We are a public policy promise breaking society. Here’s how the game is played: When a new controversial bioethical policy is proposed, proponents soothingly promise it will be strictly limited to very tightly controlled circumstances. When that gets them through the door, often, the old promises become inoperable. IVF is a perfect example. It was supposed to be limited to married couples who were infertile. Now, it involves treating poor women like mere body parts (“gestational carriers”), biological colonialism, eugenic embryo discarding, and the like.
Organ donation is another such field, although it has proved much harder to break the promises. When it was being pitched to a wary public, we were solemnly assured that only those who specifically agreed to donate their organs ahead of time, or with consent from family after death, would be donors. Now, we see advocacy to do away with specific consent–in other words to the concept of “donation”–and replace it with organ conscription, in which the state could take your organs unless you specifically opted out beforehand–a system called “presumed consent.”
Legislation was recently filed in Colorado to legalize organ conscription. From the story:
Some Colorado lawmakers say their state should be the first one where people become organ donors by default, even though other states’ efforts have been halted by worries about making such a personal decision automatic. Colorado’s proposal, introduced in the Legislature last week, would change the process for renewing driver’s licenses and ID cards so applicants are assumed to be organ and tissue donors unless they initial a statement that says they want to opt out.
The “presumed consent” system is common in Europe and is credited with dramatically raising donation rates. In the U.S., however, similar approaches have been defeated by lawmakers in at least three states – Delaware, Illinois and New York – because of concerns that donation programs seem coercive if they require residents to say no. Organ donation advocates hope for a warmer reception in Colorado, where nearly two-thirds of people carrying driver’s licenses or state-issued IDs volunteer as donors – a higher rate than in any other state.
Let me get this straight: In the state with high levels of consent, we need presumed consent? The majority gets to rope in the minority?
This, and other proposals intended to increase the number of transplanted organs–such as redefining death–would have the opposite effect, I believe, reducing the number of organs because of destroyed trust. If people knew their organs were on the line, they would worry that they or their loved ones’ organs would matter more than their lives in the event of a serious–and expensive–illness or injury. For example, I am an organ donor on my license. I would opt out in a presumed consent regime, and instruct my wife to donate my organs if I died.
Presumed consent would just be another in a long series of broken public policy promises, reducing trust in government and in the earnest assurances of restraint and control about other controversial bioethical proposals. It has no place in American medicine or bioethical public policy.
I have written about this issue in more detail. If you are interested, hit this link.