UK moves closer to presumed consent for organ transplantation purposes

Every day people die unnecessary, preventable deaths because most of us are essentially lazy. Across the world we are suffering a serious shortage of organs available for transplantation purposes. This is not because there is a shortage of people dying premature deaths in car accidents and the like, but because these people have forgotten to sign the necessary forms permitting doctors to take their organs after they have died, in order to transplant them into people who are unable to survive without suitable transplant organs. Any survey that has ever been published on this issue shows time and again that many more people are prepared to donate their organs after their death in order to preserve a fellow human beings life. However, many of these very same people forget, don't know where or how to sign the necessary papers permitting them to become organ donors. The result is that their organs are inaccessible in case of their death, and the result is avoidable deaths of people in need of transplant organs.

Anglosaxon countries, traditionally preoccupied with individual rights and individual liberties have dragged their feet longest when it came to considering changes to this lamentable status quo. More community oriented societies such as France, Spain and Iran, have long implemented an op-out system whereby people who do not wish to see their organs removed for transplantation purposes after their death have to state explicitly that they do not want to see their organs utilized after their death to save others. The results have been astonishing, to say the least. Waiting lists are substantially shorter, and fewer lives are lost due to lack of transplant organs. For once, people's laziness to deal with this matter is deployed in favor of preserving lives instead of letting go of them.

The English Chief Medical Officer has started a campaign to change regulations in England toward such an opt-out system. Sir Liam Donaldson argues that some 1000 or more lives are lost each year in England alone, because people need to opt-in to be considered as organ donors after their deaths. Surely agreeing to an opt-out system is the least we can do to change the odds of survival for our fellow citizens in need of a transplant organ. Hundreds of lives could be saved by means of this change of policy. The health care system in the UK is a devolved one, so it is worth noting that the train has departed in a similar direction to the English in Scotland. In fact, the Scots have very much taken on the role of change agent in the UK in this context.

There can be no doubt that there is something distinctly uncomfortable about the idea that unless I object to someone taking something off (not to say, out of) me after my death, I am presumed to have consented. However, equally, one wonders what good reason anyone could have to deny in death someone else the gift of life? Surely it is only a small minority of people insisting to be buried with their whole set of organs included. Why should we as society not ask them to let us know that they wish to utilize their organs to feed worms in the cemetery instead of permitting another human being to continue to live? That the majority of people disagrees with the friends of cemetery worms, when asked, in survey after survey, gives us arguably some reason to presume consent.

Pro-life activists have already responded to this new 'threat' in their traditional disingenious ways. Here's a quote from lifenews.com: 'In what pro-life advocates see as a further scaling back of the respect government should have for patients and their right to life, British Prime Minister Gordon Brown has endorsed allowing hospitals to take organs from dead patients without their consent.' Patients' right to life is subverted by taking organs from DEAD people. Yeah, sure, the dead can't get up walking again after their liver is taken out to save someone else's life. Normally the dead would go straight from their hospital bed to soccer matches, or church or whatever else they fancy. But now that those nasty politicians propose to extract organs from dead people in order to save someone who is still alive, the dead people's participation in public life is seriously under threat. Thank goodness prolifers managed to alert us to this danger to the lives of dead people.

Canada would do well to follow the French, Spanish, and hopefully soon Scottish and English examples suit. That much is surely owed by society to those of its members dying preventable deaths due to a lack of transplant organs.

- post scriptum: a shortened version of this opinion appeared on Jan 17, 2008 in the OTTAWA CITIZEN, and the Windsor Star.

Fuel vs Food - what's more important?

Interesting (if that's the right word) development. Critics of the green movement have long criticised the Green's single-minded pre-occupation with the environment. It seemed highly problematic to expect folks in developing countries to ratchet up their environmental standards if that meant a significant slowing down of economic development (with all the benefits this brings for human advancement in terms of jobs, education and health care).

Well, Australia's THE AGE broadsheet published a very interesting summary of a currently ongoing crisis in that context. Food prices worldwide have gone up at a record rate. It goes without saying that the poor are very much at the receiving end of this development. Part of the reason is that the world's farmers are switching their production to more lucrative products. Not, as you might expect, illicit drugs, but oil replacement products such as ethanol. Prices for staple foods have gone up by a whopping 18% in China, 13% in Pakistan and Indonesia and about 10% in Latin America. Reports THE AGE, 'India, Yemen, Mexico, Burkina Faso and several other countries have had, or been close to, food riots in the past year. Meanwhile, there are shortages of beef, chicken and milk in Venezuela and other countries as governments try to keep a lid on food-price inflation.'

Looks like we're heading for a head-on competition between motorists competing for ethanol fuels for their vehicles, and the much larger number of poor people trying to survive, and being unable to purchase food at affordable prices anylonger.

Scary stuff. Having just made my way to North America, I'm flabbergasted by the ridiculous number of oversized cars with absolutely gigantic engines on the streets everywhere. You know, in the UK or Germany you'd see a 3 litre V6 type car only once in a blue moon, while here it seems to be at the lower end of what people like to drive around in. Not much by way of sympathy for our poorer neighbours then...

Brits are not selfish post-Thatcherites after all

One could be forgiven for thinking that the post-Thatcherite Brits, having elected the warmongerer and privatisation fanatic Mr Blair (also better known as US President's Busch's poodle) to be PM a few times, would be a fairly selfish bunch showing little concern for those in need. After all, if even the Labour Party in that country gets into the business of privatising public education and hospital care one would not expect a great deal of civic mindedness among the citizens that elect such governments.

Well, if you thought like this, you could not be more mistaken! The British Medical Association (a doctors' trade union) conducted a survey of patients' views on organ donation. The UK system, much like the Canadian system, requires people to opt-in so that their organs may be utilised in case of their death. The problem with this system is, essentially, that because many of us are too lazy or too forgetful, we forget to sign the relevant forms and as a result when unexpected death hits us, for instance on the road, our organs cannot be utilised to preserve the lives of people in need of transplant organs. Thousands of lives are lost each year, simply because we are phlegmatic, lazy or ignorant about this important issue. It has long been suggested that we have a moral obligation toward out fellow citizens in need. For that reason it makes more sense to operate a system where we presume that a given dying accident victim, for instance, is presumed to be ok with the organ extraction instead of saying that if there's no signature saying 'you may use my organs' we may not use them. In other words, instead of actively opting in you must actively opt out to selfishly (yes, I mean it!) take your complete set of organs to your grave (so they may be eaten by worms instead...). The same phlegmatism, laziness and ignorance that is the root cause of today's insufficient supply of transplant organs would be utilised to save lives.

2/3 of 2,000 Brits interviewed in the above mentioned survey confirmed that they support the presumed consent idea. That's a strong democratic majority if this was true across the country and the survey was representative. This contrasts with only 1 in 4 Brits being on the organ donation register.

Of course, waiting for politicians to act on this, is probably as futile as waiting for them to legalise voluntary euthanasia. They have long understood that such decisions are no vote winners, so they stay clear of making them. What's new?

Courts and ethicists

You know, I have always been somewhat dismissive of the law as a good means to take forward political causes. I always thought one needed to win the substantive normative argument first, and then, somehow, miraculously the law would fall into line. Well, while I worked in South Africa for a couple of years, the Treatment Action Campaign there gave me much food for thought. They used legal cases to advance usually sensible policy matters. Of course, sometimes the law can be an ass and nothing can be achieved by means of suing one's way through the courts, but there are two cases reported today that suggest that sometimes at least the legal route just might be the more efficient way to achieve particular ethical or policy objectives.

The first case could best be described as: Whales: 1, US Navy: 0. Check it out here.
The second case I reported about on this blog. I learned today that Novartis lost its case in the Indian High Court.

Mind you, none of this shows that critical analysis and argument are not called for, but equally it seems fair to say that in some circumstances a good team of lawyers can replace a lot of academic papers and books and campaign officers, if one is concerned about achieving desireable outcomes at all.

Why are we so obessed with our 'own' children?

A crazy world this is. As I write this, many developing countries struggle with AIDS orphans counting by the millions. Common sense would suggest that it should be easy enough to set many of them up with infertile couples in their own countries or elsewhere in order to bring prospective parents and already parentless kids together. Not so. In developed countries each year billions of $$ are being forked out for IVF procedures, commercial surrogacy and such things. Nobody seems to bat an eyelid about what I would like to think is decadent behaviour by people pre-occupied with their own (somehow) genetically linked children. While Darwin explains quite nicely why many people would be driven to do such things, it is surprising how very few switch their brains on when the breeding hormones kick in, and do the ethically right thing, namely to bring up someone else's child as their own. As if this wasn't bad enough, matters got worse in Canada. In a brave act of political correctness a stop was put to the commodification of women by outlawing commercial surrogacy (ie the rent-a-womb crowd). A Bill called C6 became law in May 2004. It criminalises payments in excess of the surrogate mothers' expenses. Well, I would understand if you felt uneasy about the commodification of people, but if you do, consistency would require of you that you apply the same standards to any other instance where we sell our bodies to someone else for a limited period of time for a specific purposes. After all, that is precisely what surrogate mothers, sex workers, university professors, taxi drivers, soldiers and others do when they sign a job contract. So, may I suggest that Canada's law makers introduce Bill U1. This bill should, in line with Bill C6, legislate any work relation illegal in which anyone sells their bodies for any kind of service for a defined period of time to an employer. That should be a reasonably easy task, and it should permit us to do once and for all away with that disgusting commodification of people. It should also change once and for all the face of modern capitalism as we know it...

Now, you might object that my comparison is pretty unfair, given that there are health risks attached to surrogacy motherhood. A small percentage of women suffer adverse health consequences during pregnancy. Guess, in my defence I can only point out that this is probably true for taxi drivers , university professors and any number of other workers. So why treat surrogacy differently? Well, one argument might be that surrogate mothers might find it difficult to live up to their contractual obligations and surrender the newborn. I don't mean to sound too harsh, but surely that would be their problem... - I mean, once they have been thoroughly informed about the conditions of the deal, and they agreed voluntarily to the proposition,who are we as society to tell them that they must not because we are concerned about their capacity to cope.

However, given nature's call and our pre-occupation with our own genetically linked children, desperate hormonally challenged prospective parents will do almost anything to get their hands on their own off-spring. The decision to drive such breeding minded people into the underground is, mildly put, disastrous. They and the surrogate mothers that they're able to get their hands on will not be legally protected during their transaction. All participants will be subjected to higher levels of stress with a corresponding higher probability for a miscarriage.

Just as importantly, the wealthier of the desperate-to-breed-my-own-kid crowd will simply fly out of Canada and rent a womb elsewhere. Many such wombs belong to impoverished women in developing countries or impoverished women in developed countries. I know of a truly wealthy gay Australian man who flew all the way to Los Angeles to rent a womb (twice) so that he could have (well, buy) his genetically linked kids. The levels of selfishness that this represents is unfathomable to me. Three cheers to the Canadian government for having moved the ugly picture of commercial surrogate motherhood out of sight, and for making such conduct possible. Truly well done - not...

Nobody of those people who fly halfway around the world to rent impoverished women's wombs so they can have their kids produced for them, seems to care about kids like the one you can see on top of this blog entry. What would be so bad about giving such children a loving home instead. Surely the excuse of 'nature calling' isn't good enough to justify what's going on.

Regular readers of this blog will know my favourite little AIDS orphan charity in Southern Africa. Consider supporting them, please, please, please. If you consider flying half-way around the world to rent an impoverished woman's womb so that you can have your own little kid, may I suggest you consider growing up instead?

British Medical Association Medical Ethics Committee on Access to Abortion

The British Medical Association's Medical Ethics Committee has issued a day or two ago a position statement on access to abortion in the UK. The organisation has been in favour of women's legal right to abortion since the 1970. I excerpt here the BMA's key opinions. In a number of key areas the organisation proposes to make access to abortion easier for pregnant women. This is quite significant, seeing that it comes immediately in the aftermath of public debate in the UK about the Roman Catholic Church's hierarchy clamouring to have abortion outlawed altogether. You can find the whole report here.

The MEC supports the revision of the Abortion Act 1967 so that, in the first trimester:
• women are not required to meet medical criteria for abortion
• the requirement for two doctors is removed
• suitably trained and experienced nurses and midwives may carry out both medical and surgical abortions
• as long as safety is ensured, premises do not need to be approved to carry out first trimester abortions.

The MEC believes:• that changes in relation to first trimester abortion should not adversely impact upon the availability of later abortions
• that health professionals with a conscientious objection to abortion should retain the right to opt out of providing abortion services, but should make their views known to patients and enable them to see another doctor without delay.

The MEC believes that the requirement for medical criteria should be removed for first trimester abortions.

The MEC believes that the requirement for two doctors’ opinions should be removed for abortions within the first trimester.

The MEC believes that the level of training and experience a person has is the most important factor in determining which procedures should be undertaken by which professions. The MEC has no objection, in principle, to nurses and midwives, with appropriate training and competence, carrying out abortions.

The MEC has no objection in principle to removing the requirement for premises to be “approved” for first trimester abortions and allowing medical abortions to take place at home where that is the woman’s wish.