Cherry Mark J
St. Edward's University, Austin, Texas, USA.
J Med Philos. 2019 Sep 17;44(5):603-620. doi: 10.1093/jmp/jhz017.
Organ procurement policy from the recently deceased recasts families into gatekeepers of a scarce medical resource. To the frustration of organ procurement teams, families do not always authorize organ donation. As a result, efforts to increase the number of organs available for transplantation often seek to limit the authority of families to refuse organ retrieval. For example, in some locales if a deceased family member has satisfied the legal conditions for first-person prior assent, a much looser and easier standard to satisfy than informed consent, organ retrieval may proceed despite the family's objections. Some countries have replaced voluntary consent to organ donation with forms of organ conscription. Often referred to under the misnomer "presumed consent," such policies legalize the harvesting of organs at death, unless individuals exercise official options to opt out. As this article explores, however, there are good grounds for affirming the authority of the family to consent to or to deny organ donation on behalf of recently deceased family members, as well as to reject first-person assent and "presumed consent" policies of organ procurement. Insofar as individuals have failed clearly and competently to provide informed consent to organ donation, moral authorization for the use of the person and his body ought to be grounded on the foundational authority of the family, rather than the state's supposed interests in obtaining organs for transplantation.
来自新近死亡者的器官获取政策将家属重塑为一种稀缺医疗资源的守门人。令器官获取团队沮丧的是，家属并不总是会授权进行器官捐赠。因此，增加可用于移植的器官数量的努力往往试图限制家属拒绝器官摘取的权力。例如，在一些地区，如果已故家庭成员满足了第一人称预先同意的法律条件（这一条件比知情同意宽松得多且更容易满足），那么即使家属反对，器官摘取也可以进行。一些国家已用各种形式的器官征用取代了器官捐赠的自愿同意。这类政策常被误称为“推定同意”，它们使死后摘取器官合法化，除非个人行使官方选择退出。然而，正如本文所探讨的，有充分理由肯定家属代表新近死亡的家庭成员同意或拒绝器官捐赠的权力，以及拒绝器官获取的第一人称同意和“推定同意”政策。只要个人未能明确且适当地对器官捐赠给予知情同意，对该人和其身体的使用的道德授权就应基于家庭的基本权力，而非国家在获取移植器官方面所谓的利益。
