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If you live in Wales there will now be a presumption that you are willing for your organs to be donated, unless you explicitly opt out of the scheme.

broken glass by arnaud...

John Bingham reports on the recent legislation:

The “opt-out” system means organs could be taken from a person who has died unless they or their loved-ones actively object. It would mean that the current voluntary scheme, in which people carry Donor Cards or register their consent online, would no longer operate nationwide. Under the plans, organs taken from bodies in Wales could also be used in other parts of the country where active consent is still required…

The presumed consent system could come into force by 2015. The new consent law would apply to over-18s who die in Wales if they have lived in Wales for more than 12 months. Organs made available under the system would be the same as the “opt-in” method – including kidneys, heart, liver, lungs and pancreas – and would not only go to donor patients in Wales. They could go anywhere in the UK.

Dr Peter Saunders, chief executive of the Christian Medical said the change was “unnecessary and unethical”. He is good for a soundbite:

We strongly support organ donation but so-called presumed consent involves neither consent nor donation – it is neither voluntary nor informed and involves taking organs rather than giving them.

It means effectively that the state will be able to overrule families and there is a very real danger that it could also prove counterproductive and undermine trust leading to fewer rather than more donations.

The Anscombe Bioethics Centre submitted evidence against the new legislation. You can read their report here. The main objection is that it turns a gift into an act of theft.

Here are the main points from their report:

THE CATHOLIC VIEW OF ORGAN DONATION: ORGAN DONATION AS A PROFOUND ACT OF HUMAN SOLIDARITY

0.2  This response will first outline a Roman Catholic understanding of organ donation, and how this coheres with a true humanism and helps to reinforce positive attitudes of solidarity within society. It will then turn (in paragraphs 1.1 and following) to the consultation questions.[1]

0.3  Organ transplantation from the dead saves and transforms lives. It offers hope for those with diseases that would otherwise be untreatable, or treatable only by ongoing, imperfect means such as kidney dialysis. Transplantation is, in principle, welcomed by the Catholic Church.

0.4  When solid organ transplants were first being attempted in the 1950s, Pope Pius XII explained to Catholics that this was “not a violation of the reverence due to the dead”. Rather, it was justified because of “the merciful charity shown to some suffering brothers and sisters.”[2] More recently Pope John Paul II said that, “We should rejoice that medicine, in its service of life, has found in organ transplantation a new way of serving humanity”.[3] Far from opposing the use of the dead body in the service of medicine, the Church actively encourages Catholics to offer their organs after death. The Catechism of the Catholic Church states that “Organ donation after death is a noble and meritorious act and is to be encouraged as a expression of generous solidarity”.[4]

THE NEED FOR CONSENT

0.5  While encouraging Catholics to donate organs, Pope John Paul II emphasised that what justifies the use of the human body is the free act of donation. “Above all, this form of treatment is inseparable from a human act of donation. In effect, transplantation presupposes a prior, explicit, free and conscious decision on the part of the donor or of someone who legitimately represents the donor, generally the closest relatives. It is a decision to offer, without reward, a part of one’s own body for the health and well-being of another person. In this sense, the medical action of transplantation makes possible the donor’s act of self-giving, that sincere gift of self which expresses our constitutive calling to love and communion.”[5]

0.6  If the organs are taken without the consent of the donor, or that of the relatives speaking on behalf of the donor, then this is not an act of “donation”. It is taking without asking. The words of Pope John Paul II regarding donation without consent are very clear: “In such a perspective, organ transplantation and the grafting of tissue would no longer correspond to an act of donation but would amount to the dispossession or plundering of a body.”[6]

0.7  For this reason the Catechism says that organ donation “is not morally acceptable if the donor or his proxy has not given explicit consent.”[7] It is not morally acceptable because it fails to respect the human meaning of the human remains. Instead of donation being an expression of solidarity between people, it becomes a violation of the dead.

THE BENEFITS OF A SYSTEM OF TRUE DONATION

0.8  It should not be assumed that undermining the principle of consent will in fact increase the availability of organs. A look at the history of medicine shows that for many centuries there was a stigma attached to dissection. Bodies were taken from the poor and criminals who died in prison, and so people did not want the bodies of their loved-ones handed over to the surgeons. The consequence was a shortage of dead bodies, and this shortage gave rise to widespread grave robbing. This reached a peak in the early nineteenth century when the price for fresh dead bodies induced Burke and Hare to turn from grave robbing to murder. It was in reaction to this that, beginning with the Anatomy Act 1832, there was a concerted attempt to encourage voluntary donation and to remove the stigma associated with dissection.

0.9  The principle of voluntary donation has remedied a problem which had dogged medicine for centuries. The success of voluntary schemes should not be underestimated. According to UK Transplant a total of 17,761,585 people or 28% of the entire population have joined the NHS Organ Donor Register.[8] There are other countries which have still higher numbers of people on the organ donor register. Currently it is not clear whether people are given adequate information prior to signing the ODR, and thus whether it constitutes effective consent. Nevertheless, the success of efforts directed at increasing voluntary participation should be acknowledged as should the ethical importance of personal involvement when the decision pertains to one’s own remains: no decision about me without me. Thus, subject to adequate information, sensitivity to relatives of the dying, and other ethical constraints, it is “opting in” for organ donation that should be encouraged.

0.10  In contrast, consider the reaction to the Alder Hey scandal and the sight of parents forced to bury parts of their children in three or four ceremonies. This dramatically weakened public trust in the collection and storage of body parts. The same kind of scandal could happen with organ donation if consent is not respected.

0.11  A system of donation, in which people explicitly give permission for their organs to be used after their death, allows the human body to be used while respecting the dead. It is also helps to reinforce positive attitudes of solidarity within society. This is what Pope John Paul II meant when he talked of organ donation as part of the culture of life. An “opt out” or “presumed consent” system of organ donation undermines the principle of consent and effectively, even if not intentionally, violates the reverence due to a dead body. Even in pragmatic terms, there is a serious danger that it would harm transplant medicine because it would erode public support for organ transplantation.

An earlier paper from 2002 raises deeper issues about the ambiguity of brain death and the necessity of explicit consent in order ‘to protect the interests of the donor in avoiding premature retrieval of organs’. In other words, the unintended consequences, the risks, could far outweigh the presumed benefits. [The Linacre Centre later became the Anscombe Bioethics Centre]

Brain death

The Linacre Centre’s own view is that `brain death’ protocols are insufficient for establishing the death of the body: we have become increasingly convinced by evidence suggesting that integrated bodily activity can continue after `brain death’ has been diagnosed. There have been documented cases of `brain dead’ patients maintaining bodily functions for months or even years: pregnant women have gone through pregnancy, children have grown up and passed through puberty, etc. 3Moreover, it is well-known to transplant teams that heartbeating donors move when organs are taken, unless they are paralysed by drugs, and that their blood pressure goes up when the incision is made. It is worth noting that some anaesthetists recommend that the supposed `cadaver’ be anaesthetised when his/her organs are retrieved. Most organ donors are unaware that their hearts may be beating when their organs are taken, and that they may be pink, warm, able to heal wounds, fight infections, respond to stimuli, etc.

We would urge that while the adequacy of brain-related criteria for diagnosing death is fully and fairly investigated, the retrieval of organs from heartbeating donors should be put on hold. Donations from non-heartbeating donors – perhaps after organs have been cooled to preserve them – could continue while this investigation was carried out. At the very least, those who wish to donate their organs should be given the option of being non-heartbeating donors only, and should be fully informed of the state their bodies will be in when their organs are retrieved. Such information requires a proper interview with a medical practitioner who can explain current controversies: simply signing a donor card in no way indicates that the prospective donor understands what organ donation will involve.

Consent

In view of the uncertainties surrounding diagnosis of death, it is all the more important that an `opt out’ system of organ donation be firmly excluded. We welcome the emphasis placed on consent in Human Bodies, Human Choices. Explicit consent by the donor, in addition to consent (or non-objection) by relatives is needed both to safeguard respect for the body, and to protect the interests of the donor in avoiding premature retrieval of organs. We would urge that even if the donor had given fully informed consent to organ donation, objections raised by relatives should be seen as overriding. This is particularly the case with retrieval of organs from heartbeating donors, which can be most distressing for relatives who believe – not without evidence – that their loved one may still be alive.

In the case of non-heartbeating cadavers, we would require consent from the donor him/herself, while relatives should be kept informed and could veto the procedure if they raise strong objections. In the case of children, however, parental consent should be both necessary and sufficient for the retrieval of organs from a non-heartbeating cadaver. Parental consent should also be necessary and sufficient in the case of stillbirth or miscarriage, at whatever stage of pregnancy. Wherever practicable the consent of both parents should be obtained, as generally both will have a legitimate concern for the child, though this will depend on the circumstances of the relationship, contact and custody. However, the deliberate termination of pregnancy and the destruction of human embryos are serious acts of injustice against the child in which the parent or parents are complicit. The use of the body of a child whose life is taken in this way adds insult to injury and is wholly unacceptable.

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I was searching for information about the ‘population explosion’ and came across the Spiked campaign entitled “No to Neo-Malthusianism: Why We Oppose Population Control”. There is a string of articles exposing the prejudices and undermining the arguments of contemporary neo-Malthusians, many of them occasioned by the celebration at Spiked of the birth of Baby Seven Billion last year.

This article here by Brendan O’Neill is already three years old, but it’s a good summary of the alarmist arguments put forward by those who fear for the future of the planet and the future of humanity because of the population growth. And then, as you expect from O’Neill, a trenchant critique of their position.

First of all the facts (as they were in November 2009):

In the year 200 AD, there were approximately 180 million human beings on the planet Earth. And at that time a Christian philosopher called Tertullian argued: ‘We are burdensome to the world, the resources are scarcely adequate for us… already nature does not sustain us.’ In other words, there were too many people for the planet to cope with and we were bleeding Mother Nature dry.

Well today, nearly 180 million people live in the Eastern Half of the United States alone, in the 26 states that lie to the east of the Mississippi River. And far from facing hunger or destitution, many of these people – especially the 1.7million who live on the tiny island of Manhattan – have quite nice lives.

In the early 1800s, there were approximately 980 million human beings on the planet Earth. One of them was the population scaremonger Thomas Malthus, who argued that if too many more people were born then ‘premature death would visit mankind’ – there would be food shortages, ‘epidemics, pestilence and plagues’, which would ‘sweep off tens of thousands [of people]’.

Well today, more than the entire world population of Malthus’s era now lives in China alone: there are 1.3billion human beings in China. And far from facing pestilence, plagues and starvation, the living standards of many Chinese have improved immensely over the past few decades. In 1949 life expectancy in China was 36.5 years; today it is 73.4 years. In 1978 China had 193 cities; today it has 655 cities. Over the past 30 years, China has raised a further 235 million of its citizens out of absolute poverty – a remarkable historic leap forward for humanity.

Then the general critique:

What this potted history of population scaremongering ought to demonstrate is this: Malthusians are always wrong about everything.

The extent of their wrongness cannot be overstated. They have continually claimed that too many people will lead to increased hunger and destitution, yet the precise opposite has happened: world population has risen exponentially over the past 40 years and in the same period a great many people’s living standards and life expectancies have improved enormously. Even in the Third World there has been improvement – not nearly enough, of course, but improvement nonetheless. The lesson of history seems to be that more and more people are a good thing; more and more minds to think and hands to create have made new cities, more resources, more things, and seem to have given rise to healthier and wealthier societies.

Yet despite this evidence, the population scaremongers always draw exactly the opposite conclusion. Never has there been a political movement that has got things so spectacularly wrong time and time again yet which keeps on rearing its ugly head and saying: ‘This time it’s definitely going to happen! This time overpopulation is definitely going to cause social and political breakdown!’

There is a reason Malthusians are always wrong. It isn’t because they’re stupid… well, it might be a little bit because they’re stupid. But more fundamentally it is because, while they present their views as fact-based and scientific, in reality they are driven by a deeply held misanthropy that continually overlooks mankind’s ability to overcome problems and create new worlds.

Then the analysis:

The first mistake Malthusians always make is to underestimate how society can change to embrace more and more people. They make the schoolboy scientific error of imagining that population is the only variable, the only thing that grows and grows, while everything else – including society, progress and discovery – stays roughly the same. That is why Malthus was wrong: he thought an overpopulated planet would run out of food because he could not foresee how the industrial revolution would massively transform society and have an historic impact on how we produce and transport food and many other things. Population is not the only variable – mankind’s vision, growth, his ability to rethink and tackle problems: they are variables, too.

The second mistake Malthusians always make is to imagine that resources are fixed, finite things that will inevitably run out. They don’t recognise that what we consider to be a resource changes over time, depending on how advanced society is. That is why the Christian Tertullian was wrong in 200 AD when he said ‘the resources are scarcely adequate for us’. Because back then pretty much the only resources were animals, plants and various metals. Tertullian could not imagine that, in the future, the oceans, oil and uranium would become resources, too. The nature of resources changes as society changes – what we consider to be a resource today might not be one in the future, because other, better, more easily-exploited resources will hopefully be discovered or created. Today’s cult of the finite, the discussion of the planet as a larder of scarce resources that human beings are using up, really speaks to finite thinking, to a lack of future-oriented imagination.

And the third and main mistake Malthusians always make is to underestimate the genius of mankind. Population scaremongering springs from a fundamentally warped view of human beings as simply consumers, simply the users of resources, simply the destroyers of things, as a kind of ‘plague’ on poor Mother Nature, when in fact human beings are first and foremost producers, the discoverers and creators of resources, the makers of things and the makers of history. Malthusians insultingly refer to newborn babies as ‘another mouth to feed’, when in the real world another human being is another mind that can think, another pair of hands that can work, and another person who has needs and desires that ought to be met.

So the population panic is rooted in bad sociology, bad science, and bad anthropology. And this is leaving aside the question of whether the world’s population will, in fact, keep increasing, or whether we are more likely to face a crisis of an imploding population over the next hundred years (e.g. see this article by David Brooks).

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It’s Ash Wednesday – another excuse, if any were needed, to post about human origins. After all the festivities of Shrove Tuesday / Mardi Gras, we approach the priest on this first day of Lent to have our foreheads marked with ashes. The traditional words spoken at this point are: ‘Remember, man, that thou art dust, and unto dust thou shalt return.’ (The priest standing next to me this morning as we distributed the ashes, a former Carthusian monk of a venerable age, used the Latin phrase that was still lodged in his memory: ‘Memento, homo, quia pulvis es, et in pulverem reverteris’.)

I was connecting this with last week’s philosophical anthropology lecture about human origins. Much is still unclear, scientifically, but one of the fascinating discoveries is that human beings who are anatomically modern emerged in pre-history many thousands of years before there is any evidence of characteristically modern human behaviour.

So you can find homo sapiens skeletons from about 200,000 years ago, and in terms of their anatomy there is hardly any difference between ‘them’ and ‘us’. If a crowd of such homo sapiens came towards you on a summer’s afternoon you’d say, ‘Look, there are some human beings’.

Dame de Brassempouy: le visage haut de 3,6 centimètres (reproduction)  by fredpanassac.

The "Dame de Brassempouy", perhaps the first representation of the human face, from about 25,000 years ago

But the evidence for modern human behaviours comes much later, sometime between about 100,000 and 50,000 years ago (we are not sure exactly). Only in this period do we begin to see the cognitive leap that gives us our name (homo sapiens, wise-rational man), so that by the time of our Cro-Magnon ancestors in the upper paleolithic period (about 40,000 years ago to about 10,000 years ago) there is an astounding proliferation of new behaviours. The pattern of intermittent innovation is gone, replaced by revolutionary advances: sophisticated hunting and fishing tools; elaborate architectural designs constructed with mammoth bones; kilns that could bake clay statuettes to 800 degrees Farenheit; decorated bone tools; elaborate burial sites filled with grave goods; the well-known cave art from central France; and – my favourite – a multi-holed bone flute from some 30,000 years ago.

The question is: What happened? And why is there this lag between the emergence of anatomically modern humans and what we think of as modern intelligence and creativity? There are three possibilities: (1) The intelligence was there in potential, but some other factor needed to develop in order for it to be released; (2) the intelligence was working away, gradually, as human culture developed and human wisdom accumulated, and the revolutionary consequences of this would only become apparent, with their archaeological evidence, over a hundred thousand years later; or (3) something else happened to allow the emergence of creatures we would recognise, behaviourally as well as anatomically, as full-blown homo sapiens – people we could call our brothers and sisters.

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We have just begun the second semester at the seminary, and I started teaching a new course entitled ‘philosophical anthropology’. It’s about the nature of the human person – not from the perspective of faith (that comes later), but just from the perspective of philosophy, reason, science, experience, etc.

I start with Hamlet (Act 2, Scene 2):

What a piece of work is a man! How noble in reason, how infinite in faculty, in form and moving how express and admirable, in action how like an angel, in apprehension how like a god – the beauty of the world, the paragon of animals!

But then I go on to explain how difficult it is today to justify this classical view that the human being has these unique qualities. The thrust of so much science and philosophy is to prove that there is simply a sliding scale of natural skills, and that the differences between human beings and other animals are differences of degree and not of kind.

Dolphins in the Red Sea by Tom Weilenmann.

As an example of this type of thinking I brought out an article by Jonathan Leake and Georgia Warren from the Sunday Times from a couple of weeks ago, giving evidence of human-like traits in the animal kingdom. Here are some quotes:

In the past few years researchers have been finding similar examples of sentience and self-awareness across the animal kingdom in species ranging from elephants and dolphins to crows and parrots. Even sheep, cows and pigs appear to be far more self-aware and to lead more emotionally charged lives than we have previously understood.

It means that humans, used to regarding ourselves as unique in our ability to think and feel, are not so special. Increasingly scientists believe we are merely at the top of a spectrum of intelligence across the animal kingdom, rather than standing apart from it. We may be better at thinking and more able to articulate our feelings — but animals can do all the same things…

Last year that was topped by Alex Kacelnik, a professor of behavioural ecology at Oxford, who discovered that crows are capable of using multiple tools in complex sequences, the first time such behaviour had been observed in non-humans. In an experiment seven crows successfully reeled in a piece of food placed out of reach using three different lengths of stick.

Crucially, they were able to complete the task without any special training, suggesting the birds were capable of a level of abstract reasoning and creativity normally associated only with humans.

Last week it emerged that researchers from Padua University in Italy had found that birds were able to read numbers from left to right, as humans do, and count to four even when the line of numbers was moved from vertical to horizontal. They also showed that birds performed better in tests after a good night’s sleep.

All this is powerful evidence against the idea that people are unique and, some argue, also undermines the idea that humans should have “dominion” over animals, as the Bible puts it.

This has traditionally been the justification for the exploitation and abuse of animals in many different ways, the most emotive of which is animal experimentation, particularly involving primates…

Such ideas suggest that the cognitive abilities of animals and humans lie on a spectrum. The skills of humans may be at the top end but they are no different in kind from those of many animal species.

Thomas White, professor of ethics at Loyola Marymount University, Los Angeles, believes that some animals are bright enough to merit human rights. He suggests that hunting dolphins or capturing them for aquariums is “roughly the same thing whites were doing to blacks 200 years ago in the slave trade”.

This is the question of whether there are non-human persons. 

So I have the next eleven weeks to explain how much of this is true, but that there are still some unique qualities about human reason, freedom and moral conscience that set us apart from the rest of the animal kingdom.

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