“Advocates of presumed consent advance the following in support of their position:
Efficiency is Good. Increasing the supply of organs — that is, supply-side efficiency — is a worthwhile goal. It is sufficiently important to collect more organs that other goals and values, within limits, may be compromised;
Asking for Consent can be Cruel. Presumed consent would obviate the need to ask the donor’s family for consent at a time of family’s painful grieving.
Individual Conscience Can be Respected. Presumed consent respects the principle of individual choice by giving objectors to organ donation an opportunity to empower their anti-donation preference;
Individuals Owe Society the Effort to Register their Objection. Individuals who object to organ donation should be burdened with the task of registering their preference to the public authorities because organ donation is, presumptively, socially desirable. The burden of communicating objection should be placed on objectors to organ donation.
Presumed consent, advocates argue, combines the principles of supply-side efficiency, respect for individual conscience, and individual’s positive, yet qualified, duty to promote the good of society.
Opponents of presumed consent base their position on the following presuppositions:
There will be false positives, that is, persons who were ‘presumed” to consent but who, in fact, objected to donation. Under a policy of “presumed consent,” some individuals who do object to organ donation in principle will not register their preference with public authorities because of one of many factors. For instance, individuals on the margins of society might not learn of their option to register their refusal. Furthermore, individuals have differential access to the mechanism for registering refusal, as in the case of itinerant persons who may not receive a postcard informing them of the opting-out alternative.
Problems in Registering and Transmitting Objection Status. The mechanism for registering and transmitting objection status is likely to be inadequate. Only a nationwide database of objectors is ethically justified because individuals may suffer irreversible cessation of brain function outside their state of residence. There is uncertainty whether mailed-in objection notices will be entered on the database and whether the information will be distributed to organ procurement organizations in a timely fashion.
Individual Autonomy Speaks to a Core Value. Asking individuals to publicly express their objection to donation does not respect the individual’s right not to choose. Individuals do not have a social duty to express an objection.
To Decide Whether to Consent is Not a Dichotomous Choice. Individuals should have the right to delegate the decision to family members. Presumed consent would authorize collection of organs of a non-objector who had trusted his family to make the decision.”
What are your thoughts? Is it feasible that an opt-out system could ever be implemented here?