In her cough-riddled and gaffe-prone keynote speech to the Conservative Party Conference yesterday, Theresa May announced that her Government would change the organ donation system in England from an ‘opt-in’ system to an ‘opt-out’ one, “shifting the balance of presumption” that we will not donate our organs, to that we will donate. So, rather than hospitals requiring explicit consent to remove our organs after death, saying nothing on the matter would be taken as implicit consent for the procedure to be carried out at the discretion of doctors.
This is called ‘presumed consent’, and at first glance it might not seem objectionable. After all, many will reason, if we assume that people want to donate their organs after death, rather than make them go through the bother of signing up to a register, then surely health services will be able to harvest more organs and save more lives? What could possibly be wrong with that? Surely no-one needs their bodily remains once they are dead? Why not, in the absence of clear objection from the deceased, redistribute organs to those who need a spare liver, or kidney, in order to live?
This has the deceptive sound of common sense, but it ignores key issues of principle and practice. The Church, on the other hand, sees the whole picture, and gives us as Catholics every reason to oppose this change strenuously.
Before we explore the reasons against presumed consent, let’s be clear: the Church is pro-donation. Paragraph 2296 of the Catechism of the Catholic states clearly that “[o]rgan donation after death is a noble and meritorious act and is to be encouraged as an expression of generous solidarity”. This affirmation is reflected in explicit Papal support. In 1956, at the very inception of organ transplantation, Pope Pius XII told the Italian Association of Cornea Donors and the Italian Union for the Blind that the practice was “not a violation of the reverence due to the dead”, but a right application of “the merciful charity shown to some suffering brothers and sisters”.
The same section of the Catechism that encourages the donation of organs however, does so with the clear qualification that it “is not morally acceptable if the donor or his proxy has not given explicit consent”. This rules out presuming the consent of the organ donor: they must have explicitly stated that they consent to the procedure.
The reason for this is that two crucial principles of true donation are freedom and solidarity. On the one hand, our bodies are part of who we are and as autonomous individuals we must be the ones to voluntarily donate any part of them. On the other, that free act of donation is the heart of what it means to act in solidarity with those in need. If we do not make a free choice to give of ourselves, then it is not a true act of Christian charity, and the very idea of donation as free ‘gift’ is undermined.
To take organs without explicit permission turns the charity and solidarity of true donation into a State-mandated nationalisation and plundering of the organs of every individual in the country upon their death. This violation of the dead inverts the proper normative relationship not only between doctors and patients, but Government and the governed: that we must give clear permission to non-necessary medical activity on our persons, and the use of our bodies. Giving our bodies to others is our prerogative, not that of the State or the medical system.
It is set to be a high irony that the very same people who would so often cite ‘autonomy’ as loudly as possible on the issues of abortion or assisted suicide — ignoring in both cases the limitations of autonomy when it adversely and lethally affects the most vulnerable people — and the most explicit understanding of ‘consent’ when it comes to sexual activity, will be those most happy to advocate ignoring both those principle entirely when it comes to the donation of our bodily remains.
Another irony might well be the practical effect this policy could have. A comparative study of countries that had ‘opt-in’ systems with ones that adopted an ‘opt-out’ model found that those with presumed consent had lower levels of voluntary ‘living donors’ than ones with an opt-in system. This suggests that the free act to donate is actually discouraged by systems in which people assume that organs will be taken by society anyway, undermining the very purpose that presumed consent aims to achieve.
Worse than all this, imagine the consequences for future practice. We have already seen from Belgium the reported phenomenon of people being euthanised for the purposes of organ harvesting, and even defences of such a practice. If euthanasia were ever introduced into the UK, a system of presuming consent would make the opportunistic harvesting of vulnerable people all the easier.
More could be said about the dangers of presumed consent, but the above suffices to show that, like so many bad ideas, the support for ‘presumed consent’ typically comes through well-meaning intentions, but a shallow and superficial consideration of the issues involved. It not only undermines donation in principle and in practice, but also the foundations of a free society. Worse, it lays the ground for serious abuse on a large scale both in current and possible future organ harvesting.
By contrast, the Catholic approach to organ donation reflects an authentic humanism that looks to the facts of what such a system would really mean, and respects the complementary free autonomy of the individual as well as the integrity of human charity and solidarity. We should inform our MPs of the real issues at stake, and mobilise strong opposition to these dangerously illiberal proposals.