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?

Lord Jauncey of Tullichettle

Pausing just for a moment to remember Lord Jauncey of Tullichettle who died just over a week ago. He was a dedicated member of the Scottish Episcopal Church. [Indeed, he might even have been one of the 100 or so True Scottish Episcopalians that only exist at any one time].

I remember Lord Jauncey’s finest hour, in a synod in the Diocese of St Andrews, when he as Chancellor of the Diocese, asked the assembled company, with a passion which caused his voice to tremble, “But what, can anyone tell me, is a congregation, if it is not an unincorporated association?”

This was in the early days of the Episcopal Church’s recent inability to define what a congregation really is, who runs it and who is a member of it.

Less interestingly, Lord Jauncey represented the Duchess of Argyll in the headless man case and was one of the judges who was involved in the infamous Spanner judgement.

The Spanner Case deserves to be studied in ethics classes. Perhaps it is. It was ethics that I was really interested in when I was studying Divinity. If we thought more about how we decide what it is acceptable to do, then the church would be a much calmer place. (Which reminds me, I must do my All you need to know about Christian Ethics in 6 Cartoons gig again sometime).

The essence of the Spanner Case, as I understand it, is whether you can give consent to something which harms you, in a culture which is moving towards regarding the prevention of harm as its central ethic. It is a really interesting question. At first sight, the judgement always seemed illiberal to me, but it is an incredibly difficult ethical question to get your head around.

Anyway, after all he saw and participated in during his time in the legal and ecclesiastical worlds, Lord Jauncey deserves to rest in peace. And rise in glory.