I don’t feel at all uncomfortable with the idea that we should switch from an opt-in system of organ donation to an opt-out one (so that the default, if you don’t express a preference, is that your organs can be used).
But some people are bothered, generally people on the political right. Matthew D’Ancona is typical, fuming at “the nationalisation of the body”. He argues: “As a matter of philosophical principle, the State should presume my consent for nothing unless I specifically give it.” (Cassilis is a notable exception – but while generally on the centre-right, he’s refreshingly hard to pigeonhole.)
People on the left seem mostly not to be worried. Justin McKeating is a good example : “They might as well be saying 'Gordon Brown can pry my liver from my cold dead hand' for all the sense they're making. …
What it boils down to is putting your principles before the lives of dying people.”
That’s more or less how I feel. Corpses have neither needs nor property rights, and an opt-out system will lead to more organs being available to save more lives.
And this is nothing like inheritance tax: you won’t be leaving your kidneys to your children, who despite having decent jobs are finding it really hard to get onto the dialysis ladder.
As for the state’s ‘presuming my consent’, I don’t see how this is different from having income tax taken from your wages via PAYE, which you then might claim back – whether you’ve voted for such a saystem or not.
But I wonder. Sometimes our opinions on one thing are shaped by our broader attitudes.
Try a thought-experiment. Imagine we live in a country where healthcare is private. A new law is proposed, which would let health insurance providers start introducing clauses in their contracts saying that if you die as a member of their scheme, they have the right to use your organs for transplant – although you can ask them for a form to fill in to specify that you’re withholding consent.
How do you feel now? You’re still dead. You still don’t need the organs. People’s lives are still being saved. The opt-out is still freely available, although your consent is still initially being presumed. The utilitarian and libertarian issues remain the same.
Do leftish opt-out supporters feel less comfortable now that it’s profit-making private companies using the organs, rather than the NHS? Conversely, do rightish opt-out opponents feel more comfortable now that this is a transaction in a marketplace, rather than the clunking fist of the state reaching into your chest cavity?
Does a lot of this boil down to how much, in very general terms, we trust the state?