The Westminster and Scottish Governments are again considering the issue of a shortage of organ donors and the arguments for and against presumed consent. Lying behind the urgency, and apparent moral validity of the move to establish a norm of presumed consent, there are the very human stories of considerable suffering for those awaiting donor organs, and an underlying anguish made worse for patients and their families by the anxiety of a long indefinite wait, often against a reducing time deadline. Any reasonable and ethically defensible course of action that might mitigate such suffering and make for more hopeful outcomes, should surely elicit the support and co-operation of everyone for whom humane compassion and generous care for the other are key principles of human community.
However, the UK Organ Donation Taskforce has concluded in its recently published report that presumed consent would be unlikely to boost organ donation, and have not therefore recommended such a far reaching change in the law. To be sure there are countries like Austria and Spain where presumed consent is the norm and they have high levels of registered organ donors. By contrast in the UK only 25% of those eligible have registered despite widely acknowledged estimates that a large majority of the eligible population are in favour of organ donation. The frustration such an anomaly causes further strengthens the case for presumed consent, it is claimed. Further, the current debate is about "soft presumed consent", that is, if the law were changed to make presumed consent the norm, next of kin would be able should they wish, to withold consent to organ removal for transplant purposes, and their veto would be upheld.
A number of reasons were given by the Taskforce for rejecting presumed consent as a viable way forward. First, while in countries that do operate presumed consent the number of donors is impressively higher, the explanation is thought to lie elsewhere than in the policy of presumed consent. In these countries greater resources are invested in increasing and maintaining public awareness of the benefits to others, and in promoting programmes of social education and support throughout the entire process of recruiting and registering donors.
Second, the Taskforce believes that presumed consent would significantly undermine trust in the medical profession, and the capacity of medical professionals, under pressure from several directions, to deal with conflicting claims of those requiring organs and those potential donors who may have serious illness or injury. Whether such conlicts are real or perceived, public trust is largely based on perception, and if the public perception is less positive then the consequence would still be a serious loss of trust in the core relationship of patient and doctor.
Third, the Taskforce believes that presumed consent would eliminate the concept of "gift". When a recipient is given the organ of another human being, the fact that the organ is donated is an act of generosity, free and gratis. Knowledge of that "giftedness" is an essential element in the emotional reconciliation between the host body and the donated organ, and plays no small part in the recipient patient's future emotional and mental health. For recipients and their families presumed consent lacks the element of free gift, that willing surrender of the self that is profoundly characteristic of the key moments of human exchange.
Now a Christian approach to such a morally complex and emotionally charged debate will surely include a careful consideration of all the above. And the tone and character of the debate should reflect the life or death nature of the questions involved, and these as felt from both sides. But there is at least one nexus of Christian truths and insights that move the discussion to a different level. It is the Christian understanding of a human being as created by God with an identity and value that is inherent in each created being. And a core element in defining the nature of humanity and the dignity of each human being, is the capacity for moral freedom and ethical choice.
The legal terminology of presumed consent masks a highly dangerous and morally unacceptable claim. Who has the right to presume any "presumed consent"? If the law is changed to enact it, presumably the state. But what exactly is being presumed? That a human being's body is not inviolate but may be "used" on the authority and preumed ownership of another; in this case the State. Such a utilitarian view when applied to human beings and human bodies implies a process of commodification, and the human body becomes one more resource, which the state can presume it is free to use, (albeit for beneficent purposes), unless a prior opt out disclaimer is registered. That I believe runs flat contrary to a Christian view of human beings, human bodies and human life as defined in Christian theology and ethics.
The state has no right to presume any ownership of a person; has no right to legislate into existence a presumed right to use parts of a human body without explicit consent; has therefore no right to impose by law presumed consent in the absence of an explicit denial. If presumed consent were introduced, I would then have to opt out of a legally imposed situation in order to retain ownership, control and freedom over my own body. Which means (by a legal sleight of hand), that ownership, control and freedom over my body has already been presumed by the state and ceded by me, till I take it back.
It has not, and cannot. For a Government to presume my consent by legal enactment, it must first presume such a degree of power over me that it can take to itself the right to make decisions about the use of my body. It has no such power, and to seek such power by legal enactment would be to establish in law a dangerously reductionist view of what a human being is. It would signal an equally dangerous assumption of state power over human life and freedom that has no political or moral justification.
All that said, Christian compassion and pastoral considerations cannot be content with the status quo of acute donor shortage in a population apparently largely in favour of organ donation. That the Government is now making £4 million available for an education and awareness campaign seems an obvious and responsible first step – but the amount doesn't seem to equate to the importance and urgency of the issue. But secondly, as a Christian I belong to a faith tradition in which self-giving for the sake of the other is a central ethical and theological value, rooted indeed in my understanding of God. That has significant purchase on such socially responsive and responsible issues as being a blood donor, a registered organ donor, a strategic and generous donor of money and energy in the service of others. Then there is the importance of pastoral experience. I have accompanied several people whose lives have depended on the "gift" of another human being's organ. The profound emotional, moral and spiritual experience of the recipients takes them and those who love them to the far edges of human courage, wonder, gratitude and trust. The gift of life is like no other gift.The Taskforce were right to highlight this, and to affirm its moral and spiritual importance.
In a culture still in shock at the ongoing consumerist catastrophe, a reaffirmation of the inalienable worth and dignity of every human life is both a required corrective witness and a crucial social goal. Our Governments at Westminster and Edinburgh are going to have a hard job educating us all in the importance of socially responsive compassion, and resetting mindsets away from me, money mine. Organ donation and the concept of the "gift" require a different mentality and morality from value for money and bottom line imperatives of contemporary consumerism. For more than a generation, the self-centred lifestyle sustained by consumer commodities and celebrity focus has dominated (perhaps suppressed) moral aspiration.
For in my own admittedly personal view, our willingness to donate our organs, our blood, our money, our time and energy, and all of these for the good of others – is a moral question not a political or economic one. It is about how we view our own life in relation to others. It's about how as a Christian I look on other people's suffering and think with critical compassion of what that person's situation requires of me as a follower of Jesus. Beyond my Christian commitment I am also a citizen and a member of the human family. That too brings gift and obligation – somewhere in this mess of a world these two ideas need to be invested again with moral purpose and human possibility. You cannot legislate generosity and a sense of responsibility for others – perhaps communities that celebrate the grace of God in worship can again find the energy and imagination to embody that generous self giving love in ways that act as salt and light.
And one further thought. When each Christian community gathers around the table of communion, and takes bread and breaks it, and hears the words, "This is my body which is for you", "This my blood shed for the sake of many", we assent both to the final truth of who God is, and to the lifestyle that flows in worship and gratitude from such a source of Love. In Christian discipleship the link is explicit and essential between the Eucharist, and that giving of ourselves in love and service to God and others, in Jesus name, in the power of the Spirit.
.