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Rules on organ donation are coherent

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Rules about consent to organ donation are being reviewed in the United Kingdom and New Zealand. In law, organs and tissues cannot be taken after death if the deceased have not consented. Medical practice is also not to proceed if a family refuses consent, even against the wishes of the dead donor. These arrangements—the so called double veto—may be right or wrong but at least they are coherent, and that is encouraging, says one commentator.

The ethical situation is complex: arguments for granting a veto to one side tend to undermine those for the granting it to the other. The double veto can be interpreted as coherent by adopting an argument that it has the best effects, or an alternative argument that the rights of the deceased and their families are negative rights—against interference—as opposed to positive rights—to obtaining help—and therefore limited to a veto.

The best effects argument contends that once all costs and benefits are taken into account, including the supply of organs or tissues, effect on recipients, their families, and the dead person, even extending to effects on medical care, a veto over consent leads to greatest net benefit. Showing this needs empirical research.

The argument based on rights—in the sense of moral claims that cannot be overridden—holds that if deceased and their families have only negative rights the double veto has the beginnings of a coherent plan. This scenario seems unlikely to our commentator; instead, he argues that consent from donors or families does not impose a correlative duty on doctors to comply.

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