Is it not common sense to think of dead bodies as resources for organ donation? This depends on how we think about the recently dead. Can we harm the dead? If not, then it seems fairly straightforward: the recently dead are resources to harvest organs from at will (or so it seems). All we need to set this up is a system of presumed consent. This changes the emphasis from carrying a donor card that actively gives consent to harvest specified organs for transplants – which too few people do – to having a ready supply of dead people who may be used as useful resource to supply the growing demand for them from those on the transplant list. While their may be an opt out clause – perhaps a card that expressly denies a pathologist and transplant team to make use of organs as mere resources – the presumption is that body after death is little more than a resource to help the living.

At a deeper level this is less a question about resources and dwindling supply for growing transplant demand, and more a question of whether we can harm the dead. Again the common sense answer is no, we cannot harm the dead, because they do no longer exist as persons. To put it more logically, dead bodies do not meet the existence condition – nothing good or bad can happen to subject s at time t, unless s exists at t (Feldman 1991). However, this does mean that the dead body is a mere object. In other words, it was once an existing person that warrants respect. In this sense, it makes sense to respect the memory of the dead and to protect their wishes – even if they are no longer alive to carry those wishes out. All this is grist to the mill, for the presumed consent lobby – who do not argue that we should not respect the dead and their wishes when they were alive, just that we should not be too concerned about saying anything more than that.

Unfortunately, it is not so simple, because it does makes some sense to say that we can harm the dead body post-mortem when we consider that a recently dead body still has an emotional charge to loved ones. In fact, if we look closely at the parent evidence to the Alder Hey Inquiry, into the improper removal and storage of children’s – and sometimes foetal organs post-mortem – this was what they were saying. Many of the parents were talking about a harm done to the dead body post-mortem. While this does not make any sense if we take death as a simple boundary between existence and non-existence; it isn’t a simple boundary if one is emotionally attached to the deceased in some way. Many dead body’s are persons that once existed with wishes that should be respected by those that knew them (or at least, if very young, for a potential wish that grieving parents hold out for that child).

The problem is still deeper; if we try to really understand why the parents at Alder Hey were so upset. Some of the parents of dead children experienced harm done to them from within the experience of grief where they actually identified with the dead body. Since we have a relationship with the living this does not (magically) cease when some a loved one dies, it is little wonder that we get upset when their corpses are improperly treated. From within the experience of grief we have a continuing bond with the dead that is very powerful indeed – so much so that we continue to invest a quasi-sense of personhood in them. Whilst logically the bereaved (usually) comprehend that their loved one is dead fairly swiftly, they remain emotionally attached to the corpse – sometimes investing significance in the integrity of the body and symbolic significance of its various parts in relationship to a life shared. In short, the body itself can be harmed because of ones continuing bond with it shortly after death.

In practical terms, the improper removal of organs from dead children at Alder Hey and Bristol in the late 1990’s involved presumed consent. This was a problem because it did not take into account the anguish that close relatives experience through loss. Given Alder Hey, and the problem of grief complicating an intelligible perception of post-mortem harm, we may not be able to think of the recently dead body as ready and simple resource after all.

What the lengthy Public Inquiries at Alder Hey and Bristol taught us, is that we need to be sensitive to grieving relatives in their continuing bond with dead loved ones. To do so, the only option is fully informed consent. This may be a lesson for those who wish to extend presumed consent to harvesting organs from the recently dead – whether old, young and or foetal.

A note on style – a non-academically orientated polemic

Feldman F (1991) Some puzzles about the evils of death. Phil Rev, 100, 205-227

Adapted from:

Tomasini F (2008) Research on the recently dead: an historical and ethical examination British Medical Bulletin, 1-10

Tomasini, F.  Is post-mortem harm possible? Understanding death, harm and grief Bioethics, Blackwell, 2009, vol. 23

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