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• Too Much is Presumed in "Presumed Consent"?
  Michael Potts
  Published on: 18 May 2017

• Published on: 18 May 2017

  Too Much is Presumed in "Presumed Consent"?

  • Michael Potts, Head, Philosophy and Religion Department

  Dear Editor

  V. English and A. Sommerville [1] argue for a “limited version” of “presumed consent” for organ donation. They criticize the present law, which they claim presumes most people do not wish to donate, saying that:
  “It also seems somewhat bizarre that society assumes that most citizens are more likely to refuse than to help others, when there is no harm or benefit with either choice for th...

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  Dear Editor

  V. English and A. Sommerville [1] argue for a “limited version” of “presumed consent” for organ donation. They criticize the present law, which they claim presumes most people do not wish to donate, saying that:
  “It also seems somewhat bizarre that society assumes that most citizens are more likely to refuse than to help others, when there is no harm or benefit with either choice for the deceased.”
  Later, they say that:
  “Presumed consent represents a positive endorsement of organ donation as a good thing to do and with this formal acceptance will come a time when donation will come to be seen as the norm, rather than the exception.”
  The authors, however, presume (without argumentation) that organ transplantation is a good thing, assuming that removing organs from whom they call “the deceased” does not harm that individual.

  Many organs which are “harvested” are taken from patients declared “brain dead,” whether the criterion be “whole brain death” (in the U.S.) or “brainstem death” (in the UK). In either case, the bodies of these patients are warm, their circulatory systems are functioning, their respiratory systems are functioning (in the sense of continued gas exchange in the lungs and throughout the tissues of the body); the ventilator provides oxygenated air. The fact that such patients are dependent on machines to continue to live is morally irrelevant for declaring them dead, for many obviously living people are machine- dependent. Serious doubts have also been expressed about the neurophysiological basis for both the US and UK criteria.[2] It is by no means self-evident that “brain dead” individuals are dead; in fact, the recent evidence suggests that they are very much alive. Writing “brain death” statues into law does not magically alter reality, nor does repeating the word “cadaver” in reference to “brain dead” individuals. It may well be the case that the reason many people are hesitant about organ donation is the legitimate fear that organs are routinely being removed from living human persons. Even if one disagrees with this view and accepts brain death criteria, there is more than enough room for reasonable doubt on this issue. This is not reasonable doubt about a trivial issue; the doubt concerns whether “brain dead” individuals are being killed for their organs. Given the risk that living individuals are being killed for their organs, it is unreasonable to assume that organ donation is a good thing. Instead of a policy of “presumed consent,” potential organ donors should be told clearly and truthfully what actually goes on in organ donation–that “brain dead” donors are not dead in the usual sense of the word, that their hearts continue to beat when the organ donation surgery takes place. The reasonable course of action to take in changing the law is to add more precautions before someone signs an organ donation card, not fewer, and certainly not a policy of “presumed consent.”

  References

  (1) English V and Sommerville A. Presumed consent for transplantation: a dead issue after Alder Hey? J Med Eth 2003;29:147-52.

  (2) Potts M, Byrne PA, and Nilges RG. Beyond brain death: the case against brain-based criteria for human death. Dordrecht, Holland: Kluwer Academic Publishers, 2000.

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  Conflict of Interest:
  None declared.

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