Tuesday, January 15, 2008

Lots of nonsense on organ donations from Liberal Conspiracy and elsewhere

There really is an intellectually vapid piece over at "Liberal" Conspiracy by Justin McKeating from Chicken Yoghurt on the subject of organ donation. It doesn't actually constitute an argument in favour but simply calls anyone on the Right that has issues with the philosophical consequences of so-called "presumed consent", sanctimonious, selfish, pig-headed and self-contradictory. According to Justin,
"Needless to say most of the umbrage is coming from the Right. They might as well be saying 'Gordon Brown can pry my liver from my cold dead hand' for all the sense they're making. They bang on about the 'murder' of foetuses by the 'abortion industry' but are seemingly willing to stand by and let walking, talking people die because their politics have been offended."
Hmmmm... I am on the Right; I don't agree with presumed consent; but I'm also not anti-abortion and did, in fact, take the piss out of the phrase "abortion industry" by cracking a gag about factory production lines and knitting needles. Justin's argument couldn't, just possibly, be a straw man could it? Or perhaps it would be fairer to note that he's banging on making no sense? Or should I just say he's talking bollocks, that's much fairer.

The founder and contributer to "Liberal" Conspiracy seems to have swallowed Justin's argument hook line and sinker as well. I'm not sure whether that is a good thing or a bad thing, but Sunny Hudal says,
But Justin's basic point still stands - why does the right suddenly find choice abhorrent when it comes to abortion... but in this case can't stop falling over themselves to display their libertarian credentials?
No it doesn't stand at all because off the top of my head I can think of a number of people on the Right who's views disprove the rather weak argument that Justin is making. Justin then goes on to the miss the point spectacularly about property rights and ownership.
'It strikes at our relationship with the state,' they say. Well get this: You can't have a relationship with the state when you're dead. You can't assert ownership over your own corpse. Why? Because. You. Are. Dead.
Who said that that it strikes at our relationship with the state when we're dead? Only a complete idiot would say that, or someone constructing another straw man perhaps which wouldn't make them an idiot but would make them foolish. The relationship in question is actually between living individuals and the state because "presumed consent" takes the starting point that all human beings are to be owned by the state unless otherwise stated. That is a major shift in the relationship of the individual and the state because it shifts liberty and ownership in favour of the state from individual as a default position.

Of course, some others might make even weaker points than Justin in support of him. Take for example Bob Piper. Putting aside the usual crap at the beginning that says those against the idea are "right-wing loonies", he says,
"What seems to have slipped past the minds of the sanctimonious right is that the phrase 'opt-out' gives those who are alive and care about these things, an opportunity to.... errm, how shall I put it.... opt-out."
He'll be reading Vogon poetry to us next, just after he tells us that "all the planning charts and demolition orders have been on display in your local planning department in Alpha Centauri for fifty of your Earth years, so you've had plenty of time to lodge any formal complaint and it's too late to start making a fuss about it now".

OK, so quoting Hitchhikers might seem odd, but that is the fundamental of Bob's argument really. He's saying that because there is an "opt-out" that we should all be happy. But what if you haven't had the opportunity to do it? What if you get run over on your 18th birthday? In fact, the assumption that an opt-out is sufficient "choice" is another example of how the relationship between living individuals and the state will switch it's default starting point.

Back to Justin though, there is the final piece of crappy argument. That being that those who opposed 'presume consent' want to let people who need organs die. If in doubt throw in a nice bit of emtional nonsense and essentially call any political argument against equivalent to murder by-proxy. Sounds like the same logically weak argument pro-lifers give doesn't it? But Justin is not being 'self-contradictory' oh no! The thing is there are ways in which to improve organ donation rates without having to shift our liberty over ourselves into a new default position that places ownership with the state from the moment of our birth. For a start healthcare professionals could be more pro-active in encouraging people to fill out donor cards rather than leaving them on the desk for people to notice.

As I have said before, if people were asked whenever they went into hospital if they were willing to be a donor as a simple signing in question then, if polling on organ donation willingness is correct, you would see an increase in available donors. The problem is not that the 'opt-in' doesn't work, it's that no one asks the question until the worst possible time to the distraught next-of-kin. Stop presuming, start asking.

Update: Unfortunately, due to the limitation of my phone I was not able to write this bit this morning. Should you be wondering why the word Liberal is in quote when I say "Liberal Conspiracy" it is because the argument that Justin et al is claiming is right wing is actually the classical liberal one. Unlike their argument which isn't.

40 comments:

Cassilis said...

"The relationship in question is actually between living individuals and the state because "presumed consent" takes the starting point that all human beings are to be owned by the state unless otherwise stated"

Utter nonsense I'm afraid Dizzy - there's absolutely nothing here about 'ownership of human beings' nor anything at all to do with 'living individuals and the state' - this is about nothing more than a mass of tissue and bone. The core issue which you're ducking is whether or not individual will should be allowed to remain sovereign after it has ceased to exist - the only possible defence of that position is a religious one and for many (me included) that's not a legitimate one. There is no political or ethical issue here - while you're alive your body is your own and these proposals don't impact that at all. When you're dead 'you' can't have any claim or rights over 'your' body or organs because there is no 'you'.

The Great Simpleton said...

cassilis,

Can I take it from your arguments here that you don't even consider an opt out as an option and that all bodies should be used as the state sees fit?

Ed said...

I love that fact that today it's the "Right" who are against it when many Labour MPs voted against it last time including John Reid. The "Left" have very short memories, don't they?

Neil Reddin said...

Supporters of presumed consent seem to be conveniently forgetting the small issue of the families and loved ones of the deceased. One major issue as present, as Dizzy points out, is asking the next-of-kin at the worst possible moment.

The wishes of the n-o-k should be overruled only by the express wishes of the deceased when they were still alive.

If so many n-o-k find it difficult giving consent so soon after death of their loved one, how will they feel (and picture the headlines) when doctors go ahead and start carving up the deceased anyway because the State orders them.

dizzy said...

I'm afraid it's not "utter nonsense", you have simply failed to grasp the philosophical difference that exists for living individuals between the two positions and have instead taken the line that "you're dead so you cannot exrecise rights". This is not about what you cannot do when dead, it is about the starting position of liberty when you're alive and your relationship to the state during that time.

The current status quo of 'opt-in' means that when you are alive consent is yours and only ever yours. You have the 'freedom from' the state doing what it want with your body when you die unless you exrecise the 'freedom to' allow it do so. The state meanwhile has the 'freedom to' nothing.

Meanwhile under 'presumed consent', who's nature has a clue in the use of 'presumption', means that consent is no longer yours and yours alone. You do not have the 'freedom from' the state doing what it wants to with your body when you die as a starting point unless you exrecise the 'freedom to' tell it it cannot. Meanwhile the state has given itself the 'freedom to' your body as the default reality of your relationship as an individual with it.

The individuals sovereignty in life has thus been limited and the limitation imposed represents a transfer of sovereignty to the state in the change of the starting position.

Cassilis said...

Sorry Dizzy but you're still ducking a fairly fundamental part of this argument:

"You have the 'freedom from' the state doing what it wants with your body when you die"

But when 'you' die it can no longer be described as 'your' body - this is fairly basic stuff. It's a mass of tissue and bone at that point - nothing more. That basic biological fact trumps any amount of philosophical obfuscation about retrospective will and subtle shifts in freedom etc.

To focus on what these proposals mean in terms of abstract or theoretical relationships between the individual and the state while people are dying represents the worst sort of right wing ideological nonsense - if you object sign your opt-out form and start talking about things that matter...

dizzy said...

"But when 'you' die it can no longer be described as 'your' body - this is fairly basic stuff"

I didn't say that it could so there is no ducking. If you stop and actually read what I said I was refrring to the nature of what you have the freedom from and freedom to _in life_. The issue is not about whether your "mass of tissue" is yours or not in death. It is about whether you have the right to know that you are the ultimate arbiter in all decisions of your freedom in life.

To then go for the (a) right wing ideology crap and (b) you're killing people by proxy bollocks. Is not argument, it's pathetic. It's made more so amusing by the complete negation of the other proposal put forward that we should be proactively asking people to opt-in, which we do not do. Of course ignoring that makes sense because to acknowledge would mean that I was not being nasty and not caring about people dying.

Incidnetally, I have a donor card. I opt-in.

Croydonian said...

Cassilis,

Dizzy's position, and indeed, my own might be accused of focusing on 'abstract or theoretical relationships between the individual and the state', but your position is essentially one of utility, sliding into the emotional - 'while people are dying' - rather than one based on principle.

If I have no ownership of my body after death, then would it be legitimate for the state to seize my body from a mortuary that my skin might be turned into a lampshade the better to illuminate Alan Johnson's desk?

Cassilis said...

"I was refrring to the nature of what you have the freedom from and freedom to in life."

...and these proposals make absolutely no material change to any of those freedoms. Name one freedom that 'presumed consent' removes or restricts when an individual is alive?

And if the answer refers to 'freedoms of expectation' after death then it's blurring the issue for ideological reasons..

Anonymous said...

Two points I can think of:
a) a car full of teenagers hits a tree, several fatalities, a veritable harvest of organs. Only the kidneys can stored for a short while the other organs have to be used almost immediately,not all are compatable with currant needs. Can the State then sell them on elsewhere?
b) A while back there was a doctor who took organs from dead babies to further "research". What an uproar that caused.

If the state owns my cadaver, will it pay my funeral expenses?
I do have a donor card.

Man in a Shed said...

Giving the state unrestrained rights to harvest your organs is just plain stupid. (Remember the state mostly also gets to decide if your dead or not.)

Its an extension of this idea that the state owns everything - and just grants life to those is deems worthy ( the thin and non-smokers according to Gordon's recent pronouncements ).

It will also act as a break on research that removes the need for organ transplants, but reducing the driver.

Organ transplants are far *far* from ideal. A Heart transplant may give you 10 years, but its not guaranteed - my Father lasted 4 weeks and Aunt 2 years. (When you see TV documentaries they never really dwell on life expectancy.)

I have the greatest respect, and in the two cases above thanks, to those generous people and families who make these gifts. But that's what they should be gifts, not taxes.

Why can't people be asked ? The answer is because they fear the answer will be no - so really this is a plan to remove organs from people who would object if they had really thought about it.

Lee Griffin said...

Asking who, Dizzy? The point of presumed consent (and opt-in) is that people are able to convey their wishes one way or another while alive. If the only option for those that haven't opted in to donate their organs is through the family then what are the guarantee's that your wishes are going to get carried out there either?

There is a very sanctimonious side to this argument that says that it's wrong for someone to have their organs taken when they didn't want it to be so, and examples like your 18 year old getting run over are thought provoking while at the same time being too picky when it is not clear how this policy would shape up in to actual procedure yet. But what about when the shoe is on the other foot and you have people that would be extremely annoyed if their organs went to waste yet some family member with completely different values stops that from happening, or indeed that there is the same cock up on the system that some people are deriding opt-out for?

There is the potential for both sides and both views to not get their wishes in both systems, all this does is shift which side has those issues in favour of also saving more lives with such errors.

comfy socks and co-op rum said...

"Lots of nonsense on organ donations from Liberal", when I saw this I thought you were on about the Tory guy forgetting that the loads of money he had been given needed to be declared, or some such rubbish. I wonder if Mr. Camerons lads are about to be embroiled in the where did you get that cash thingy ? I do Hope so.The dead bit, don't care when I'm dead you can take what you want, all I ask in return is a few quid for the Labour Party coffers.

Nick said...

This whole debate is pointless.

On oneside, I have sympathy with those needed a transplant.

On the other, they can't have the transplant if people don't want to donate. It is wrong to assume they do.

Make it simple. If you want a passport or driving license, you have to make a choice. Donate or not to donate. If you don't make a choice then you don't get the passport or driving license.

That way, everyone gets what they want and there is no moral issue.

The only problem is that the government can't run a computer system.

Mrs Smallprint said...

The body may only be tissue and bones after death but that doesn't mean they should automatically belong to the state. After all our other goods and chattels are disposed of by will or the intestacy rules. I'm sure there would be uproar even amoung the 'oh so charitable left' if a law was introduced that the state could help itself to any bits of a deceased estate it fancied unless the person opted out during their lifetime.

canvas said...

I am NOT on the right - and I never have been. And I probably never will be.

I DO NOT agree with 'presumed consent' because it's not consent at all. The entire concept of 'presumed consent' is fundamentally wrong.

I believe in my human rights - and surely having ownership over my body is one of them?

Croydonian said...

Out of interest, I wonder whether any of the 'presumed consent' lobby would be happy for any surplus organs to be supplied gratis to any private hospital that performed transplants for profit?

dizzy said...

Name one freedom that 'presumed consent' removes or restricts when an individual is alive?

Will that's pretty simple really. The freedom of a truly free choice. In the current set-up, during my life, I choose between two options. "In" or "Out". Carry a donor card, don't carry a donor card.

However, under presumed consent the "In" option is already decided by law. I have no actually choice over it during my life like I do under the status quo. The only choice I have is "Out".

So as I say, the freedom of a truly free choice, which is not a freedom of expectation after death. But a freedom to make a decision with two options both freely open to me in life.

anthonynorth said...

First time I've clicked on Liberal Conspiracy. Their comments policy isn't very liberal is it?
Just what I'd expect.

Lee Griffin said...

Croydonian, even in the schemes wildest dreams it could only hope to clear 50% of the yearly waiting lists as opposed to the current 12%, so your scenario is quite a while off yet.

Anthonynorth: What is illiberal about respecting others opinions, even if some on the comments there don't necessarily follow that thinking?

Dizzy: you really seem to be stretching here. You have freedom of choice if the automatic is "out" and you need to say to get "in" but suddenly there is no freedom when you're "in" and have to ask to get "out"? That really doesn't make much sense, both options are "freely" open to you, you just start out on a different one.

JuliaM said...

Justin's argument couldn't, just possibly, be a straw man could it?

Oh, you'd never go too far wrong assuming that from the start about any of McKeating's 'arguments'.

The 'they're just selfish meanies' argument had been put a little plainer by the idiot Harding, dissected nicely over at Longrider's and The Devil's Kitchen:

http://devilskitchen.me.uk/2008/01/classic-harding-resistance-is-futile.html

dizzy said...

Errr Lee, if there was either (a) a call for legislation to make the default option 'out', or (b) there was already a legislative default option of 'out' you might have a point but there isn't so you don't.

Hence the freedom to make a truly free choice exists in the current status quo because there is no legislative default option and the choice of either in or out lies solely with the person making the decision.

In the presumed consent world the decision to be in has already been made for that person, they have no says over it, and it's been made as a matter of law. Let me repeat, the out option does not exist as a matter of law in the status quo. The matter of out is a matter for the individual, not the state which is the correct way it should be.

Interestingly though, you seem to be conceding, even in your misrepresentation and misunderstanding of what I actually said, that the change does represent a shift towards the state away from the individual, or am I reading that wrong?

Sepoy Agent said...

Dizzy

I like your point about making your choice clear when you go into hospital each time.
I had an operation in October in a private hospital. The two consultants concerned were present when I signed the consent form for the op. I said, "by the way I carry a donor card, and am on the central register of donors, and if anything happens I wish any organs which may be useful to be used."
The consultants were horrified, "don't say a thing like that", they said.
Well I realize they wouldn't like anyone to think their op might fail, but if I didn't speak up before I went into theatre it would have been too late.

Athos said...

Has this argument yet been bumped up against the religious angle?

I seem to recall that a wide variety of faiths stand against any 'tampering' with the body after death. The prospect of the government committing mass blasphemy because the state will have the right to harvest our corpses for its full value.

Bob Piper said...

Even were I undecided previously I would be persuaded by the prospect of seizing Croydonian's body from a mortuary so that his skin might be turned into a lampshade.

Do we really have to wait for him to die though?

JuliaM said...

Congrats to Bob Piper on winning the 'Godwins Law' medal tonight...

As I've already pointed out on another blog, wasn't it the Nazis who reduced people to commiodities?

Like your side of the argument, Labourites?

Cassilis said...

Sorry Dizzy - I hate pointlessly extended arguments as much as the next guy but I really have to take issue (again) with you - you say:

"..under presumed consent the "In" option is already decided by law. I have no actually choice over it during my life like I do under the status quo. The only choice I have is "Out".

That's simply not true. Read the story again - you're presumed in but you can opt out, you can effect an identical range of outcomes as you can under the current system - absolutely identical. At the moment taking no action defaults to out, under this system it defaults to in - BUT THE EXACT SAME OPTIONS ARE OPEN TO EVERY CITIZEN.

Lee Griffin said...

Now come on Dizzy, you're just playing the semantics game here. Without a definite statement from ones self to say that you are a donor and without conversation occuring with relatives, you are a non donor by default. You can spin it and twist it as much as you like, but we live in a situation where by default you are "out" of the donor system and have to register that you're in, regardless of legal representations of that fact. This is a simple reversal of the proposal and it is still well within your power to make the choice to get out of it. This isn't to say I disagree with your other assessment about simply asking people as they use the healthcare service, but also not to say that I believe either solution is "better" than the other except in the eyes of public perception.

As such, I don't think I can concede that the state gains rights over the individual on this occasion.

And athos, there are I think two areas of religion that object to organ donation in practice, and that is small subsects of Christianity and Jehovah's witnesses. In the case of Islam, Shariah directives state that organ donation should be supported. Like with non-religious people most of this means that it comes down to personal choice. It's hardly blaspheming to make this sort of policy, especially as...we repeat once more...you can opt out.

judith said...

Mr Piper, since Blair, Reid and Brown all voted against the 'opt-out' concept a few years ago, does this make them mindless right-wing loonies?

Has the Prime Minister explained his dramatic conversion?

Will you be happy when the State insists that everyone is cremated, because cemetaries are getting full? After all, it's only the dead, who cares.

And in a probably hopeless attempt to educate you away from labelling everyone whose opinion you disagree with a Tory loonie: I am pro-abortion, I have formally willed my body to medical research and stipulated no religious ceremony when I die, and have spent the last 30 years doing community voluntary work.

And I'm a card-carrying Conservative.

Croydonian said...

Lee - One might think you were avoiding the twin prongs of Morton's Fork, but I'm sure you are not.

Bob - You old liberal you.

dizzy said...

you can effect an identical range of outcomes as you can under the current system - absolutely identical. At the moment taking no action defaults to out, under this system it defaults to in - BUT THE EXACT SAME OPTIONS ARE OPEN TO EVERY CITIZEN.

Shouting doesn;t make it so, but it does make you contradict yourself. How can the same option be open to everyone if you're going to argue that merely the defaults change. Taking "no action" as you call it remains something within in the power of individual also and effects an outcome, and evidently the outcome of in action is different so the same options are not open to all citizens, or more correctly subjects unless we've become a republic and no one has told me.

As I've already pointed out, in the current system the choice of either lies totally with the individual. There is no automatic default option in law, and arguably, given the fact people who have never filled in a donor card can become donor after death, it suggests there is no default option at all. In comparison you wish to enshrine a default option which, guess what, coerces the individual to make a choice else the choice is decided for them automatically without question.

So you see, to START SHOUTING whilst totally ignoring the reality of what you want to have compared to the reality of what we currently have is quite amusing and complacent to boot. We havn't even needed to get onto the dehumanising nature of the policy either.

Lee, it's not semantics at all and you are not out by default at all. There is no law that says if you have not opted in you're body will not be used as a matter. That is fact.

Incidnetally, Cassilis, the argument about not having rights in death. Does this mean you oppose he concept of Wills?

Steve_Roberts said...

If there is a shortage of freely given organs for transplant, the obvious next step is to pay the (estate of) the deceased for such organs. I can't understand why this is taboo - everybody else in the transplant transaction gains - medical staff are paid their wages, the recipient gains in health - why can't there be payment towards the donor's funeral costs ?

Alex said...

Croydonian: just for your interest, I am a vaguely right, vaguely libertarian (or thought i was, anyway) who is in favour of presumed consent BUT with the option of a NOK veto. And I would be happy for private hospitals to sell anything and keep the profit for themselves. But maybe my views don't represent the majority.

Cassilis said...

Apologies on the capitals - I forgot the old conotation about uppercase text and I wasn't intending to shout so much as stress the point.

Lee makes my point well and you've misrepresented him a little - true, there's no law that those without a donor card are deemed out but in practice that's the normal outcome. This proposals just reverses that.

Anyway I suspect we've reached an impasse - just worth stressing that you still haven't provided any example of material options or liberties that this proposal would deny people. Yes those options and liberties are altered slightly and passive / active outcomes are different but that should be understood in the context of more lives saved. Your insistence in arguing the semantic detail or philosophical changes and ignoring hard outcomes and common sense reminds me, and this isn't the dig it sounds Dizzy, of arguing with old Marxists like my dad - I thought the right eschewed that sort of ideological stuff...?

Anonymous said...

Dizzy does seem to be considering the practicalities - there are a wide range of pragmatic ways to increase the proportion of organ donors, as mentioned.

I note that the use of the word 'material' by Cassilis fits within left/marxist terminology (i.e. materialism) rather than being universal.

Another angle: I want to opt *in* to donation. Would that still be possible? Do I still have the right to make a positive decision in favour, if the State would use my body that way anyway? Does this proposal, in effect, remove the potential for a moral act (i.e. I can withhold, but I cannot give)?

Before this subject came to the fore, I'd assumed I was in favour of presumed consent (yes, the phrase sounds increasingly paradoxical). But I see myself as a person before I am a citizen. And the state belongs to the people, not vice versa.

According to some views expressed, that makes me right wing. That's not how I'd identify myself: I feel a little affronted that what I belive are moderate views are treated as extreme by an area of the political spectrum where I'd naturally feel more at home. So where now...?

Lee Griffin said...

My last comment seems to have been lost in the ether. So let's try again. The Human Tissue Act 2004 states quite clearly that I am indeed wrong in my analysis that if you don't state your intentions.

"Activities involving material from adults who lack capacity to consent

Where—

(a) an activity of a kind mentioned in section 1(1)(d) or (f) involves material from the body of a person who—

(i) is an adult, and

(ii) lacks capacity to consent to the activity, and

(b) neither a decision of his to consent to the activity, nor a decision of his not to consent to it, is in force,

there shall for the purposes of this Part be deemed to be consent of his to the activity if it is done in circumstances of a kind specified by regulations made by the Secretary of State."

i.e. the state can presume your consent, as long as some paperwork is filled out and some hoops jumped through, if no-one knows your status and if no-one is able to clarify. Given that families at current hold no legal sway in this matter this is essentially a more bureaucratic version of what is being proposed, and certainly would appear to be not well known.

So yes, the default option legally would appear to be "in" as it stands, but nothing is made clear on the issue and with organ shortages still it is clear the health service rarely uses the power available to them.

And yes, anonymous, you could obviously still "opt in", and it may be prudent given families have a return of their rights to choose in your death.

dizzy said...

Did you read the the sections on "appropriate consent" as well? I mean it was a nice try, but the section you've quoted refers to a very small group of people, i.e. people that would be known in America as "John Doe". It also clearly states "neither a decision of his to consent to the activity, nor a decision of his not to consent to it, is in force". The state has given itself the power to do something in a very specific circumstances which do not exist until they exist though so it doesn't make the default option "in" actually.

What is actually clear in the law is that the default status is neither in or out. All that exists is that state has the power to take a decision in a temporal relation to a decision being required. Prior to the moment where such a decision is taken there is no presumption for the person in question which is the difference between that piece of legislation and the proposals being made.

It's not merely a more bureaucratic version of the same thing because no presumption is made prior to the event and whether such an event were to occur is unknown. The key though is that a person without the capacity for consent is not presumed upon by the state until it becomes established that capacity of consent does not exist. Prior to that moment they are presumed to have the capacity for consent and the section on "appropriate consent" would apply in relation to whether they were "in". As such the default option is not "in".

Anonymous said...

I can only presume that all the socialist scum fuckers who are in favour of 'presumed consent' are also in favour of increasing inheritance tax so that the state 'presumes' possesion of the entire estate of everyone who dies!? (or at minumum everyone who dies without leaving a last will and testament)

If not, please explain the difference. When alive I decide what should happen with my estate when I die. This includes my body, which is MINE, not Gordon fucking Brown's.

Zorro

Mark M Heenan said...

I was watching the debate on this on THIS WEEK just now, and it seemed to me that the problem people have is the idea of the state commandeering an individual's corpse. One possible way to overcome these objections would be to hold a referendum on the matter. That way the people as a whole would give their consent (subject of course to an opt out) and the state would not have been involved. How does that grab you?

Lee Griffin said...

Yet the realities, Dizzy, are one or the other. If I am wrong on my interpretation that is fine, but the the original situation I was discussing remains. For all intents and purposes you are "out" of the donation system unless you give consent. You can argue until you're blue in the face that by not consenting you haven't not consented, but the end result would be the same...no organs being taken from your body.

If I'm not wrong, however, and the term "person without the capacity to consent" is the same as it is elsewhere in the profession, then the default position is almost certainly a form of presumed consent already present.

Either way there is no middle ground that can be taken in the reality of what can be done with your organs when you die. Argue about specific times all you want but in practice if you haven't made a decision until you die and you haven't made a decision, then the stance attributed to you in your death may as well have been the one you adopted for the life before you.

Anonymous: Well in all honesty the state presumes that you would want it to go to your family. Perhaps we should be crying here about how if you don't write a will but want all of your possessions and wealth to be transferred to Ms K Kruger of Germany, the state will so mercilessly steal that money from you to redistribute in a way that you didn't want? Presumptions like this occur all over the place as it happens, shocker eh?