Annex A
PRESUMPTUOUS CONTENT
I was interested in the articles I read relating
to presumed consent" and submit a layman's point of view.
Regarding Veronica English's contribution, I
was arrested immediately ( and angered ) by the sheer lack—absence,
almost—of either intellectual rigour or logical thought.
From the very start, I was alarmed by a kind of facile assumptiveness—implicit
in phrases such as "it seems likely that", "we
all have the same aim", "changing the default
position", "assuming... unless there is evidence
to the contrary", "analyses seem to indicate"
et al. They set the tone for the whole piece. Add to those
the ones that spell danger because they conceal (albeit under
a thin disguise) some sinister sub-texts and there's a cause for
grave concern. I always worry when something is presented as being
"easier for all concerned" (as though convenience
were the main—even the sole—criterion). It alerts
me immediately to the probability that something is being slipped
in and that an attempt is being made to disarm or anaesthetise
my critical faculties!
Looking at the essay more closely, I found roughly
what the cursory reading had led me to expect: the ethical issue
is simply not dealt with at all! The entire "argument"
(to call it that) is based on convenience and on the assumption
that any system which increases the number of donations requires,
ipso facto, no further justification. Countries where the
donation rates are highest are thus presented as "evidence"
that a "presumed consent" policy is `better'.
I found the first major assumption of the piece
both baffling and disgraceful: that bodies had been buried or
cremated "intact" (rather than used for organ transplantation)
"not because people objected to donating their organs
but simply because they never got around to making their wishes
known!" That anyone should present such an obviously
self-serving proposition on the basis, merely, that it "seemed
likely" was, I thought, staggering.
The rest of the piece is riddled with logical
falsehoods and ineptitude. The idea that because some people may
"support organ donation" as a principle they
will necessarily be willing to give pre-emptive consent to the
use of their own organs—and that without being made fully
aware of the conditions under which this will happen (and understanding/accepting
those conditions)—is preposterous.
I've no doubt, of course, that the idea that
an assumption that people want to donate unless there is evidence
to the contrary will cause an increase in availability. That's
obvious. But—as in the whole of Ms English's thesis—this
makes not the slightest attempt to confront (even to touch on)
the moral issues. Mostly, throughout her entire essay, moral considerations
are simply ignored. As far as she's concerned, increased availability
= success = justification; which even a naive moral philosopher
like myself can see to be nonsense. It's back to the old end-justifies-the-means
debate.
And when she questions the validity of "current
law" because it "assumes, when people die, that
they are in the minority who do not wish to donate",
she is on equally thin ice; in fact, on no ice at all. Dead in
the water! Of course the law assumes that! It "assumes"
that unless I make it clear before my death that when I die I
wish to "donate" something that belongs to me to a specific
cause or for a specific purpose, then I do not so wish.
Otherwise, all kinds of "assumptions" could be made
about how I might want to dispose of my possessions (including
my own body): eg, that I wanted (in the absence of any clear indication
to the contrary) to donate my body to medical research or that
I wished the proceeds of my estate to be donated to the Battersea
Dogs' Home!
Once we start "assuming" what people
want, we're already part way down a very slippery slope. It soon
becomes an assumption of authority to decide what people ought
to want. As if that were not enough, the people "who do
not wish to donate" are implicitly derogated as a "minority".
(I've noticed before that when people want to foist otherwise
untenable notions on others, they often use the "minority"
idea as an argument. It's typical, I've found, of such people
to assume that the majority is always right; which is something
no intelligent and honest person would ever claim!)
I'm amazed, too (though perhaps not), that the
basis itself for establishing that people who do not wish to donate
are a minority is so ill-defined. "Surveys show... !!"
It's one of those corny old expressions—like "research
on both sides of the Atlantic has established... " or
"A highly-placed Government source assures me that..."
(I note, in this case, that the only reference to any actual survey
is distinctly anonymous and general: a "UK Transplant
Survey". If such a survey existed, I would be very interested
to see and analyse the questions on which its conclusions were
based. I would anticipate much of the kind of box-ticking that
manoeuvres respondents into false positions by cutting off their
options (probably without anaesthetic!).
As regards her claim—and apparent surprise
at the fact—that "although 90% of the population
supports donation, only 23% have registered their wish to donate",
one can only register surprise oneself that Ms English is surprised.
The questions to be asked are, surely, (a) if this is so,
why is it so? and (b) why have people like Ms English
not asked (and found the answer to) this obvious question? The
obvious answers, it seems to me, are: (a) that a general
support for the idea of organ "harvesting" is
very different from a willingness to give permission for one's
own organs to be used; (b)) that without far more—and
far more precise—information concerning how and under
what circumstances one's organs might be removed and re-distributed
and one's death defined, one would, of course, be reluctant to
make any commitment whatsoever.
And one has only to consider the "efforts"
( eg strategies ) "to improve transplantation rates over
the last decade" to see even more clearly where Ms English
is coming from. For "publicity" read "propaganda",
for "education" (with its facile and patronising
implications—that if only we can explain to these simpletons
(the 90%) just how silly and selfish their point of view is, they
will fall in line and thank us for it—) read, effectively,
"coercion". For "simplifying the process"
read "falsifying the reality" through carefully contrived
box-ticking questionnaires that manipulate the respondents into
compromising positions by offering limiting alternatives which
discourage both freedom of thought and accuracy of response.
Nor would I have a jot of confidence in "extensive
publicity advising people how to opt out". We've most
of us, at some time or other, been supplied with "opt-out"
information, or been offered opportunities to "register objections".
Those of us who've attempted these complicated and often (I suspect
deliberately) baffling procedures would, in most cases, I think,
be very sceptical; if for no other reasons than that the people
offering the opportunity don't want you to opt out!
Paragraph 5 seems to me to be the most offensive
of all. The idea that the relative of a dead or dying "target"
person who has not opted out should be asked if they know of any
"unregistered objection" is bizarre—and,
in a sense, wicked. The terminally sick or deceased person not
having opted out (confusion, mental fatigue, the near-to-death
physical condition itself, not even having considered the matter,
etc), the relatives, if they fail to declare knowledge of an unregistered
objection, "are informed of the intention to proceed!"
The only reservation allows the possibility of the process causing
the relatives "severe distress". Well—we've
all seen how expressions like that have helped to open the flood
gates to literally millions of abortions whose justification depended
on "severe mental distress" being caused to the "mother"
and have created a climate in which mass-murder presents itself
as social concern.
Ms English goes blithely on to show—though
the phrases describing her frames of reference ("careful
analyses seem to indicate") ring immediate alarm bells—that
in countries where the policy of "presumed consent"
has been implemented there have been "higher donation
rates". This is one of the few assumptions she makes
that I would not be disposed to doubt. It's the one thing about
which I'm sure she's right. But in spouting these statistics she
is only coming up with the answer that most people would expect.
She has still not even begun to address the moral issue
that would concern most people; and clearly doesn't see that there
is one. Firstly, she implies that the government argues lack of
support for "presumed consent" without any serious
attempt to test this assertion (where, I wonder, does that idea
come from?), then claims—with the arrogant assumptiveness
that one has now come to expect of the whole piece—that
"We all have the same aim: to improve donation rates."
That, I think, caps everything! Any other criterion is irrelevant.
People who do not agree are committed to a "strategy that
has failed" but which they "doggedly pursue".
It's all pretty insulting—and one of the most facile pieces
I think I've read. The lack of logic, even, coupled with the over-confident,
hectoring tone is itself an insult. Whatever one's moral instincts
concerning this issue, one would have to be no more than a half-intelligent
person to feel disquieted by it. The "strategy"
that she condemns can be judged a failure only if you agree with
its fundamental premise: that to "improve donation rates"
is the sole criterion of success.
The bullet points with which she concludes are
an appropriate summary of her method and of the sloppiness of
her thought.
Gordon Skilling's article accepts, almost without
demur Ms. English's whole thesis, while throwing a casual sop
to conscience by accepting that "The issue is complex"
(Wow!!) "having spiritual and religious facets",
but sees the only way forward (ie to the achievement of the stated
aims) as devising "strategies to address public perception"
(ie, to show dissidents that they're wrong). Well—one would
hardly expect a balanced argument from someone who maintains "there
is no convincing ethical argument against presumed consent"
and accepts English and Somerville's claim that "most
major religions positively encourage donation". What
he understands by a "religion", I'm not clear. All the
"inspired" documents that form the bases of the world's
major religions came into being, obviously, centuries before the
idea of organ transplantation was even seriously imaginable. I
don't think he—or Veronica English—have any real intention
to grapple with the ethical or religious issues. He asserts blandly:
"The bottom line is that a system of presumed consent
would save many more lives each year". If that's the
case, then there's no point in any argument at all; except to
say "No! It simply isn't. That is not the `bottom
line'". As for his ideas about the infringement of personal
autonomy—they seem to me to be intellectually puerile. "If
we breach the autonomy of those who do not wish to donate by presuming
consent", he writes, "then so too do we breach
the autonomy of those who wish to donate but whose organs are
not used." I could hardly believe I read that. Is he
really saying that a person who has donated organs but whose organs
are either unsuitable or surplus to requirements has had his "autonomy"
breached? Would he use the same "logic" in support of
the use of all organs offered—including diseased
ones—for fear of breaching someone's "autonomy?"
(See Gwendoline Harlow's comment about former cancer patients,
who are "not permitted to donate blood, never mind organs!")
It doesn't surprise me, therefore, that he should come up with
"To give more moral weight to a decision not to donate
than to a decision to donate is illogical." What a muddle!
The point has to do not with donating or not donating but with
donating freely, on the one hand, or being pressured into
donating on the other, or having one right to decide whether or
not to donate unfairly influenced or actually abrogated. And that
the notion of infringement of autonomy can be proved to be "already
accepted in our society" by comparing the legal requirement
to wear safety belts in cars with "presumed consent"
is, frankly, risible!
Not surprisingly, I liked Michael Potts's
article and the contributions by Graham Kyle (not, I hope,
merely because I agree with their ethical premises ) and—in
a slightly modified form—Barry Groves's provocative
and feisty comment on human "cannibalism".
Also, the contribution by Dr David W Evans
had, I found, a strength and a depth of focus that the others
did not. I particularly appreciated (a) its undistracted
concentration on the central issue, (b) its closely reasoned
logic, c) its calm non-rhetorical delivery, d) its
precision of statement. Yes—"The fundamental ethical
issue... is that of truth and its telling." I believe,
too, (as argues earlier) that he is absolutely right in his judgement
concerning the attitude that "may well explain the difference
in numbers of those declaring support for organ transplantation
in the general, impersonal, sense and those prepared to register
as "opt-in" potential donors..."
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