Voters Weigh Up Ethical Aspects Of Organ Donation

(MENAFN- Swissinfo)

In practice, not much will immediately change if Swiss voters accept a new“opt-out” organ donation law this weekend. But the shift in mentality underpinning it has raised ethical debates.

Originally from Ireland, Domhnall worked in research and writing in a couple of European countries before joining swissinfo.ch in 2017. He covers direct democracy and Politics and is usually in Bern.

Under the current system of organ donation in Switzerland, unless you register support for the idea during your lifetime, you are assumed upon death not to have wanted it – although your relatives can decide otherwise. Under the proposedExternal link opt-out system, which polls reckon will be accepted on Sunday, this is reversed: unless you actively reject the principle, you are presumed to have been in favour – although your relatives can still decide otherwise.

Is this a radical shift? The government and the backers of the law – passed in parliament last year – have been arguing it's not. It's“an important evolution, not a complete revolution”, Interior Minister Alain Berset said on SRF public television last week. Since the next-of-kin will still be consulted,“not a huge amount will change”, Berset said. And if no family is found, no organs are taken.

The proposed revision to the law on transplantations is an indirect counter-proposal by the government to a people's initiativeExternal link , which called for presumed consent to be written into the constitution. This initiative, which in 2019 handed in the 100,000 signatures needed for a vote, did not include the provision of consulting family members. The initiators have since provisionally withdrawn their text, and will drop it completely if the vote passes on May 15.

Supporters have rather argued that the consent issue is part of wider efforts to boost Switzerland's comparatively low donation rate. Last year, the number of deceased donors was 19 per million inhabitants, and 72 people died while on a transplant waiting list. In some other European countries, many with opt-out systems, rates are much higher, supporters say – although they admit studies have not found a direct causation effect.

They also claim the opt-out system would reduce the gap between high public support for donation (as reported in surveys) and low follow-through upon death. The law would“better reflect what the population actually wants”, Geneva doctor Anne-Laure Martin told RTS public radio last month. Like Berset, she added that“the modalities of the transplant procedures would not change a lot”.

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This content was published on May 13, 2021 May 13, 2021 A proposed change to the law in Switzerland will presume the deceased wanted to be a donor unless they explicitly said otherwise while alive.

But the opponents – a cross-party, citizen-led group who collected the necessary 50,000 signatures to bring a referendum – think the change is fundamental.

Firstly, for the family of a potential donor, the presumption of consent will lead to more pressure not to oppose the new norm, they claim. The National Advisory Commission on Biomedical Ethics (NCE) said the same thing in a 2019 report: family members might be wary of saying no for fear of appearing“unmoral or lacking in solidarity”, the NCE wrote. It is sceptical of the presumed consent model.

Secondly, opponents say the plan is unworkable and potentially exclusionary to groups who lack the skills needed to stay informed of their options. The issue is a big talking point right now, but“what about in a few years, when we've forgotten about this vote – what will people still know about their legal rights?” said Jean-Luc Addor of the right-wing Swiss People's Party.

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But perhaps most importantly, opponents see a fundamental shift in the relation between state and citizen. In future, individuals will have to actively opt out in order to be guaranteed their constitutional freedoms – notably the right to physical integrity. This is like having to put a sign in front your house saying“please don't break in”, theology ethics professor Peter G. Kirchschläger said on SRF television.

Indeed, while they agree that more donations are desirable,“the goal does not justify the means”, Alex Frei of the opposition committee told the Tages-Anzeiger newspaper. Rather, there are other ways, such as better information campaigns, or simply asking people. The NCE has suggested an obligatory declaration system, where citizens would be regularly asked for their position, for example when applying for a driver's licence or taking out insurance. This idea was rejected as intrusive for citizens by the government.

However, if the ethical elements of the vote grabbed the attention of some philosophers and editorialists, they largely failed to ignite the public to the same extent as previous ballots. This was maybe most detrimental to the opposition campaign. In the last official opinion poll published on May 4, despite rising opposition to the law, some 61% of voters said they were planning to accept it.

If it passes, meanwhile, it's not likely to suddenly be implemented; the Federal Office of Public Health (FOPH) says it would come into force in 2024 at the earliest. Not only will the government be obliged to inform all six million adult citizens of the shift, so they are aware of their new opt-out rights; they will also have to create a new national register where people can log their preference.

After a security slip earlier this year concerning the current organ donation register, operated by the Swisstransplant foundation, they will want to make it as secure as possible.

Beside the referendum on organ donations, Swiss voters will also decide on an increased financial contribution to the European Frontex border agency and a reformExternal link of the film law to force online streaming giants to invest more in Swiss productions.

It's the second of up to four sets of votes in Switzerland this year as part of the country's system of direct democracy.

About 5.5 million citizens, including registered Swiss expatriates, are eligible to take part.

Ballots are also scheduled in many cantons and municipalities on Sunday.

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Articles in this story

• Organ donation consent: lifting the burden off those left behind
• What is your position on organ donation?
• A global stress test for freedom of expression

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