Presumed Consent

Last night the Welsh Assembly agreed a new policy of presumed consent with regard to organ donation. Now, instead of opting to become an organ donor, in Wales it will be presumed that a person is willing to donate their organs after death, unless they have opted out.

I find this one an incredibly tough call, but I think that the Welsh Assembly is wrong. I’m opposed to presumed consent. I think it is wrong.

And yet I’m in favour of organ donation. I am on the register of organ donors. I recently had to renew my driving license and happily ticked the box indicating that I would be happy to consent to my organs being used to give life to someone else after I die.

My problem with presumed consent is that I have a problem with presumed anything. The dominant discourse in medical ethics hitherto has been around the the notion of informed consent. Presumed consent undermines this significantly. It also changes the relationship between the state and the individual in a way that makes me feel very uncomfortable.

It seems to me that the gift of organs after one has died is one of the greatest gifts that can be made. This legislation takes away from that sense of giftedness.

I’m opposed on pastoral grounds too. For many relatives the idea that they can consent to the donation of healthy organs from someone who is at the point of death is a wonderful and powerful thing. If the decision is no longer theirs then something has gone which has mattered to many.

If I needed an organ donation then I’ve no doubt I would long for anything that made more organs available. However, if I ask myself whether I would want to receive an organ from someone without knowing whether or not they wanted that procedure to happen I find myself having to think long and hard. Would I want an organ from someone who’s relatives were opposed to the organ removal? Organ donation can currently help people’s grieving processes. It now has the potential to complicate grief immesurably for some.

People often don’t know what it will feel like when someone dies. The ability to make decisions at that time is crucial. Removing the possibility of decision making concerns me greatly. Some urgently want whatever good that can come from a death to come to pass. However others don’t want a body to be touched more th an is necessary either. I’ve no doubt that some will see this as a violation and the way that they will cope with the death in those circumstances is entirely unknown to us but cannot be easy.

We are not simply flesh that the state owns and from which it can harvest. Somehow I can’t get away from the idea that we are more than that and that our laws should recognise that.

I’m not really aware of how the debate about this has gone in Wales. I’ve been paying attention to other moral discussions here recently. These are just my initial instictive reactions to news reports today.

As I said at the outset, I don’t find that a comfortable position to come to or to articulate. However, uncomfortable decisions are precisely what life makes us make.

What do you think?


  1. Steven says

    For a change I profoundly disagree with you on this issue. This is a real step forward and will, as you acknowledge, likely may a huge difference to those who are, literally, dying to get a transplant. I take your point about the lack of giftedness but that is something that can be dealt with as the lesser injustice. Alternatively, the state is assuming that gift on the basis that those who object and care enough will decide to opt-out.

    Where I do sympathise is in respect of your pastoral concern. No doubt there will be many who will – at the point of death for a loved one – suddenly find this objectionable and that will cause further heartache at the most awful possible time. There is no satisfactory answer to that problem save to rely on the broader public interest and the balance of any harm – i.e., I wouldn’t want you to take my wife’s organs if she had died and we did not consent to that process BUT I would also want my wife to receive organs, by that very means, if she was going to die otherwise.

  2. Steven says

    My only personal experience of organ donation comes from an old school friend who married a couple of years ago. Her new husband needed a liver transplant. It was a terribly difficult time and he was very ill for a long time. Eventually he had the transplant which was, as I understand, a further traumatic and uncertain time. He has now, thankfully, recovered and is doing very well. So well, in fact, that my old school friend is now pregnant with their first child! Death begat life which begat more life!

  3. As I said, I’m in favour of organ donation. I’m on the register myself.

  4. Steven says

    I don’t think we differ on being in favour of organ donation. We differ on whether or not the state should legislate to require an opt-out procedure. My argument really resolves to a somewhat pragmatic balance of harm test. I would be interested in your views on that?

  5. Linda Watson says

    As the widow of a kidney transplant patient I am hugely relieved by the Welsh Assembleys decision to bring in Presumed Consent. I have two reasons. The first is that it takes away from the medical profession the moment when they have to ask that most difficult of questions and the very worst time. Also at the moment, even though you may carry a donor card or be on the register your loved ones can still refuse to donate organs at the time of your death thereby going against your wishes as happend with a friend of mine. I think as well many people don’t register because they can’t be bothered or they don’t really think it is important, if they feel strongly about presumed consent they will make sure they opt out. Believe me we, as a family, have debated this issue many many times!

  6. Nicholas says

    I agree with every word, Kelvin, except ‘license’.

  7. Bro Dah•veed says

    Does this apply to anyone who dies in Wales or only to Welsh nationals?

  8. Blair Robertson says

    It will be interesting to watch how this develops in Wales, and the public reaction: how long will it take before pressumed consent is endorsed by public awareness and knowledge. I have been involved with families, and staff, at times of organ donation (I’m a healthcare chaplain.) My feeling is that staff will still ask for the consent of the next of kin before harvesting the organs, and if they say no, nothing can be done. The consent that is being presumed is that of the patient, not the next of kin. Medical staff are unlikely to proceed with the family ‘on board’ – they would need to sign documents anyway. But the point about giftedness is powerful. And at what point do we start seeing dying persons as objects to do with as society wishes, thereby removing autonomy and dignity?

  9. Paul Trathen says

    I’m with you on this one, Kelvin.
    I hold that it is a duty of the Christian vocation to give one’s life away for others – and so, it seems to me, voluntary consent to have your organs available, post-mitten for the benefit of others is a gift of the good.
    I am happily on the organ donor register.
    I agree that the shift is a major and worrying one in medical ethics, which is rightly predicated upon the principal and practice of informed consent.
    The dimension of this which most unsettles me, though, is the abrogation of the rights of the individual and the family to ‘the state’. It is, in effect, the nationalisation of our flesh! My body is a wonderful gift from God, and I choose to gift its energies to others, but I do not think that any ‘civil’ authority can claim that entitlement.

  10. I also agree with your thoughts on this complex issue Kelvin. I have deep reservations about ‘presumed consent’. I think in this case the state is not entitled to make that sort of decision.

  11. Kirstine says

    I don’t think it is a case of the state deciding for you. Having read the consultation document the main difficulty that will be solved is that currently, if the deceased has not made their wishes clear, and the family do not know the wishes of their relative, and do not wish to make that decision for them, then generally the organs are not used. Under this legislation, if the deceased person made no objection during their lifetime, and the family also do not object, then consent will be presumed. It is in this way a burden lifted from the family and a way to ensure that people who die without objecting to donation will be able to donate, as a majority of people wish to do. Of course this will only work if every effort is made to ensure the register of those who object is sound.
    And, as I understand it, this only applies to Welsh residents dying in Wales, so the English needn’t fear if they happen to get involved in a crash on the M4 and die in Cardiff by mistake.

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