The Importance of Consent in Organ Donation

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Following the lead of the province of Nova Scotia, New Brunswick became the second jurisdiction in Canada to adopt a policy of “presumed consent” for organ and tissue donation. Instead of willingly opting in to be an organ donor, residents 19 years and older, with limited exceptions, will be opted in by default.  

While many see this as a solution to the perpetual demand for transplant organs, laws like these treat the ethics of organ donation as a settled matter while treating humans and their bodies as means to other ends. Even more, considering Canada’s policy of Medical Assistance in Dying (MAID), this step will corrode the already thin ideas of “autonomy” and “consent” while incentivizing a utilitarian view of human nature. 

For context, Canada has already experienced a dramatic expansion of MAID toward not only those facing a terminal medical diagnosis but also for those suffering from mental illness deemed “grievous and irremediable” (those who suffer solely from mental illness will not be eligible until 2024). In 2021, assisted deaths rose by 35%, reaching over 10,000, or 3% of all deaths in the country. Opponents of MAID, including virtually every disability rights group in Canada, continued to warn that a so-called “right” to die will inevitably devolve into a duty to die. People are seen, both by themselves and by others, as burdens using precious resources better spent on those with better prospects for a “better” life.  

These warnings were, to put it mildly, ignored. As numbers climb, so do stories of pressure and coercion. Consider the Canadian veteran suffering from PTSD who was offered MAID instead of treatment last year.  

The presumed consent of the New Brunswick law adds a perverse incentive: the immense value of organs for transplant. The mismatch between supply and demand, not to mention what balancing that mismatch would mean, has always dominated the ethical conversation about organ donation. Currently, over 4,300 Canadians are waiting for an organ transplant, and as a government website states, hundreds “will die waiting. ...”  

Canada’s end-of-life policies already incentivize death. If donors request death, not only is the difficulty of obtaining consent more easily settled, so is the issue of preserving organs. Law professor F.H. Buckley explained in the Wall Street Journal,  

"Last year … two Canadian medical researchers and a Harvard bioethicist argued that [waiting until the patient is declared dead] could reduce the quality of donated organs. A superior model, they suggest, could be to kill the patient by removing his organs. After all, the best organs come from live people, like those who donate one of their kidneys. ...  

[B]y linking assisted suicide and organ harvesting, it ratifies the premise that euthanasia can help create a more efficient organ supply chain. … Where euthanasia is legal, the temptation to link the time of death and the demand for organs may similarly become too strong to resist. On a slow day there’s no hurry, but when a patient [who] is waiting for a heart is in the next hospital room, you’d expect greater pressure to euthanize a patient. ... 

Medical professionals should not be given the incentive to see their patients as sacks of valuable organs rather than as human beings."

The farther the medical world moves from its founding principle of “Do no harm,” the more harm is done. Take for instance China, where one top transplant doctor admitted that “effectively 95% of all organ transplants were from prisoners.” As unthinkable as it sounds, experts warned that these prisoners were likely executed by the means of “organ removal.”   

Dame Cicely Saunders, founder of the modern hospice movement and vocal opponent of euthanasia, was deeply influenced by Christianity. She once wrote, “The question of how one feels about so-called ‘rational suicide’ is, I believe, ultimately governed by the question of how much faith one has in human nature.” Powerful market incentives will only worsen an already epidemic disregard for human life. For Canadians, “presumed consent” is another stage in the downward spiral of a culture of death. If it continues to spread, there will be no opting out.  

This Breakpoint was co-authored by Kasey Leander. 

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