Wilkinson T M
School of Population Health, University of Auckland, Private Bag 92019, Auckland, New Zealand.
J Med Ethics. 2005 Oct;31(10):587-90. doi: 10.1136/jme.2004.009654.
The current position on the deceased's consent and the family's consent to organ and tissue donation from the dead is a double veto-each has the power to withhold and override the other's desire to donate. This paper raises, and to some extent answers, questions about the coherence of the double veto. It can be coherently defended in two ways: if it has the best effects and if the deceased has only negative rights of veto. Whether the double veto has better effects than other policies requires empirical investigation, which is not undertaken here. As for rights, the paper shows that it is entirely possible that individuals have a negative right of veto but no positive right to compel acceptance of their offers. Thus if intensivists and transplant teams turn down the deceased's offer, they do not thereby violate the deceased's right. This leaves it open whether non-rights based reasons-such as avoiding bad publicity or distress -require intensivists and transplant teams to turn down or accept the deceased's offer. This, however, is beyond the scope of this paper. The current position may or may not be wrong, but it is at least coherent.
目前关于死者同意以及家属同意死后器官和组织捐赠的情况是一种双重否决权——双方都有权拒绝并推翻对方的捐赠意愿。本文提出并在一定程度上回答了有关双重否决权连贯性的问题。它可以通过两种方式得到连贯的辩护：如果它具有最佳效果，以及如果死者仅拥有否决的消极权利。双重否决权是否比其他政策具有更好的效果需要实证研究，本文未进行此项研究。至于权利，本文表明个人完全有可能拥有否决的消极权利，但没有强迫他人接受其捐赠提议的积极权利。因此，如果重症监护医生和移植团队拒绝死者的捐赠提议，他们并不会因此侵犯死者的权利。这就留下了一个问题，即基于非权利的理由——比如避免负面宣传或痛苦——是否要求重症监护医生和移植团队拒绝或接受死者的捐赠提议。然而，这超出了本文的范围。目前的立场可能是对的，也可能是错的，但至少是连贯的。
