Memorandum by Nicholas Blyth
I've witnessed with increasing dismay—albeit
from a layman's distance—the current debate concerning organ
transplantation and "presumed consent".
I have a number of observations to make and
they concern what seem to me to be three points—both major
and (largely) overlooked.
The first is quite simple. Most of the articles
I have read—including (indeed, notably) one by Veronica
English (see bma.org.uk or venglish@bma.org.uk: "Is presumed
consent the answer to organ shortage? Yes")—were
driven by one single consideration and directed towards one single
objective (and these were one and the same): the assumed desirability—above
(and, indeed, to the exclusion of) most other ends—of an
increase in the number of organs available for transplantation.
In many cases there has been little or no serious attempt even
to begin to address the ethical issues involved. The assumption—and
Ms English's article is both facile and massively assumptive—arises
from a failure or neglect of serious thought and of moral logic
(in fact, sometimes of any proper logic at all). That the transplantation
of a vital organ can prolong life is, of course, undeniable. Her
next "step" , however, (though in reality it's more
of a clumsy lunge) reaches the conclusion that organ transplantation
on as large a scale as possible is, ipso facto, desirable;
and that any case against it is inconceivable; in fact, unthinkable;
which is possibly the reason why people like Ms English don't
trouble to think about it at all, but are contented simply by
the demonstration that in countries where "presumed consent"
is practised, the organ "harvest" is far greater than
in the UK. (It amazes and distresses me that Ms English is the
BMA's Deputy Head of Medical Ethics should occupy this—when
she appears not to know what an ethical issue actually is!)
The fact remains (and will continue to remain
until it is properly addressed) that there are ethical issues
to be confronted.
I would not dream of trying to introduce a debate
on whether it is morally right for a person to be given the heart,
lung or liver of another (deceased) person. That is beyond the
realm of discussion and I suspect that instinct, natural squeamishness
and religion are three, at least, of the motivational forces that
might determine how people align themselves concerning this matter.
There are, however, areas in which debate can and must take place,
and with your patience I shall try to identify them.
1. There must be a serious attempt to agree
on a definition of "death". I am indebted to articles
by a number of medical practitioners on this subject—especially
one by Dr D W Evans of Queens College Cambridge, formerly a physician
at Papworth Hospital—in which the confusion over current
definitions is identified and high-lighted. It would be impertinent
of me to rehearse arguments already delivered by experts, but
my point is a simple one: people who are being solicited as prospective
donors (and soliciting becomes a considerable pressure when the
"presumed consent" factor is introduced) are entitled
to a detailed and unmistakably clear explanation of exactly what
is to be understood by "death" insofar as it relates
to these circumstances. In other words, when I am invited to carry
a donor card stating that I give my permission for any (or all)
of my bodily organs to be used for transplantation on my "death",
I must know, beyond all doubt and ambiguity, precisely what definition
of "death" is being used and under what conditions my
body—supposed lifeless—will be operated on for the
removal of my organs. Unless people know the full facts, it is
impossible for them to make a responsible and informed decision
about the matter. I have a suspicion—not, I admit, susceptible
of proof—that the confusion that exists and that has been
so lucidly expounded in Dr Evans's article is more than accidental.
The writings I have seen—by Veronica English and the many
others of her "persuasion"—are so eager to gloss
over the detail with breezy, casual assumptions, specious arguments
and sloppy logic that I become uneasy. One of the easiest (and
most time-dishonoured) methods of control involves keeping people
in the dark or confusing them with a deceptive twilight. Where
water-tight definitions and lucid explication are provided, people
are obliged (or at least able) to see things as they are and to
make responsible decisions. In the current case, the opposite
is true and I suspect a large measure of disingenuousness.
2. Once the definition of death is concluded
and agreed upon (by those who decide these things) steps must
be taken to ensure that the information is available in a comprehensible
form to everyone. Nor must those who provide this information
hold back from clarifying exactly the circumstances under which
a person declared dead will be operated upon to have his or her
organs removed. Anything less is an insult to people's intelligent
and a totally unjustifiable violation of their rights.
3. There must be an end, once and for all,
to the "presumed consent" monstrosity. It's a logical
nonsense in itself, of course: designed (along with the various
strategies of obfuscation) as a means of exerting pressure on
people. When it comes to something as important as the donation
of organs, people must opt in not out! And this
must be the case, even if it means that the number of organs
available for transplantation diminishes! The numbers card
must never be played when ethical issues are at stake. The medical
profession—also, sadly, the BMA—are disgracing themselves
in this matter.
For further discussion of Ms English's article
and point of view, I attach my own article—available also
as a "rapid response" to that article on the BMA web
site—in case any of your committee feels it would be worthwhile
to read it; also this submission.
October 2007
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