Who owns you? Do you own you? Are you the ultimate one that has ownership of your person, your being and your physical presence? There is one thing for sure in the news this morning, the Government doesn't think so. The Government thinks it owns your body. Alan Johnson, the Secretary of State for Health, has decided to make the question of registering everyone on the organ donor register unless they opt-out part of the health agenda. He's raise a "taskforce" to look at the question of what they like to call "presumed consent".
On past perforamnce it is fair to equally presume that the this "solution" to the lack of available organs for transplant is their stated position, however it is wholly disingenuous to call it "presumed consent". It is actually "presumed ownership". At its very core, a policy that automatically states that every man, woman and child in the country is available for harvest after death unless they specifically say otherwsie shift the the ownership presumption of our very physical presence on to the state.
"Ahhhh!" but the cries go up. "We need organs and this will solve the problem, and you can still opt-out". The argument against however is not a negation of the problem. It is simply putting the fact that whilst something must be done, this something is not something we must do. How about, instead of using donor cards which require a person to consciously make the decision to ask themselves the question about donating, we start asking the question to people more directly?
There is nothing to stop a doctor/hospital registration process asking the opt-in question. Whilst it may sound macabre to say "if you die do fancy giving your corneas away", it is certainly better than the state presuming ownership of people unless they state otherwise. After all, how can you presume that the person you take the organs from is someone that wasn't on their way to opt-out when the bus ran them over? Let's not beat around the bush here, the argument on this one is not about solving the problem of organ donation, it is far more deep than that.
This is about the fundamental relationship between individuals and the state, and the ultimate question of property rights. The reality that we own ourselves is evident in so much of our law already, a quick look at the fact that it is not illegal to take but merely illegal to possess them tells you this fact.
I own me. Not the Government. It has no place presuming ownership of my body from birth until I tell it otherwise. To do so is an affront not to my civil liberties, but liberty itself.
21 comments:
Given that there are laws on marketing email to insist on opt-in schemes, it seems bizarre that they would do this with people's body parts. Ick.
Even if an opt-out system isn't the best solution, at least people are now aware of the problem and realise that something has to be done.
I can see that CCTV cameras can provide useful info and am fairly happy with ID cards but this, I agree, is a step too far. Dave B's thoughts also went through my mind when I read your blog.
Have we turned into the road leading to Soylent Green?
Or has my paranoia taken a step too far?
It seems to me that ownership of my corpse and ownership of my body are two entirely different things.
If it's ownership of my body (alive that is) then I agree entirely with your point. Ownership of my corpse is another matter.
If you take the structure of your argument to extremes you'd stop anybody breathing in air you'd once exhaled.
'If you take the structure of your argument to extremes you'd stop anybody breathing in air you'd once exhaled.'
WTF?
This is a fascinating ethical argument. Until recently, I thought I agreed with the 'opt-out' proposal, but am steadily resiling from that as I read arguments such as yours.
I do think everyone should think much more about their end-of-life options; my corpse will go to the School of Anatomy if it is viable, otherwise take whatever is useful and cremate the rest.
Whatever their choice, individuals should make it clear to their executors, who are the 'owners' of the corpse in law.
I'm not surprised - this ever more totalitarian government is pushing forward the concept of the state owning everything - Napoleonic style. It is starting with permits to use the water around our shores, the skies above our heads, the roads and pavements under our feet - and why should we be surprised that they feel they own our very organs? Welcome to Soviet Britain. Of course - it is all for our own good.....
As usual the government completely fails in its job which is to make the case for Donor Cards and advertise them widely. So they opt to interfere with our right to choose positively. I have a Donor card and want my body to be available but if this opt-out system is instigated I will opt-out.
My point wasn't very well put. I was alluding to the fact that my exhaled breath contains matter that was once part of 'me'. Just as my future corpse will have been once part of 'me'.
Perhaps it would have been better to use my hair clippings on a barber's floor as an example. If anybody were to sneak up behind me and steal a lock of my hair that would be depriving me of owning it.
However once disconnected from me in the barber's there is an assumption of consent for the barber to do what he will with the 'dead' hair.
I view my future corpse in the same way as my hair on the barber's floor.
Inheritance law already recognises this in that if one dies intestate there are assumptions made regarding the distribution of the estate.
Taken to the extreme your argument would lead to the destruction (burying or cremation) of ones worldly goods were one to die intestate.
Look upon the proposed legislation as an avoidable death duty/inheritance tax.
What a complete load of bollocks.
I used to casualy think that opting out was the way to go cos it doesnt realy matter to me what they do with me after im dead.Now you naughty man have made me think about it and your right the state can go fuck off it cant just assume ownership of my corpse.I dont presume ownership of the cat that lives at my house,money changed hands and i feed and vet him but i dont own him.
I agree with Dizzy's arguments. My body is ineluctably mine and when I die, my family will take ownership of it and dispose of it for me. Not the state.
The presumption of the state owning people's mortal remains is sickening. We always respected the dead before. We even respect the bodies of our pets who die because they housed that personality, that character, that spirit.
And how nightmareish for the family to know that the body of their loved family member is being carved up and plundered even before they've left the hospital.
I have loathed, from the first time I read it, this dreadful, manipulative use of the word "harvest", which is meant to sound so lovely and unthreatening and so full of the goodness of nature. Crops are grown to be harvested. That is their point. That is why they are planted. Specifically to ripen and be harvested. You cannot "harvest" something that wasn't grown for the purpose.
This whole thing is being driven by the aggressive transplant industry in the West. There's nothing more aggressive and arrogant than medical science.
The very serious ethical considerations aside, there's also the problems of universal access to healthcare - would we see a change in the attitudes of medics to those who had opted out???
Would an already authoriatarian government decide that once they owned our bodies after death insist that we kept them in a fit state during life?
This is potentially more explosive even that euthanasia as a fundamental shift in the reposibilities of medics over us as patients.
As Dizzy stated at the end - it is an affront to liberty.
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wonderfulfor...
If you see no problem with the use of your body after death - fine. Get on the donor register, it's there, it works.
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This may be a bit far-fetched, but given the way this government has behaved over the last 10 years, it could be the thin end of the wedge. Compulsory donor register + identity and DNA database by stealth = "Give us one of your kidneys. You can manage fine with the other one."
Dizzy: keep re-raising this one, please. This something that can't just be a passing debatelet.
So, the State wants to determine the final disposal of all or part of our corpse. But the State already possesses all our medical records. The State is therefore in a position to "predict" whose organs would be beneficially harvested on our death. [Not necessarily beneficial for the present user, though.]
Once they have pushed this presumed "consent" through, are we then going to have a resurgence of the debate about euthanasia? Not only would the person who refused to die on cue be a nuisance to the health care system, be maliciously withholding the inheritance from their heirs, but also be unreasonably delaying the hopes of carefully selected photogenic priority would be transplant recipients! The seriously ill person would deserve to be despatched for the greater good of society. Wouldn't they?
Would Hitler/Stalin have approved of this measure?
There really is a great deal to resist here.
Dizzy, you wrote at 1,59:
'What a complete load of bollocks'
There's no answer to that.
And if we do opt out, where will that fact be recorded?
In some humungous state database, no doubt.
What's the betting that, come the moment, it turns out they can't access it? (it'll be down for maintenance, or shut for lunch, or just hopelessly corrupted, or just plain down, or they'll forget Doris' password, you know, the one that always does this stuff for us, etc)
And then it'll be "presumed consent" all right.
The opt-out will be worthless.
I sent in a comment on this subject and it wasn't run. It certainly wasn't offensive in any way - indeed, it supported your position - and when I clicked Send I got the notice about blogowner approval. I was wondering why it wasn't approved.
I sent it in when Hugh at 3:56 yesterday afternoon was the last commenter.
"...would we see a change in the attitudes of medics to those who had opted out???"
Would we be able to notice a change from their current attitude, I wonder...?
Many attempts have been made to increase the supply of organs: governments run publicity campaigns that extol the virtues of transplantation; donor cards make it easy to identify volunteers; bodies such as Eurotransplant have been set up to co¬ordinate the exchange of organs and encourage transplantation. But none of these measures has worked. The supply of transplantable organs is still erratic.
`Presumed consent' is controversial. Its opponents, and there are many in the medical profession, believe it undermines basic notions of civil liberty. In Spain, for example, doctors have simply ignored the opt-out legislation introduced by their governments, their desire to respect the dead and not to offend distressed relatives putting a brake on attempts to use the law to increase the supply of organs.
On Sunday 28 July 1991, Christophe Tesniere was cycling home in the northern French town of Dieppe when he was knocked off his bike by a passing motorist and suffered a crushing blow to his head. The nineteen-year-old was rushed to the local hospital with injuries so severe that his breathing failed. To keep him alive, doctors placed him on a ventilator and three days later flew him sixty miles by helicopter to the University Hospital of North Amiens, which is better equipped to care for patients with serious head injuries.
As well as being the department's unit chief, Tchaoussoff was also the president of the northern section of France Transplant and, once he had broken the tragic news to the Tesnieres, he asked them whether Christophe had ever expressed the desire to be an organ donor. `We had never discussed this idea,' says Alain. `Why should a young man who is in good health think about his death? Why should he expect to die in five minutes by crossing a road? So we did not know.'
Tchaoussoff then asked Alain and Mireille their opinion of organ donation. Legally, due to the opt-out law, there was no need for Tchaoussoff to make this request – but, as a matter of courtesy, doctors tended to consult relatives if they could find them. Alain Tesniere had always supported organ donation, and had recently been moved by a TV programme about a young boy on the waiting list for a transplant, so he raised no objections.
Mireille, however, wanted to know which organs would be taken and says she asked for reassurance about the extent of the disfigurement that the removals would cause. Her son's body had already been badly damaged in the accident and she didn't want to add to the mutilation. She says the doctor asked for four organs: Christophe's heart, his liver and both his kidneys and then he assured the parents that their son's body would otherwise be left alone. Mireille was content with his explanation and the parents gave their agreement for the doctors to remove four organs.
The trouble began with an accounting error. The Tesnieres received a bill from the University Hospital of South Amiens (where Christophe's organs were removed) asking for 300 francs to cover the cost of their son's hospitalization. It should not have been sent to them and they received an apology. But the damage was done: on the accounting form was a list detailing which organs had been taken. It was in code but its length puzzled them. The Tesnieres had agreed to the removal of four organs, but the list contained more. They asked for an explanation and found that surgeons had not only taken the heart, the liver and the two kidneys, but had also removed veins and arteries from Christophe's legs and, worst of all for the distressed mother and father, both of his eyes so that his corneas might be used to restore someone's sight.
Christophe Tesniere's body was still in the hospital mortuary when his parents discovered the extent to which it had been emptied of its organs. Alain's visit to the hospital to say goodbye to his son before he was buried turned into a nightmare when he saw that Christophe's eyes had been replaced by what he describes as oversized glass ones. `When I think about Christophe,' he says bitterly, `I can't remember him as he was when he was living. It's a frightful thing not to have a memory of my son. I remember his eyes, those terrible eyes. It's like a second death.'
Mireille was just as angry at what she saw as a violation of her son's body. `They stole our memory of Christophe,' she says. `We had implicitly refused to donate his eyes. For us they were the symbol of life, muck more important than any other organ.
The Amiens affair, as it came to be known, blew up into a major row. The Tesnieres took their distress to the press, gave endless interviews to the newspapers and on television. They wrote to the health minister asking for an enquiry into organ transplantation. Alain Tesniere even wrote a book. The effect of the publicity on the kidney-transplant service was disastrous.
`Immediately afterwards, there was a dramatic drop in organ donations of 20 per cent,' says Dr Philippe Romano, at L'Etablissement Français des Greffes, the organization that has now replaced France Transplant. `This has not picked up, it has still dropped by 10 per cent. It was obviously not just due to the Tesnieres, but this dramatic story put a spotlight on this problem. In people's minds, there has been a loss of confidence with medicine in general and with medical people.'
The Tesnieres also consulted a lawyer who discovered that the doctors who removed their son's eyes might have broken the law, despite the existence of France's `opt out' system. The reason was an oversight in the drafting of the Caillavet Law that introduced the presumed consent system of organ donation in 1976. This law did indeed permit the removal of organs from a brain-dead body without the need to consult with relatives. But it said nothing specifically about the corneas – and there was another statute dating back to 1949 called the Lafay Law which said that corneas could only be removed if a dead person had agreed to this in writing in their will. The cornea was an exception to the `opt out' system. So in 1992 the Tesnieres decided to bring a prosecution against the doctors, charging them with theft and violation of their son's body.
`There was a contradiction between the two laws, a legal gap,' explains Professor Didier Houssin, the director-general of L'Etablissement Français des Greffes. `It led to the ability to build a legal case ... and it also showed the limits of what is tolerable in terms of multi-tissue harvesting. There has been a tendency to harvest many organs and tissues, to think: "While we are here we will take everything." it is an easy option but it has very negative aspects. It is a practical attitude which can be perceived by outsiders as a lack of respect, even if that wasn't the intention of the doctors.'
Tchaoussoff says the Lafay Law was written before people's bodies could be kept alive artificially on ventilators. He believes it does not apply to brain-dead bodies and, given the existence of the opt-out legislation, he does not accept that he overstepped the mark. `If I didn't mention taking out Christophe's eyes to his parents, it's partly because it is not always technically possible to do it,' he says, `but also because it is a particularly difficult thing to speak about with families.
The damaging row also helped to bring about a fundamental reassessment of the French approach to organ donation. The 1976 Caillavet Law was a product of the political philosophy current in France in the 1970s in which the family took second place to the needs of society. Patients in need of organs were given a higher priority than the feelings of the families of potential donors. `If the family happened to be present and expressed the deceased's opinion, saying no or yes, that was good,' says Professor Houssin. `But it was not obligatory for the doctor to approach the family. This was the 1976 law.
The idea was to avoid imposing the burden of the decision onto the family.'
The Tesniere case also highlighted a major problem with pre¬sumed consent: there was no practical, foolproof way of making your views about organ donation known during your lifetime. `If someone wanted to prevent their organs being taken,' Houssin continues, `they had to sign a register at the entrance of the hospital. In fact, this was practically impossible for if you arrive at the hospital brain-dead or nearly brain-dead, you are in no condition to sign anything. This hadn't been clearly thought out.'
The Catholic Church also waded into the fray, letting it be known that it felt that the balance between the needs of society and the rights of the family had swung too far in favor of the community. `The family should be approached – this was the popular feeling expressed by various associations and much of public opinion as well,' explains Houssin.
In July 1994 the French parliament responded to public concern by abandoning the Caillavet Law in favour of new legislation, the Bioethics Law, which tilts the balance back in favour of the family and, in so doing, has seriously undermined the country's opt-out system. `The idea behind it,' says Houssin, `is that the human body should be respected and protected, that respect for the human body is related to the dignity of the human person.'
The new law established a national computerized register to allow people who want to opt out to say no. It also forces doctors to approach the families of potential donors, not to ask for the family's consent but to double-check what the dead person's wishes were. In theory France still has an opt-out system; in practice, fears about its corrupting effect on doctors' approach to the dead have so weakened it as to make it unworkable. After the Amiens affair, no doctor is going to risk taking the organs from a potential donor if their family opposes the idea. `If the family says no, you can't do anything,' says Professor Houssin. `Presumed consent has been seriously attenuated.'
The Tesnieres, at least, will be pleased at this news: their once generous support of organ transplantation has been fatally undermined by presumed consent. They are now such bitter opponents of spare-part surgery that Alain Tesniere has written the following inscription in his social security card: `In memory of my son Christophe, I forbid any removal of organs, tissues and other remains from myself and from my son Oliver who is a minor.'
Rather die if I ever needed an organ,' he says. `I think that a person is unique and that we shouldn't change organs from one person to another. Human beings are not a collection of organs like a car. An organ is part of a person's identity. I prefer to die because I know how doctors practice in France.'
Mireille is just as hostile. `At the time I thought it was important to help someone to live,' she says. `But if I had known then everything that I know now I would have lied and told them that Christophe was opposed to organ donation. I think it is inhumane. The doctors took everything they could from Christophe's body and I have to live with that even today.'
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