Organ donation and the reversal of non-consent

If White Rose is all about how little bits of bad news add up to a bigger, badder picture, then my experience today of some things that were said during a BBC4 Radio programme to be broadcast in the autumn is, I think, relevant.

The programme is to be about organ donation, organ selling, etc. I was arguing for the right of individuals to sell their body parts, but the dominant attitude was that donation for free would be quite sufficient, provided that presumed consent replaces the rule of presumed non-consent. This was what Dr Michael Wilks, the Chairman of the Ethics Committee of the British Medical Association, said, and as you can see from this 1998 BBC report, he has been arguing for this switch for some time.

At present, if you want it to be known that your bodily organs are available for transplant in the event of your death, you are urged to carry a card to this effect. What Wilks wants is that if you do not want your organs used thus, you must carry a card to that effect. Or maybe, by way of an alternative, that you must put your name on a national computerised register of the unwilling, so to speak.

I don’t know exactly how huge a change this would be. As infringements of civil liberties go, this one is quite subtle, quite deft, quite gentle. But as with so many proposed new arrangements, much depends upon the people running the system being both highly competent and highly trustworthy.

Wilks said something else rather creepy, which explains a lot about the way the law is increasingly being misused in Britain to impose new arrangements of questionable value. He said that in practice, reversing the principle of presumed consent wouldn’t make that much difference, because what really mattered was for the NHS to spend more (i.e. be given more to spend) on transplant surgery. The reason we do less transplant surgery than certain other countries (Spain in particular was held up for our admiration) is not that we still presume non-consent, but that we spend less on transplant surgery. So, in other words, this national donor card system or this national computerised register, which you must carry or register on if you do not want your organs being transplanted after you’ve finished with them, would, in Britain, be somewhat superfluous.

So why bother with it? Well, the nearest to an answer we got was that switching the law around like this would stir up some good publicity for the general cause of transplant surgery, and thus indirectly make it more likely that those “increased resources” of which he spoke would in years to come be forthcoming from the aroused taxpayers of Britain – it being easier to change the law than get all the money he wanted. But I got the distinct impression that if offered either the law change or the money, but not both, he’d take the money in a blink and leave the law untouched. This is our old friend “law as sending a message”, law as the way to scare up a “national debate” which lots of people take part in because the law is threatening to mess them about, law change as the answer to “apathy” (a word that was much used in this particular debate).

Wilks is not the only one to think like this about the law. Indeed, proposing legal change simply to get attention for one’s particular enthusiasm is a national mental disease right now, I would say. It’s one of the many reasons why we have so many laws, and so many more laws than we should have. And having lots of laws means that the idea of only the guilty needing to fear increased state surveillance doesn’t work, because all of us are bound to be guilty of something.

But I digress. Personally, face to face, Wilks was civility and sanity itself. He was just the sort of GP that you’d want, and in fact used to be a GP. That he thinks like this is not, I should guess, because he is in any way a wicked person, but merely because he breathes the same intellectual air that the rest of us do.

It’s somewhat off the message of this blog, but I can’t resist adding that after Wilks had gone, a rather more down-market contributor to the programme – a lady Jehovah’s Witness no less – pointed out that part of the reason that Spain excels in transplant surgery, more so than Britain, is that they are worse drivers than us, and thus have a greater supply of nice fresh young organs, of the sort that the transplant surgeons prefer. Hah!