Friday, December 18, 2009

Presumed Consent.

Today, Edwina Hart, still Minister for Health and Social Services in the Welsh Assembly Government announced that she wants to introduce an opt-out, rather than an opt-in system of organ donation. This was a fully expected announcement. Mrs Hart had told us previously that she wants to introduce a system of 'presumed consent - and she likes to get her own way. There has been a 'consultation' exercise, which delivered exactly the response that it was designed to. Now, there is absolutely no argument about the need to increase the level of organ donation, but I do not believe that this is the right way to deliver it. It will be a case of 'government' taking people's organs because they didn't get around to saying they did not want then to be taken. But this post is not about the principle. That argument was lost when the Minister made her decision many months ago.

This post is about what happens next. Its the first time I have to consider a difficult moral issue - for real. To deliver on the Minister's intention, the next step will require the National Assembly to propose a Legislative Competence Order facilitating the transfer of the power to make this change of policy from the UK Parliament to the National Assembly for Wales. And it could easily be that consideration of this LCO by MPs will occur after the next General Election - and it could be that by then I'll be one of these MPs!! It might not just be me expressing my opinion on a blog. It could be for real. Blimey.

Now what does an MP who shares with me the following two opinions do? Firstly, that law making powers in devolved policy areas should be transferred to the National Assembly - and secondly, that presumed consent, a system that I consider to be morally wrong, and practically dangerous, should not be introduced. I suppose party discipline could cloud the issue - but it shouldn't, on what is a moral issue. And there's no room in this post to explore all the trans-border issues if Wales goes it alone.

Early days, but my initial inclination would be to support the transfer of the power to introduce presumed consent in Wales to the National Assembly - while arguing that AMs should oppose any subsequent measure. There's a big problem with this stance though. It might seem entirely logical to me, but I fear it would be a difficult position to explain to John Humphreys. "Explain to me Mr Davies, why you want to hand over power to another body which would immediately use it to introduce a system of which you disapprove? Tough question. Exciting prospect. Which is why I cannot understand all these MPs opting out of the opportunity to be involved in such decision making.


James D said...

"Mr Humphreys, that's what democracy means."

It's a genuinely honourable position. It's arguably the only honourable position given the clear democratic mandate of the Assembly. I'm sure everyone has some issue that they feel should be devolved, despite the policies of the devolved government -- I feel that way about the existing devolution in higher education.

But on the broader issue, the pressure to become a donor is already there on the driving licence renewal form -- it already has to be declined (and for what little it's worth, I have declined it (and I'm sure I'm now the most unpopular man in Wales for having admitted that)). So this would only affect people who either don't drive or haven't needed to renew their driving licence since the invention of those photocard monstrosities.

Peter Black said...

Don't worry Glyn the odds are that you will not be in a position to face such moral dilemmas after the General Election.

Glyn Davies said...

James D - I've always thought that door to door, distributing application forms would be the best approach.

Peter - The odds are indeed as you say. Should add that I intend to call my autobiography 'Against the Odds'. Anyway, thanks for trying to help me through my dilemma. You're a good friend.

Anonymous said...

Another one where Edwina stamps her foot and the world obeys - no way she is wrong
This is an opt in not an opt out question
I will be so glad when she and her ilk are out of office and rep;aced probably by Plaid /Tory Alliance
I just hope it will be more open and democratic

Anonymous said...

Glyn without wishing to sound offensive I don't see your problem.

As an MP, the only thing you will be asked to decide is whether the decision should be made at a national level or at Westminster.

If you wish to influence that decision which the Assembly subsequently makes, you are of course able to speak out as a citizen (or you could seek election to the Assembly yourself)

Quite frankly if you feel your decision is likely to be clouded by the likely reaction of John Humphies or any other journalist, and feel incapable of justifying a perfectly logical position, then I'm afraid that I would seriously question whether your are cut out to be an effective MP.

Quite frankly I think most of us are pretty sick of that sort of political cowardice in the face of the self serving media.

Glyn Davies said...

VM - On this issue, I'm particularly impressed by Jonathon Morgan. His line (and mine) are not popular, and media presentation of Edwina's proposals are designed to make anyone who takes a contrary position as uncaring. We all know of the shortage of donated organs, and would like to see more donors. But having 'the state' change the law to take organs from dead people who have not freely given their permission is a big step to take - and a step to far for me.

Anon - I promise not to be offended, as long as you're not if I suggest you could not see a tongue in a cheek six inches distant.

And anyway, you are mistaken. Experience shows us that MPs are taking upon themselves a rather greater involvement than you suggest. Some LCOs have been sent back for redrafting.

shioperc said...

I'm totally against Edwina Hart's agenda. There is no way I would be happy to learn that a relative had organs removed because they failed to register an opt-out. What of people like me who are Welsh but don't live in Wales, what if I died on a visit to Wales, would I have my organs removed? I am telling my American friends to avoid travel to Wales in case they involuntary give up their organs. Might sound alarmists, but most Americans don't believe the state owns human bodies. The policy is wrong, it will turn into a tourism disaster for Wales - believe me, I will make sure thousands upon thousands of Americans know about this 'opt out' policy if it is introduced in Wales. The policy is morally wrong, it is for people themselves to decide and if they don't decide to opt-in, there should be no presumed consent to remove organs from their bodies. The opt-out policy is immoral and offensive, and represents a slipery slope to government take over of our bodies even before death.

So the Lib-Dems support this police of opt-out. Wow - another reason to regard them as the third/turd party that they are.

Jackson said...

Nobody would disagree that the plight of people on transplantation waiting lists needs addressing. The question is how. I am not sure what Edwina Hart thinks this will achieve - perhaps she hopes Wales going first will lead the rest of the UK in this direction. For sure if it happens only in Wales it may not have the desiredimpact in Wales. Why? Transplantation is run by UK Transplant based in Bristol to ensure organs are provided in the fairest way (there is a list) and to minimise waste. So transplants that happen in Wales or outside of Wales for Welsh patients can potentially come from across the UK. People whose organs are donated in Wales can be and are used in other parts of the UK. This is because it is important to get the best possible match between the donor and recipient to provide the best opportunity for the donation to be successful. It is surely not intended to withdraw from this because it is likely that Welsh patients will suffer from access to a smaller pool - particularly people from minority and ethnic communities. So what happens when a Welsh person has the misfortune to die in an English hospital or vice versa - how will this be applied? What will the scheme cost to run and what will it provide for Welsh patients (what else might the NHS in Wales spend the money on to save lives, possibly more lives)? The issue will still come down to asking relatives in a vulnerable state to give their permission. If the relatives know that the person was pro-donation, great, but that is how things are now. If they know that the donor was against the idea but had not opted out they can say no - so no change there either. And if they don't know...they might feel pressure to say yes and who knows how that might impact on families of donors. Bottom line here is we need to make sure that everyone is asked in these situations. You do not need some expensive opt out system to do this. Does this happen now? You can have a beautiful opt out system but if people are not asked it will change little. Setting aside the freedom issue (I can understand how some people might wonder where this could lead to) there are some hard questions that need to be answered here. Perhaps somebody will roll up and answer them - it would be interesting.

Incidentally, the only major organ transplants that happen in Wales are kidneys and some pancreatic transplants at University Hospital of Wales, Cardiff.

Glyn Davies said...

shioperc - Bit early to decide not to travel to Wales because of this. It may not ever become law. It will certainly take a lot of time, and the difficulties of legislating for Wales to go it alone will not be completed befor ethe next Assembly election.

Jackson - These sort of questions will have to be answered before any law/measure is passed. My post was more about where the answers to these questions should be discussed - at Westmister, or in Cardiff Bay,

Anonymous said...

I am completely opposed to compulsory organ opt-ins. I think organ donation is great idea and I wholeheartedly support the idea - BUT it must be voluntary and not presumed. I have now torn up my donor card in protest at moves to turn what should have been a wonderful gift from one human to another into a Frankenstein Farming!

I also, personally, don't think the Assembly should be given more powers (but not because of the Hart issue). Why do we want to give more power to Labour/Plaid just at a time when we could remove them in Westminster.

shioperc said...

Glyn, according to fact #37 in "Wales 101" the Welsh tourism industry is worth "£3 billion a year".

Edwina Hart had better think again, the Welsh tourism sector won't be worth three shillings.

Dr Richard Lewis said...

Dear Glyn,

You mention that you are particularly impressed with Jonathan Morgan’s view on this issue. As I pointed out to him and now to you, we must accept that the system currently operating is not working. The system does not meet the demands placed upon it, and people are dying waiting for organs.

We recognise that the introduction of an opt-out system would be a controversial decision, and as such those who do not want to donate their organs will sign up to opt out. A law on presumed consent would, at a single stroke, save lives whilst still giving the individual the right to have a choice.

Given the very high level of support for organ donation expressed in repeated surveys it is reasonable to presume that those who die without making their views known are in the majority who want to donate, rather than the minority who do not.

Presuming consent rather than presuming objection is more likely to achieve the aim of respecting the wishes of the deceased person.

We believe that with further debate and information about the way such a system would operate, there will be widespread public and professional support for such a change.

Let’s show that we still care deeply about the health of our nation and that we are willing to lead with bold initiatives whilst other countries dither and waver.

Kind Regards,
Dr Richard Lewis, Welsh Secretary, BMA Cymru Wales

Jackson said...

Interesting to read the responses on this.

I take your point, Glyn, about where the decision should be made and that this issue is an exemplar for the kind of problems that are posed by devolution.
My problem is that I am unconvinced that this will make any difference to kidney patients and may make matters worse. Can Dr Lewis put his hand on his heart and really state that the NHS is doing everything possible to identify all potential donors? But more than this is the non-sequitur that allows Dr Lewis to leap from people favouring organ transplantation to being prepared for government to legislate an opt-out. I fear that this is based on a reliance on public apathy. Dr Lewis I am very pro transplant - happily carry my card, want my organs to be donated. I do not want and you should not presume that I therefore want government to legislate for an opt-out system. I do not believe that this is the government's right. It is my decision not yours.