Department of Philosophy, University of Amsterdam, Oude Turfmarkt 141-147, 1012, GC, Amsterdam, The Netherlands.
Theor Med Bioeth. 2011 Aug;32(4):259-69. doi: 10.1007/s11017-011-9182-0.
Opt-out systems of postmortem organ procurement are often supposed to be justifiable by presumed consent, but this justification turns out to depend on a mistaken mental state conception of consent. A promising alternative justification appeals to the analogical situation that occurs when an emergency decision has to be made about medical treatment for a patient who is unable to give or withhold his consent. In such cases, the decision should be made in the best interests of the patient. The analogous suggestion to be considered, then, is, if the potential donor has not registered either his willingness or his refusal to donate, the probabilities that he would or would not have preferred the removal of his organs need to be weighed. And in some actual cases the probability of the first alternative may be greater. This article considers whether the analogy to which this argument appeals is cogent, and concludes that there are important differences between the emergency and the organ removal cases, both as regards the nature of the interests involved and the nature of the right not to be treated without one's consent. Rather, if opt-out systems are to be justified, the needs of patients with organ failure and/or the possibility of tacit consent should be considered.
死后器官获取的选择退出系统通常被认为可以通过假定的同意来证明其合理性，但这种合理性证明取决于对同意的错误心理状态概念。一种有前途的替代合理性证明诉诸于类似的情况，即当必须对无法给予或拒绝同意的患者的医疗做出紧急决定时。在这种情况下，应根据患者的最佳利益做出决定。那么，需要考虑的类似建议是，如果潜在的捐赠者既没有登记他愿意或拒绝捐赠，那么就需要权衡他更倾向于还是不倾向于移除他的器官的可能性。在某些实际案例中，第一种选择的可能性可能更大。本文考虑了这个论点所诉诸的类比是否有说服力，并得出结论，紧急情况和器官移除情况之间存在重要差异，涉及到所涉及的利益的性质以及未经同意进行治疗的权利的性质。相反，如果要证明选择退出系统是合理的，就应该考虑器官衰竭患者的需求和/或默许同意的可能性。
