Swiss Review / April 2022 / No.2 21 presumed consent is good news for loved ones. In her job, she has often seen how stressful the decision on donating organs can be for them. This will nowput themunder even more pressure. “Society will expect them to give consent on behalf of the deceased,” she says. Organ donation at the end of life is a personal matter on which debate is split not only along party-political lines, but also shaped by personal values and experience. Clauss, a local SP politician in the city of Biel, opposes the idea of presumed consent, whereas express their opinion, provided nothing attests in writing to the deceased having explicitly ruled out organ donation. If no loved ones can be contacted, the removal of organs will not be permissible unless there are clear instructions to the contrary. Furthermore, proactive measures will ensure that all sections of the population are informed of their presumed consent. A clear majority in parliament voted in favour of thiswider interpretation of the opt-outmodel. The authors of the original initiative withdrew their proposal on condition that the indirect counterproposal comes into effect. However, the counterproposal now has to survive the ballot box, after a referendumwas submitted in January 2022 by campaigners who say that Switzerland needs to debate the matter. Not without “informed consent” The referendumwas forced not by political parties or associations, but by private individuals and experts from the fields of healthcare, law and ethics. Susanne Clauss, cochair of the referendum committee, is one of them. Clauss, who comes from Berne, wants the current system – voluntary, informed consent, as she puts it – to remain the same. Without informed consent, which is a key principle inmedicine, organs should not be removed, says Clauss, a nurse andmidwife who runs a home birthing service. “If there is no clear evidence that the deceasedwanted to donate their organs, organ removal is unethical and questionable on constitutional grounds.” Most opponents of the counterproposal will agree that a sufficient supply of donor organs is in the public interest. But they doubt whether the principle of presumed consent will solve the problem. And the system would involve the government encroaching on personal freedom, which also extends to the bodies of the deceased, they argue. If staying silent is deemed to be the same as giving consent, this could erode the right to bodily autonomy. “Physical integrity preserved” Clauss disagrees with the assertionmade in the parliamentary debate that a broader application of the principle of most of her Social Democratic parliamentary colleagues at national level voted in favour of it. Conversely, Lucerne National Councillor Franz Grüter from the right-wing SVP supports the law change, but his parliamentary party does not. “Enough safeguards have been put in place to ensure that the physical integrity of organ donors is preserved,” he says, adding that people, while alive, should be trusted to be able to say no if theywant. And if they don’t specifically say no, their loved ones can still say no if they think the deceasedwould have objected to organ donation. Concern for his daughter This issue is close to home for Grüter, an IT entrepreneur. His 26-year-old daughter suffers from a heart condition and has already had six operations. “She is doing well at the moment but will probably need a donor heart eventually,” he says. Four out of five donor hearts needed in Switzerland come from abroad, as he is aware. The country’s low donation rate gives Grüter pause for thought. As a father and politician, he has put himself on the organ donor register andwants to get involved in the referendum campaign. In addition to presumed and explicit consent, a theoretical third option is also possible: mandatory choice. The model would regularly require people –when visiting their GP or renewing their identity card, for example – to state whether they are willing to donate organs. The Swiss National Advisory Commission on Biomedical Ethics recommends this approach. Germany recently introduced it to complement its opt-in model. However, Swiss parliamentarians have rejected related motions, saying its implementation would be too laborious. “Enough safeguards have been put in place.” FRANZ GRÜTER, LUCERNE NAT IONAL COUNCI LLOR FROM THE RIGHT-WING SVP “This will put loved ones under more pressure.” SUSANNE CL AUSS CO-CHAIR OF THE REFERENDUM COMMI TTEE
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