In My Time Of Dying

The argument over a proposed policy of “presumed consent” regarding organ donation rumbles on. Well I say that; it rumbles on in the blogosphere at any rate. In the wider world – where according to this report around 66% of people support a policy where you would have to specifically opt-out of donating your organs in the event of your death, as opposed to the current policy where you have to voluntarily opt-in – I’m not sure there is the same level of debate. Based on the figures for Wales that feature in this report, while only 22% of people are currently on the NHS Organ Donor Register, 90% are willing to sign up for it; which suggest that if you are the sort of person who goes around presuming consent on the matter, you would be right far more often than you’d be wrong.

I have written before about how most objectors to a policy of presumed consent seem to have been blinded by their ideological instinct on the issue, bemoaning the “state taking ownership of our bodies”, and from what I have read this week I think that still holds. The main arguments put forward seem to be that such a policy would fundamentally alter the relationship between the state and the individual, that the state would now assume a degree of control over us when we die, and that we alone should decide exactly what happens to us once we are dead. Well, maybe; but consider

  1. You arrive home one evening to a terrible scene; your house cordoned off, police conducting a fingertip search of your property, a loved one apparently murdered. As things currently stand there is nothing to prevent you from approaching the officer in charge and announcing “The deceased is…was…a lifelong Libertarian; so I thank you, agents of the state, for holding the fort, but if you could all just run along now I think I’ll take over from here. If you could just tidy up after yourselves when you leave; that powder’s getting everywhere”; but I’m just not sure how far it would get you. Similarly, there is nothing now to stop you from printing off your own cards bearing the message “In the event of my suspicious death I refuse permission for a post-mortem” and carrying one around with you wherever you go; but alas I fear that should you end up on the slab your card will interest the coroner for only as long as it takes him or her to locates the nearest bin.
  2. If you die in testate, then as things stand it is for the courts to settle your estate. Unless you write a will, in effect opting out of this arrangement, then it is administrators appointed by the state who will divide up and apportion your property or debts, who will decide what goes to whom when you die. Either way, you end up paying inheritance tax. You may feel that it is wrong for the state to assume such powers, but it is still what happens under the current system. Now, you could of course argue with some conviction that there is a big difference between your property and your body parts, and you’d be right; in my case I can well imagine that my collection of Led Zeppelin vinyl LPs is far more valuable than any bit of me you could care to mention. I really don’t think you’d want my liver.
  3. I can make whatever arrangements I like for my funeral, organise an impressive do involving white horses, a gilded carriage, paid mourners and a wake at the Midland Hotel; but it could all be in vain. If my family decide instead that they want to pocket the money and chuck my worthless corpse in next door’s skip in the dead of night, hidden beneath a defoliated Christmas tree and that old chipboard from the garage that won’t fit in the boot, then unfortunately that is exactly what will happen me, and there is nothing I can do about it.

None of which means that a system of presumed consent is necessarily the best way to alleviate the shortage of donated organs; perhaps we should instead make more of a proactive effort to try to increase the numbers on the voluntary register first (one Doctor working in Spain’s much praised system states in this article that in itself “a change to presumed consent doesn’t improve the donation rate”), while a controlled market for donated organs could be considered. However, the point I’m trying to make is that I don’t believe a policy of presumed consent would in fact be quite the fundamental shift that some people are claiming; because the real fundamental is that when you’re dead you’re dead, and there’s fuck all you can do about anything anymore. And no government bill is going to change that fact.