicians have laid any form of claim to our bodies, without us having any say in the matter, is an unpleasant look no matter the cause it is in service of. Efforts and funds should be better directed towards a scheme that both encourages organ donation, inspires greater awareness, and, crucially, ensures people’s wishes and dignity are respected.
Written by Guest Conservative Writer, Oliver Pike
Point of Information
It’s information change, not system change, that will preserve bodily autonomy – A Labour Response
Oliver says “The fact that civil servants and politicians have laid any form of claim to our bodies, without us having any say in the matter, is an unpleasant look no matter the cause it is in service of.” If politicians really had laid claim to our bodies without us having any say, this would, of course, be horrendous (as any pro-choice feminist will happily tell you). People should absolutely retain the right to bodily autonomy as much as possible after death. The fact is though, the opt-out system doesn’t compromise this any more than the opt-in system.
The whole point of the opt-out system is that you are still free to…well, opt-out, if you so wish. The government cannot force anyone to donate their organs if they said they didn’t want to. I agree that the messaging around the change of system must be a lot stronger. It is unacceptable that people may be unaware of the change and therefore not take this opportunity to make the right decision for them. But that is not a fault with the system itself and could be fixed fairly easily with a widespread public awareness campaign.
It is also a fault that could be found with the previous opt-in system. When I applied for my driving license before the change, I was asked whether I’d like to opt-in to organ donation. I was unfamiliar with the system but nonetheless very keen to opt-in. I was annoyed with myself that I hadn’t stated this preference until the age of seventeen. I’d always known I would want my organs to be donated. However, like many others, was not clued up on the issue, didn’t really know what the process was, and never got round to signing up. I half-assumed that donation was the default. While it’s impossible to know statistics for sure, there must be a large set of deceased people who would have wanted their organs to be donated, but never got round to saying so. Essentially, their wishes were failed by the opt-in system in the same way some wishes will be failed by the opt-out system in the absence of an information campaign.
In terms of families being able to overturn their loved ones’ wishes, this is undoubtedly a problem that, again, would lead to unfortunate results in an opt-in or an opt-out system. Both systems are flawed. The only difference is the flaws with the opt-out system are at least mitigated by the potential that lives could be saved. The solution to the problems of both systems is that everyone should be made aware of how the system works. Everyone should also be encouraged to have the conversation with their families during life.
Written by Junior Labour Writer, Jessica Wilson
Opt-out Organ Donation is a violation of autonomy, no matter the positives – A Liberal Response
I have to disagree with Jessica that “the opt-out system doesn’t compromise [bodily autonomy] any more than the opt-in system.” While the system as a whole might not, when people opt-out and make their decision beforehand, the case upon which the system rests, of “presumed consent” when a person has not been able to make and register that decision, is a violation of bodily autonomy. We do not make assumptions of presumed consent in any other context relating to bodily autonomy, for example, sex or abortion. If someone said they had “presumed consent” to have sex with someone, that sounds like rape, not a consensual experience. On the point of bodily autonomy, I have to agree with Oliver, that government mandating what is done with our bodies, either before or after death is abhorrent.
I agree with both of my colleagues that the change in the organ donation system should have been better publicised and brought under a greater level of scrutiny. There may be some positives if the new system can be proved to increase rates of organ donation. However, from a liberal perspective, these positives cannot justify the state assuming that it can make decisions about our own bodies. The system change should have been accompanied by significantly more information and awareness. But the principle stays the same – you should not take anyone’s organs without their explicit consent.
Written by Junior Liberal Writer, Emma Hall