Iltis Ana S, Denny Briana
Wake Forest University, Winston-Salem, North Carolina, USA.
J Med Philos. 2025 Apr 18;50(3):212-24. doi: 10.1093/jmp/jhaf008.
In the United States, individuals who authorize organ donation through various mechanisms make a legally binding decision that only they may revoke. When a person who has given first-person authorization for organ donation becomes eligible to donate organs, according to laws across the United States, their next-of-kin should be informed, not asked, about the impending organ procurement. Despite this, sometimes families are asked for permission to proceed with donation, or they express unsolicited objections to donation. Some scholars and activists argue for the importance of honoring first-person authorization and not accepting what are sometimes called "family overrides" or "family vetoes" of donation. We consider two arguments for this view, the respect-for-wishes and the prevent-harm arguments and defend a more nuanced approach to family objections to organ donation in the presence of first-person authorization. We also examine the role of families or legally authorized representatives in making decisions regarding premortem interventions for potential donors who are not yet deceased. We argue that such decisions are about living patients and should be treated like all other clinical decisions that legally authorized representatives make for incapacitated living patients.
在美国，通过各种机制授权器官捐赠的个人做出了具有法律约束力的决定，且只有他们自己可以撤销该决定。当已进行第一人称授权器官捐赠的人符合器官捐赠条件时，根据美国各地的法律，应告知其近亲即将进行的器官获取事宜，而非征求他们的意见。尽管如此，有时仍会询问家属是否允许进行捐赠，或者家属会主动表示反对捐赠。一些学者和活动家主张尊重第一人称授权的重要性，不接受有时所谓的捐赠“家属否决”或“家属凌驾”。我们考虑了支持这一观点的两个论据，即尊重意愿论据和防止伤害论据，并在存在第一人称授权的情况下，为处理家属对器官捐赠的反对意见提出了一种更为细致入微的方法。我们还研究了家属或法定授权代表在为尚未去世的潜在捐赠者做出生前干预决策时所起的作用。我们认为，此类决策涉及在世患者，应像法定授权代表为无行为能力的在世患者做出的所有其他临床决策一样对待。
