Under Tony Blair's leadership, the presumption of innocence and the burden of proof were so systematically weakened that I was wondering what Gordon Brown could possibly do for an encore. It looks like he's at least trying to rise to the challenge... today he has spoken strongly in favour of a "presumption of consent" where post mortem organ donation is concerned. Mr Brown has opted into the current system, which depends on potential donors registering themselves as such.
It seems to me there are two discussions here: one about the general ethics of organ donation and transplantation; that's a complex debate which I don't want to get into in depth for the moment, but one should bear in mind that there are those who have strong moral or religious views against organ donation.
Then there's one about the social contract. Throughout my life (and even, in various ways, before my birth) I have a fundamental right to my own bodily integrity. The state does not have the right, for instance, even to renewably harvestable bits of me such as my bone marrow, bodily fluids, hair and so on, let alone the things of which I have only a finite supply.
Isn't there something inherently strange about the idea that, on death, I should suddenly turn into a harvestable public resource by default, when that has never been the case up to that point?
Liberal Democrat MP Dr Evan Harris, who is also a member of the Ethics Committee of the British Medical Association, is reported as saying that "under an opt-out scheme donor's [sic] real wishes will be more often respected". That's not really the point, though, is it? The risk is that there's a greater probability that non-donors' real wishes may not be respected.
Under an opt-in scheme, there's a high degree of certainty that anyone who has signed up wishes to be a donor. Under an opt-out scheme, it's certainly true that some people will end up as donors because that is their considered wish. However, it's also true that people will end up as donors not because they wish to, but because they had not come to a conclusion about this complex subject, or because they hadn't got around to opting out before dying. That raises a further practical concern. Presumably there will be an age below which a person cannot express an informed and binding preference to opt out: for instance, could a 4-year old child legally opt out, or would the onus be on parents to make the decision explicitly on behalf of their offspring?
The statistical reality is that, among the population of opted-in donors there will be fewer non-consensual donors than there would be amongst a nation-wide population of "presumed consent" donors. The Prime Minister says he wants there to be a national debate on the subject. I guess that means that, either for that or for a subsequent opt-out system, we all have to become medical ethics experts.
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