{"id":792,"date":"2010-12-17T20:37:31","date_gmt":"2010-12-17T19:37:31","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=792"},"modified":"2010-12-17T20:37:31","modified_gmt":"2010-12-17T19:37:31","slug":"conference-report-consent-and-organ-donation-seminar-keele","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2010\/12\/17\/conference-report-consent-and-organ-donation-seminar-keele\/","title":{"rendered":"Conference Report: Consent and Organ Donation Seminar, Keele"},"content":{"rendered":"

Guest post by Sorcha U\u00ed Chonnachtaigh<\/a><\/strong><\/p>\n

On Thursday, 9 December, the Centre for Professional Ethics at Keele hosted a Wellcome funded seminar entitled “Consent and Organ Donation<\/a>” to coincide with the final lecture in a series on organ donation by visiting Leverhulme Professor Martin Wilkinson.<\/p>\n

Martin’s lecture on Wednesday evening (8 December), “Reforms for the UK? \u2018Presumed Consent\u2019 and Organ Sales”, provided an excellent starting point for our discussions on consent the following day.\u00a0 Martin criticised two possible policy responses to the scarcity of organs for donation: moving to a “presumed consent” (or opt-out) system and a state regulated system of paid donations.\u00a0 The latter does not appear to be of direct relevance for consent but both proposals have been made in response to the de facto “family veto” (about which Martin has written elsewhere<\/a>).<\/p>\n

Martin’s objections to the “presumed consent” proposal mostly focused on two empirical issues.\u00a0 First, where presumed consent systems appear to have been successful, it is not presumed consent alone that accounts for an increase in organ donation (Spain<\/a> is a good example of this).\u00a0 Secondly, even ‘presumed consent’ or opt-out systems do not operate on a genuinely (or fully) presumed consent (or opt-out) basis because in both opt-in and opt-out systems, consent of the donor can be over-ridden by the family.<\/p>\n

Martin endorsed a paid donation system.\u00a0 It would be inappropriate to say that he is in favor of organ sales because the policy he endorses is a state monopsony whereby the focus on purchase and the “payment” need not be cash but might consist in any number of incentives, such as funeral costs for the deceased or vouchers.\u00a0 The single-buyer market would be far from a free market – organs would have a set “price” (or value) and the buyer (the NHS) would be obliged to provide pre- and post-operative care, the latter of which would obviously only apply to living donors.\u00a0 Martin responded to various objections to “paid donations” including those related to commodification, dignity, the importance of the “gift” relationship, altruism, coercion and consent.\u00a0 The lecture provoked interesting questions both from the academic delegates and lay attendees.\u00a0 It gave us all food for thought in advance of the Consent and Organ Donation seminar the following day.<\/p>\n

The seminar had three themed panels: organ donation policy and practice; the philosophy of consent and tales from other jurisdictions.\u00a0 The first panel consisted of three speakers with extensive policy experience: David Price (De Montfort), Jonathan Montgomery (Southampton) and Jean McHale (Birmingham).\u00a0 David gave a very interesting presentation on the legal and ethical policy issues arising from the treatment of prospective donors.\u00a0 The indications given by many policy institutions is that certain treatment decisions would be considered problematic if they prioritise organ retrieval over “best interests” of the patient.\u00a0 David outlined some of the problems with this position.<\/p>\n

Jonathan Montgomery’s presentation on the compromises required for consensus in policy-making was particularly topical.\u00a0 Jonathan focused on his experience on the Organ Donation Task Force<\/a> and their considerations of an opt-out system and on the Nuffield Council on Bioethics working group, which produced Public Health: Ethical Issues<\/em><\/a>.\u00a0 It was interesting to look at the tensions arising from public opinion (following deliberative engagement), political context, empirical evidence and the expert membership of policy committees.\u00a0 Jonathan also spoke about framing in policy, in particular about the increase in public willingness to donate organs when asked if they would like to receive an organ in contrast with traditional questions about willingness to donate to others.<\/p>\n

Jean McHale spoke about policy responses to organ transplant tourism (“EasyJet transplants”), specifically focusing on how the criminal law might address breaches of domestic law abroad.\u00a0 Here there is an issue of consistency in the law and Jean drew on some interesting analogies with blackmail, extortion and murder that occur extraterritorially.\u00a0 She made a self-described controversial claim that the law, for consistency’s sake, might want to impose sanctions on those who go abroad for transplants with regard to provision of post-operative care. A number of questions from the floor touched on the most significant aspects of the paper.\u00a0 First, would sanctions only apply to those who need treatment for complications (and not those who have successful transplants), and what implications would this have for consistency in the law?\u00a0 What is the basis of imposing sanctions: the notion that any harms arising are self-imposed or the perceived ethical issues (e.g. exploitation) associated with organ donation in some countries?\u00a0 Depending on these kinds of details, we might have very different responses to Jean’s proposal.\u00a0\u00a0 A very provocative paper indeed\u2026<\/p>\n

In the second session on philosophic of consent, Janet Radcliffe Richards explored the notion of having rights over our dead bodies and the role of law in changing cultural attitudes.\u00a0 Neil Manson critiqued Ben Saunders’s recent concept of “normative consent”.\u00a0 Saunders argues that we should have an opt-out system and for those who do not opt-out but whose wishes are unknown we should retrieve their organs.\u00a0 Because it is the right thing to donate, we should assume that people would.\u00a0 Neil’s analysis rightly dismissed the weak objections, such as the claim that such an approach constitutes organ conscription or is a manifestation of a totalitarian approach to organ donation.\u00a0 Both objections fail to recognise that Saunders protects refusals (decisions to opt-out) for any reason (even those that are irrational or invalid from a normative perspective).\u00a0 Neil’s major criticism rests on the distinction between consent as agreement and consent as permission, where consent as agreement is the undertaking of obligations\u00a0 and consent as permission is the waiving of obligations.\u00a0 Consent has a second order liberty right, whereby the consenter is free of obligation and free to consent or <\/em>refuse.\u00a0 Consent, Neil says, is a two-step process involving the undertaking of obligations.\u00a0 The normative claims as Saunders outlines them involve direct substantive obligations, in which case consent plays no role. Hence, Neil concludes, normative consent is not consent at all.\u00a0 There were some interesting questions about triggering rights as opposed to claiming rights with consent having a second order liberty right.<\/p>\n

The final panel with the theme “tales from other jurisdictions” consisted of Govert den Hartogh (from the Netherlands) and Martin Wilkinson (visiting Keele from New Zealand).\u00a0 Both speakers used the theme very liberally to allow them discuss issues in organ donation that interest them.\u00a0 Their loose interpretation of the theme was to our benefit.\u00a0 Govert discussed the Volenti principle – in particular, the issue of consent as a sufficient justification for the removal of living organs.\u00a0 This raised interesting questions about indirect paternalism, however I missed some of Govert’s paper and must wait for the publication of it to really explore this further.\u00a0 Let’s hope the wait is not too long.<\/p>\n

Martin Wilkinson once again had an evening slot but kept discussion lively.\u00a0\u00a0 Martin argued for an impartially defensible method for acquiring and allocating organs, using the case of the “racist donor”<\/a> (in which the deceased donor of her family give consent for donation with conditions).\u00a0 In such cases, it is often argued that we can only operate a system of donation with an impartial principle of allocation, that anything less is indefensible.\u00a0 Martin made the argument that if we refuse to accept organs with conditions attached (such as exclusion of recipients of particular skin colours), we will have lose organs.\u00a0 Martin also argues that we don’t discourage partiality in organ donation that partiality may not be something we wish to discourage at all given that partial motivations for living intra-familial donations which introduce organs into the system that otherwise would not be available at all.<\/p>\n

One recurring issue was the role of the family in consenting to organ retrieval for donation purposes.\u00a0 This wasn’t explicitly addressed though it was mentioned in Martin’s Leverhulme lecture and in both David’s and Jonathan’s presentations. I imagine it will continue to be a significant issue in discussions around organ donation and consent.<\/p>\n

Congratulations to my colleagues who organised the seminar, particularly Sheelagh McGuinness, and thanks to the Wellcome Trust<\/a> for supporting the event.<\/p>\n","protected":false},"excerpt":{"rendered":"

Guest post by Sorcha U\u00ed Chonnachtaigh On Thursday, 9 December, the Centre for Professional Ethics at Keele hosted a Wellcome funded seminar entitled “Consent and Organ Donation” to coincide with the final lecture in a series on organ donation by visiting Leverhulme Professor Martin Wilkinson. Martin’s lecture on Wednesday evening (8 December), “Reforms for the […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[185,591,328],"tags":[],"class_list":["post-792","post","type-post","status-publish","format-standard","hentry","category-conferences","category-life-and-death","category-philosophy"],"yoast_head":"\nConference Report: Consent and Organ Donation Seminar, Keele - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2010\/12\/17\/conference-report-consent-and-organ-donation-seminar-keele\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Conference Report: Consent and Organ Donation Seminar, Keele - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"Guest post by Sorcha U\u00ed Chonnachtaigh On Thursday, 9 December, the Centre for Professional Ethics at Keele hosted a Wellcome funded seminar entitled “Consent and Organ Donation” to coincide with the final lecture in a series on organ donation by visiting Leverhulme Professor Martin Wilkinson. 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