Wednesday, March 03, 2010

Easing hard decisions

I just listened to the Hack episode discussing organ donation. They spoke to a number of different people with a number of different perspectives. The main contention was whether relatives should have the right to veto a person's decision to donate organs. One guy said that having the right to decide to honour his little brother's decision to donate had been empowering and helpful to them. On the other hand, a woman spoke about how she had been the only person in her family who could emotionally deal with the decision to donate her father's corneas. One thing she mentioned was that she found the descriptions of the procedures involved to take the tissues were very, very hard to hear. She felt it only made it more difficult, and provided no benefit at a time when she was distraught.

This got me thinking - it seems reasonable that people should know what they are agreeing to (both family members and people signing up to be organ donors), but the time of someone dying is really not the time to learning it. I think that as part of personal development at high school, the subject of organ donation should be discussed. The technicalities of what the procedures involve can be covered in a more neutral way, and kids can consider their own position on the subject and discuss it with their parents.

The take-home message from the whole story was that the moment of the catastrophic event is not the time to be discussing organ donation - it should be the time to implement what everyone already knows is the understood decision. I think this applies to procedural information as well as the philosophical position.

And for all that, I am an organ donor that knows nothing of the procedures and don't want to. I haven't been in a position to authorise the donation of another person's organs, but I have supported people who have. Still, if I had been told this stuff at school, it would be filed away with those "things I know and don't think about" like the Pelopennisian wars and rice farming in Asia.


  1. "The take-home message from the whole story was that the moment of the catastrophic event is not the time to be discussing organ donation - it should be the time to implement what everyone already knows is the understood decision."


    My family discusses this kind of thing all the time (also: funeral arrangements and wills - what can I say, we're morbidly practical!) and we all know what we all want.

    For my own part, the process doesn't play a role in my decisions on organ donation. If I'm involved in making a decision re someone-not-me, my only question will be "what did they want - ok, that's what we're doing" and I will use the full force of my argumentative training to ensure that that is what happens, even if other family members disagree (unlikely in my family, but with relationships etc who knows?).

    I have elected to be an organ donor when I die (if my organs are suitable) and even if I was squicked out about the process, that would still be my decision (after all, I won't be around, will I? ;) ).

    (I'm kind of curious now about the process - I know some of it, but not a *whole* lot.)

    As for anything that can't be donated: I'm thrilled at the idea of it all going to science (if only to first year anatomy students who are going to slice it up really, really badly! I'd much rather they did that to my dead bits than to someone else's live bits...).

    Having said that, while the process doesn't play a part in my own decisions, I can definitely understand why it might for others, and this is why I absolutely agree that the information should be out there and there should be encouragement for discussions well before the time comes to make the decisions.

  2. I feel pretty much exactly the same as you, and we also have pretty regular family conversations about all these things.

    You've made me think of something, though. When my father died, his ashes were the focus of the mourning and an important symbolic part of the ritual. I think that if my body were to go to 1st years (which is totally cool with me), there would need to be something to take the place of the ashes in the various mourning rituals. I'm thinking maybe a lock of hair, or perhaps the ashes of a thing that is significant to me (but not a huge waste to destroy). Hmmmm. Interesting.

    Does that aspect matter to you and your family? Is it something you've discussed? Have I just stepped over the line by asking such questions? (In which case, please ignore them.) :)

  3. That's really interesting. It is not something we have discussed (and no, no line-stepping - it's funny, private as I am about some things, there are other things which are generally considered completely private which I am very happy to be open about - death etc is one of them).

    I can definitely see how a physical symbolic something could be important. Like you, I don't think it needs to be the body or the ashes, but I think that is the role they usually play, especially in the "putting them to rest" sense.

    Thinking about my grandparents' funerals: all had coffins which were present at the funerals. That may have been important to some of us, but I don't think it was to me. Two were buried, two cremated. I have never visited the graves of those who were buried (except as part of the funeral process), and I actually don't know what happened to the ashes of those who were cremated (well, now I think about it, I vaguely remember something about a memorial garden somewhere - I have never visited, and interring the ashes wasn't part of the ritual for us). All my grandparents died in the same city, and none of my (immediate) family live there, and AFAIK none of us ever do visit the physical remains.

    I think the process of the funeral / grieving is important to my family, but it appears that we attach much less significance to the physical remains than most people. The dialogue in my family about dead relatives is that we carry them with us in some way. Not their spirit, but the knowledge of them. My family is not a religious one (each of us is either agnostic or atheist), and while there's a bit of "X may be somewhere and may know what is happening", there's much more of "X would have been very proud". That idea of the idea of the person being important, rather than the presence or whereabouts of their physical remains, fits within my family's ethos of thought and rationality.

    And that actually brings me back to donation of body parts (whether organ donation or donation to science generally) quite neatly. I suspect that each of us feels pretty strongly that such a use is less wasteful, and because we don't attach too much importance to knowing precisely what is done with the physical remains, for us, donation is a better use - more respectful, in some ways. (I understand that, for others, having a physical site or some other physical symbol that can be visited may be a more useful use.)

    (Our discussions about cremation vs burial also tend to focus on whether it is better to use less ground on the one hand, or to be less wasteful of fuel resources and add yourself to the general biomass on the other.)