Gouge Away

by Quinn

I don’t consider myself a great ideologue – I don’t know, you may well disagree – and I don’t really approve of ideologies, but I do of course have my own set of beliefs and a sense of morality that could be described as such. I am implacably opposed to the idea of private education for one thing; it seems a basic and fundamental inequity in society that the rich can buy better schooling for their offspring, and if it were in anyway practical I would like to ban the practice. But…if I could afford to, and I was faced with the option of sending my children to a private school or putting them through a state school that I felt was so poor that it would severely hamper their prospects, then I would choose the former over the latter. I wouldn’t deny the charge of hypocrisy, what I would say is that whatever my own personal beliefs, the future of my children is more important than any ideology I may subscribe to.

This thought – that there is a time and place for ideology – popped back into my mind when reading about the current debate surrounding organ donation. Liam Donaldson, the Chief Medical Officer, has called for a change in the law regarding organ donation so that we have a system of “presumed consent”; rather than “opting in”, so that you have to be on a register for your organs to be used after your death, you have to “opt out”, so it is presumed you are happy for your organs to be used unless you specifically state that they can’t. This has caused a stir; over at Stumbling & Mumbling, for example, a number of commenters have objected, arguing that the proposal violates our rights to do with our bodies as we wish, even after death, and that this is another example of the overarching state. One commenter even says that should this proposal come to pass he will opt out of it, whereas currently he opts in to the voluntary scheme.

But are those opposing the plan reacting ideologically rather than looking at the issue pragmatically? I take it that they all have an aversion to a domineering state and value our human rights, which is fair enough. But human rights are not just abstract concepts to be debated; they are there for a reason, for our benefit. In this case, since there is a clear opt out suggested, and as long there are safeguards in place that ensure any database is properly maintained, that relatives wishes are respected, and that where there are doubts about the prospective donors identity the organs are not used, then I can’t see anyone’s rights are being violated.

And in concentrating on the issue of human rights have the opponents of the move instinctively assumed their position out of ideological reflex, while losing sight of the reasons for this proposal itself; which is simply to reduce the shortfall in the number of organs currently available for donation, so to save the lives of some and to improve the quality of life of others? Even if you do feel that a policy of presumed consent violates our rights, is it such a violation that it trumps the rights of other people to live? Can it be said to be proportionate? I don’t suggest we just jettison a belief in human rights on any occasion that someone sees some benefit in doing so; each instance should be viewed on its merits and it is right to question any proposals. But in the case of organ donation, I wonder if the opponents of presumed consent are reacting on a theoretical level to what they see as an assault on our rights, rather than looking at the issue itself and at what our rights are there to achieve. I wonder if ideology has made them lose their perspective on this occasion.

There may be some good arguments against presumed consent; The Economist last year reported that although Spain already has this policy, it has only “pushed up supply a bit” – which itself suggests that there has been no mass body snatching by the state in that country – and that it has not solved the supply problem. The Economist’s solution with regards kidneys is to allow people the right to sell one of them; this has happened in Iran, so eliminating their waiting list for the organ (they don’t offer a solution to the shortage of organs for heart transplants, though.) My initial reaction, perhaps because of my own ideological position, is to reject the suggestion; but if, as is claimed, the surgery is safe, and if it is true that with proper regulation screened donors with one kidney actually live longer than the average person with two, then why not? Shouldn’t it at least be considered, whatever the understandable concerns?

But perhaps there is a another, simpler way to solve the donor shortage for those who so hate the state interfering in our lives. When the law requiring people to wear seat belts in cars was first introduced I remember Doctors at the time commenting that they were seeing a reduction in the number of suitable organs becoming available for transplant, as people who would have previously died in road accidents were surviving, so denying the world of their organs. Well, doesn’t the seat belt law, and indeed the requirement to wear a crash helmet on a motorbike, infringe our civil liberties? Don’t we have the right to wear what we like when driving as long as it doesn’t affect others? If so, and if these laws were indeed repealed, would the likely increase in fatal road accidents that resulted perhaps provide us with all the organs that we so clearly need?