Monday, February 26, 2007

'Presumed consent' is wrong

according to this opinion article by Catherine Colton

The issue of Presumed Consent for organ donation in Ontario has recently become a much discussed topic and this timely opinion gives us much to consder when forming our views. Because of the intense interest I'm posting the entire article as written.

The Timmins Daily Press
Saturday, February 24, 2007

The issue of whether the government should decide for us if our organs can be donated to someone (after we've died, that is) raises quite a few moral questions, not the least of which is: Do we need the government to interfere in our private lives?

Should they ever interfere?

Is it alright for the government to legislate seatbelt use, for instance, or if and when and where we smoke?

How about abortion - is it in their jurisdiction, or should it remain a private matter? Where do we draw the line?

In other words, what is and is not the government's business?

Canada has one of the worst organ donation rates in the developed world, despite public opinion polls that indicate the vast majority of Canadians support it. This is much the same as blood donation. Canadians believe that about 26 per cent of us donate blood, when in fact the true number is three per cent.

It seems to me we have to be fairly careful about giving the government control over our own ethics, though.

After all, this is the same Big Brother that wears green ribbons in the House of Commons to signify, well ... concern over organ donation/transplantation and/or bipolar disease and/or environmental issues and/or Chechnyan solidarity and/or farmers of America!

Should we actually entrust such an important issue to them? One has to seriously wonder.

The Ontario government is in the position of either increasing the number of organs available for transplant, or paying for transplants out-of-province and/or out-of-country.

Health Minister George Smitherman is apparently very comfortable with making organ donation "presumed," although it's still the case that family physicians consult with the family first before going ahead with the already presumed consent.

Currently, the province does not reimburse those who go elsewhere to receive a transplant.

Those who need the help clearly cannot wait for it - it is truly a matter of life and death, and they aptly name it "the gift of life." The history of transplants is fairly long, dating back as far as the second century B.C., long before post-operative survival techniques were established.

They have ranged from skin to cornea, arteries and veins, kidneys and lungs, hearts and livers, even faces.

As modern immunosuppression techniques developed, so did survival rates - infections were reduced, drug therapy expenses have gone down and transplant patients' daily lives have improved dramatically.

This discussion really involves deceased donors.

Living donors are considered a separate topic entirely.

Living donors are largely family members or close friends, and are viewed by many physicians as the way of the future.

They are also considered by most to be clear examples of selflessness, kindness, generosity and goodness - doing right only for the sake of doing right.

But what the provincial government is attempting to address through its "Citizens Panel on Increasing Organ Donations" is what it terms "presumed consent" by deceased donors.

What this really means is that they're consulting with us (citizens) about increasing organ donations, but one has to wonder if they're trying to justify our giving our organs without our consent by cloaking it in a "panel."

Doesn't that sound a bit like trying to get us to care, and if we don't, then they'll just legislate it!?

Remember when the cable company tried this backward type of reasoning?

You know, you automatically were billed for every channel on Earth unless you contacted them to say you didn't want them all.

That's what the government is proposing - unless you opt out, your organs are available.

When you die, your remains are fair game. Do we really want this?

Such organizations as the Step by Step Organ Transplant Association have no qualms about requesting full provincial funding for out-of-province transplants. But it's no wonder - their members represent those who have been personally touched by tragedies resulting from a lack of available donors.

A recent decision by the Ontario Divisional Court in denying compensation has been ridiculed as disgraceful by them.

Who could expect them to feel any other way - they are in the middle of things and can't possibly make an impartial decision.

For those of us lucky enough to be considered outsiders looking in, however, it's about a host of other motivations such as:

Religion - what if you don't consider it ethical to remove organs for transplant;

Exploitation - what if you have no money and the only way to get it is by donating a kidney, for instance? Isn't that really just out and out coercion? What if your human rights are violated? For example in China, there are cases of organ harvesting from politician prisoners. What if it becomes just another money-making proposition? What if it's done for fame? Or how about somebody who just feels it's too "yucky" to even think about?

It has also been suggested that this is just an extension of Canadians' extreme sense of entitlement - after all, we get "free" health care, so it's not that big of a stretch to assume we should get organs if and when we need them.

But just wait a minute - don't we all have some measure of moral responsibility here? This is a pretty big dilemma, for sure. But can't we think it through ourselves? Do we need to abdicate our duty, and let the government decide for us?

All this being said, it's downright difficult to think about or speak about.

We have to get the discussion going, but mandating it is just not the route to go. Personal morals shouldn't be dictated by governments; we're not told we have to donate blood unless we opt out. We shouldn't be told we have to donate organs either.

Human beings have one natural advantage over the rest of creation - free will. Organ donations should absolutely increase, but not because the government says so.

They should increase because we are educated about the need and feel moved by it. They should increase because we can think and talk about our mortality, and decide on our own, without any government coaxing, that donating our organs could make a life-saving difference to another human being.

Allowing the government to invoke "presumed consent" is like letting them think for us, and make moral decisions for us.

Surely we don't need to give them this kind of authority.

Donate your organs, by all means, and tell everyone that you are going to do it.

Make a big deal out of it if that feels right, and encourage everyone you know to do the same - but don't just leave it up to the government - after all, it's your body.

Catherine Colton holds a B.A. in psychology, a certification in alternative dispute resolution and is currently completing a master's degree in humanities. She is a writer, rights adviser, counsellor and mediator.

No comments: