Corpus Christi College, University of Oxford, Merton Street, Oxford, UK.
J Med Ethics. 2010 Feb;36(2):84-7. doi: 10.1136/jme.2009.033423.
One way of increasing the supply of organs available for transplant would be to switch to an opt-out system of donor registration. This is typically assumed to operate on the basis of presumed consent, but this faces the objection that not all of those who fail to opt out would actually consent to the use of their cadaveric organs. This paper defuses this objection, arguing that people's actual, explicit or implicit, consent to use their organs is not needed. It borrows David Estlund's notion of 'normative consent' from the justification of political authority and applies it to the case of organ donation. According to this idea, when it is wrong to withhold consent to something, the moral force of that lack of consent may be null and void. If it is wrong of a person to refuse to donate their cadaveric organs to others, then it may be that their actual consent is not needed. This supports an opt-out system, which provides protection for those who have genuine reasons to refuse donation, and spares the worries as to what the deceased would actually have wanted.
增加可用于移植的器官供应的一种方法是转向默认同意的器官捐献登记制度。这种制度通常基于推定同意，但这面临着一个反对意见，即并非所有未选择退出的人实际上都同意使用他们的尸体器官。本文消解了这一反对意见，认为人们实际上明确或暗示同意使用他们的器官是不必要的。它借鉴了大卫·埃斯特朗德（David Estlund）从政治权威的正当性中提出的“规范同意”概念，并将其应用于器官捐赠的情况。根据这个想法，当拒绝同意某事是错误的时候，这种缺乏同意的道德力量可能是无效的。如果一个人拒绝将他们的尸体器官捐献给他人是错误的，那么他们的实际同意可能是不必要的。这支持了一种默认同意制度，该制度为那些有真正理由拒绝捐赠的人提供了保护，同时也免去了对死者实际意愿的担忧。
