Right of Reply: Michael Wilks

HOW FAR can society go in requiring its citizens to be altruistic, and at what point does the balance shift between the rights of the dying and the living? These ethical questions lie at the heart of the debate about organ donation.

Professor John Harris stakes out the claims of the living. He argues that those whose lives might be saved by organ transplantation take precedence over those who are reluctant to have their bodies tampered with after their death.

He draws an analogy with post-mortem examinations, for which consent is not required. But that is a false parallel. There is a difference.

In addition to the very different purposes for which the organs are taken, there is of course the natural feeling that a patient whose heart is beating, even if artificially aided, is different from a corpse.

Doctors have a duty to act in the patient's individual best interests, until the moment of death. This distinction is important because if the public began to feel that dying patients were seen in a utilitarian light as a source of spare parts, then support for the transplantation programme would collapse overnight.

The BMA's medical ethics committee would want to tread much more cautiously. We believe it is reasonable to hope that most people will be willing to donate their organs and to shift the balance in favour of transplant recipients by moving to a system of "presumed consent". But we do not believe it is reasonable to require donation. It remains to be seen whether the BMA and the medical profession as a whole will support a change from an opt- in to an opt-out system. John Harris's intervention is likely to polarise feelings and undermine the interests of those he is most concerned to help.