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The dearth of transplantable organs remains a serious problem in the United States and in much of the world. There are 123,000 Americans currently waiting for an organ. 18 of them die every day because demand continues to exceed supply. The problem has drawn the attention of many activists and policymakers, but sometimes the proposed solutions have proven more unpleasant than the problem. Chief among these unsavory solutions is the policy of opt-out organ donation.
Opt-out organ donation operates on the principle of presumed consent. This means that the government assumes that an individual is willing to have their organs harvested upon their death unless that individual has explicitly opted out of being a donor. Advocates for this system argue that this would greatly increase the number of organs available for transplantation and would save many lives.
The advocates for opt-out organ donation ignore something very important in their rush to claim dominion over the bodies of the dead: ordinary people’s views of the human body. To most Americans, the inanimate human body is more than a mere container of usable tissues. Even absent the spark of life, a body is usually seen as still being part of the deceased person.
This is not so much a religious or even spiritual sentiment, but a deeply human one. We attach significance to the body, whether it is a shell or all that remains of a person who was. We see it often as something worthy of respect.
This is why the body is not only essential to many funerary rituals, but is also a critical part of many people’s personal mourning and remembrance. It is why, in the wake of natural disaster, a huge amount of effort is put into the recovery of bodies that could have no medical use. It is why soldiers risk their lives to recover the remains of their fallen comrades. In essence, there is a personhood that we acknowledge by convention and sentiment even in the case of the dead.
Why is this perception of the body antagonistic to opt-out organ donation? Because it gives the presumption of ownership and control to the government.
Defenders of an opt-out policy might retort that because no one is obliged to donate their organs and can tick the box to remove themselves from the list, the self-ownership of the individual is not compromised. That reasoning is deeply flawed because it ignores the fundamental quality of the very idea of presumed consent. By presuming consent, the government essentially says that it owns your remains unless you go through a process that explicitly tells them otherwise. That completely turns on its head the idea of self-ownership as a baseline assumption.
Self-ownership, the underlying right of an individual to be independent of external domination is nullified when an individual has to sign a petition to prevent the state from harvesting their organs. What an opt-out system does is change the relationship of the individual and the state in such a way that the state has a much greater presumptive power over the individual’s very humanity.
Furthermore, there is an unpleasant smell of utilitarianism about opt-out programs. It seems to relegate choice to a secondary concern to the overall welfare of the polity. When the state begins making such a calculus about the disposition of its citizens, it does not take long for it to view them as means rather than ends. For citizens to be truly free they must not simply be agents of the state apparatus. There must always be some distinction between individuals and their societies.
There are other ways to increase organ donations. Donor drives are just one example. Whatever encouragements they offer, the burden must be on the state to encourage people to make the decision to donate their organs, not to just assume people have already consented.