25 July 2007

You awful, awful person (no. 3)

Previous recipients of the You-awful-awful-person award here and here. Once again, I stress that the individual in question should be regarded as representative of their profession rather than as a scapegoat.

The UK's medical establishment has called for organ donor status to be presumed, unless there is evidence to the contrary. Since the onus would be on you to arrange for your preferences to be asserted and enforced, we are effectively talking about a shift in ownership of organs from individual to state, with the main justification being "you're dead so why should you care". Describing the proposal any other way is simply dishonest.

It's not that different from barring inheritance, i.e. demanding that a person's property should pass to the state on death. Is the organ version less serious or more serious than inheritance? More, if you take into account the possibility, however low in statistical likelihood, that you're not beyond recovery when they consider removing your organs. (For some reflections on this issue, see here.)

It appears hundreds of people in the UK die every year for want of a replacement organ. Since about 600,000 others die in the same period, the vast majority non-donors, it seems as if people ought to be a bit more willing to register as donors. Surely it's just irresponsibility on their part, the argument goes. But who knows why people do something or don't do it? Their motives may be obscure to those who don't share their viewpoint, but they may nevertheless have good reasons. If you must, indulge in some public "education" campaigns about the issue, though I'd prefer not to have taxpayers' money spent on it, particularly as there's no sign taxpayers want to be educated about this.

* * * * *

For doctor Ann Robinson, writing in the Guardian, the shortage of organs is "shameful". She implies there is some kind of moral failure involved, but makes no actual arguments in favour of adopting this perspective.

Perhaps she should have invoked that leading light of so-called "bioethics" (= legitimisation of medical authoritarianism) Professor Sir Ian Kennedy, who has always been quite happy to promote the wishes of doctors over those of individual patients. Commenting as long as ago as 1979, he wrote that the Bar Council came out in 1971 against contracting-out for organ donation
because it invaded the rights of the individual ... but this is patently question-begging, as it depends on which individual is considered, the deceased, his spouse or relative, or the dying patient. *
(A very convenient but thoroughly specious argument, and analogous to one often used by leftists against private property.)

Now supplying an opinion that (a) someone deciding not to make a sacrifice is morally disapprovable is one thing; advocating (b) semi-coercion quite another. Yet for Dr Robinson, the jump from (a) to (b) seems entirely unproblematic. No issues about liberty apparently arise. She considers only two possible objections. First, the fear of abuse, which she cannot bring herself to take seriously even as a piece of patient psychology:
I wonder whether some of us harbour fears that perhaps the medical profession wouldn't do all it could to save our life, if there was a need for our organs. I don't really think that even those most suspicious of the medical profession would believe that ...
As a doctor, she may simply be living in a fantasy world in which the perspectives of patients don't impinge on her — because, being a member of a state-licensed monopoly, she does not need to consider them. So she can believe that no one could possibly think such a shocking thought. I think it's far more likely that she is, consciously or subconsciously, aware that the fear is not only not uncommon but not unrealistic.

The only other possible objection she can come up with she manages to dismiss equally airily:
There are some people who object to organs being removed for transplant because of their faith. Those who believe in a literal form of life after death prefer to have their bodies left intact. At a guess, most UK residents nowadays don't share that belief system.
So in her book, the fact that the majority don't subscribe to a belief that generates an absolute horror of having your body robbed after death makes it okay to steamroller over the preferences of those who do. So much for respecting minority viewpoints.

Dr Robinson's attitudes are entirely typical for a member of the medical profession. Doctors no longer have to even pretend much to take the wishes of their individual patients into account. The preferences of society, and the views of the Chief Medical Officer about what is in everyone's best interests, shall be decisive.

(For another dissenting voice see Guy Rundle, also in the Guardian.)

* reprinted in Treat Me Right, Clarendon Press 1988, p.252.

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