23 January 2008

Organs and 'social justice'

In theory, removing organs on this basis [presumed consent] can be made to sound humane, but remember the law of unintended consequences. Anything promoted by government as life-enhancing can be turned into the opposite by greedy and/or unscrupulous individuals (Peter McKay, Daily Mail, 14 January 2008.)

As usual, reference is made to the risks of ‘greedy and/or unscrupulous individuals’, but not to risks which arise from agents of the socially oppressive system.

‘We must never be denied the right to choose’, says Melanie Phillips weakly, but we already are, if we allow ourselves to be forced into contact with the medical Mafia. Whether or not consent to remove organs after death is presumed unless refused, what is to prevent disapproval of those who refuse being covertly expressed in bad treatment by doctors and nurses? I have seen it suggested that those who refuse to donate their organs should themselves be refused treatment.

If doctors are able to presume consent for organ removal, they will be given even more power to do things against the will of their patients. It is clear that a considerable percentage of the population would not consent to removal, and not all of them will be efficient and initiativeful enough to register their lack of consent in the required way. Even those who do will be at the mercy of the system, and will have to be confident that there will never be any failure to communicate their refusal at the right time to the right doctor. Given what we know of the fallibility of computer systems and of the medical profession in modern society, there is a very obvious and serious uncertainty here.

To be sure that they are not violating the will of their patient, doctors should wish to have an explicit expression of consent.

But, of course, a modern person may say, even if an individual does not consent, they ought to. A person who says this is welcome, so far as I am concerned, to set up a charity financed by like-minded individuals, but not by the state, to convince people that they ought to want to donate their organs.

The issue of the motives, including unconscious ones, of the people implementing the proposed scheme is, as usual, entirely left out of account. This includes those operating the computer systems as well as the doctors. In borderline cases, it may be difficult to determine whether a person is dead or not, or whether it would have been their wish to be resuscitated. In such cases, the motives and preferences of the doctors will inevitably exert some influence. It is assumed that their motives can be only virtuous and disinterested, and that the only risk of abuse could come from outside the system. But in a borderline case, the characteristics of the organ-possessor may be relevant. If they are aged and infirm, there may well be a stronger tendency to give up on them than if they are young and have what the doctors consider to be an adequate quality of life.

Nor, given the way that considerations of ‘social justice’ are entering into medical ‘ethics’ (as well as everything else) these days, is it inconceivable that ideas about ‘fairness’ might influence their decisions at the margin. Might not a ‘privileged’ middle-class individual be more likely to be treated as ‘dead’ than a more ‘deserving’ working-class patient? Might not ‘do not resuscitate’ decisions be affected by whether somebody has a harvestable organ?

In considering the dangers of databases, reference is only made to the risk of abuse by criminal individuals who are not agents of the collective or otherwise authorised users of the data base. An upper-class banker (John Monckton) was murdered in his entrance hall two years ago by someone who used published information to target wealthy people. There was some suggestion that the murderer’s motives may have included resentment of the rich, as well as the usual pecuniary one. What is to prevent a person with similar motives from being among those who have official access to a data-base and using it to seek out people whom he or she regard as too well-off? Or perhaps just using the access to delete their refusal to have their organs harvested after death, as a way of expressing his aggression?

Agents of the collective such as doctors, teachers and social workers are just ordinary people. They are no more immune from the risk of behaving irresponsibly or abusively than anyone else.