This paper defends an ‘opt-out’ scheme for organ procurement, by distinguishing this system from ‘presumed consent’ (which the author regards as an erroneous justification of it). It, first, stresses the moral importance of increasing the supply of organs and argues that making donation easier need not conflict with altruism. It then goes on to explore one way that donation can be increased, namely by adopting an opt-out system, in which cadaveric organs are used unless the deceased (or their family) registered (...) an objection. Such policies are often labelled ‘presumed consent’, but it is argued that critics are right to be sceptical of this idea—consent is shown to be an action, rather than a mental attitude, and thus not something that can be presumed. Either someone has consented or they have not, whatever their attitude to the use of their organs. Thankfully, an opt-out scheme need not rest on the presumption of consent. Actual consent can be given implicitly, by one's actions, so it is argued that the failure to register an objection (given certain background conditions) should itself be taken as sign of consent. Therefore, it is permissible to use the organs of someone who did not opt out, because they have—by their silence—actually consented. (shrink)

I argue that a policy of presumed consent for cadaveric organ procurement, which assumes that people do want to donate their organs for transplantation after their death, would be a moral improvement over the current American system, which assumes that people do not want to donate their organs. I address what I take to be the most important objection to presumed consent. The objection is that if we implement presumed consent we will end up removing organs from the bodies of (...) people who did not want their organs removed, and that this situation is morally unacceptable because it violates the principle of respect for autonomy that underlies our concept of informed consent. I argue that while removing organs from the bodies of people who did not want them removed is unfortunate, it is morally no worse that not removing organs from the bodies of people who did want them removed, and that a policy of presumed consent will produce fewer of these unfortunate results than the current system. (shrink)

Death, Posthumous Harm, and Bioethics offers a highly distinctive and original approach to the metaphysics of death and applies this approach to contemporary debates in bioethics that address end-of-life and post-mortem issues. Taylor defends the controversial Epicurean view that death is not a harm to the person who dies and the neo-Epicurean thesis that persons cannot be affected by events that occur after their deaths, and hence that posthumous harms are impossible. He then extends this argument by asserting that the (...) dead cannot be wronged, finally presenting a defence of revisionary views concerning posthumous organ procurement. (shrink)

It is possible for an act to wrongfully harm a person, even if that person is dead. David Boonin explains the puzzle of posthumous harm and examines its ethical implications for such issues as posthumous organ removal, posthumous publication of private documents, damage to graves, and posthumous punishment.

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

If pressed to identify the philosophical foundations of contemporary bioethics, most bioethicists would cite the four-principles approach developed by Tom L Beauchamp and James F Childress,1 or perhaps the ethical theories of JS Mill2 or Immanuel Kant.3 Few would cite Aristotle's metaphysical views surrounding death and posthumous harm.4 Nevertheless, many contemporary bioethical discussions are implicitly grounded in the Aristotelian views that death is a harm to the one who dies, and that persons can be harmed, or wronged, by events that (...) occur after their deaths. The view that death is a harm to the one who dies infuses, for example, the debates over abortion and euthanasia, while the view that persons could be harmed or wronged after their deaths informs much of the debate over, for example, policies for the posthumous procurement of transplant and the ethics of research on the dead.In Death, Posthumous Harm, and Bioethics, I argue that we should reject this cluster of influential Aristotelian thanatological claims, and instead endorse a trio of views that together constitute what I term full-blooded epicureanism: That death is not a harm to the person who dies, and that persons can neither be harmed nor wronged by events that occur after their deaths. …. (shrink)

_Death, Posthumous Harm, and Bioethics_ offers a highly distinctive and original approach to the metaphysics of death and applies this approach to contemporary debates in bioethics that address end-of-life and post-mortem issues. Taylor defends the controversial Epicurean view that death is not a harm to the person who dies and the neo-Epicurean thesis that persons cannot be affected by events that occur after their deaths, and hence that posthumous harms are impossible. He then extends this argument by asserting that the (...) dead cannot be wronged, finally presenting a defence of revisionary views concerning posthumous organ procurement. (shrink)

A chief objection to opt-out organ donor registration policies is that they do not secure people's actual consent to donation, and so fail to respect their autonomy rights to decide what happens to their organs after they die. However, scholars have recently offered two powerful responses to this objection. First, Michael B Gill argues that opt-out policies do not fail to respect people's autonomy simply because they do not secure people's actual consent to donation. Second, Ben Saunders argues that opt-out (...) policies do secure people's actual—if not explicit—consent, provided that certain conditions are satisfied. I argue that Gill and Saunders’ arguments are not successful. My conclusion does not imply that jurisdictions should not implement opt-out policies—their failure to secure people's actual consent may be outweighed by other considerations. But, my conclusion does imply that Gill and Saunders are mistaken to claim that opt-out policies are respectful of people's autonomy. (shrink)

Opt-out systems of postmortal organ procurement are often referred to as ‘presumed consent’ systems. A presumption directs us, in a case in which no compelling evidence is available to hold that P, nevertheless to proceed as if P were true, unless there is sufficient evidence that it is false. It is recommended to presume consent in this case, because, in the absence of registered objections of the deceased, it is held to be more probable that she consented than that she (...) did not. Whether this suggestion makes sense, however, turns out to depend on the proper interpretation of the concept of ‘consent’. On a mental state conception of consent we are allowed to presume it if we have reason to suppose the deceased to have been in favour of donation. However, we should rather understand consent to be a public action of authorisation. On that view consent cannot be presumed, and the opt-out systems as we presently know them on the European continent and elsewhere do not satisfy the requirement that the deceased should have consented to the removal of his organs. (shrink)

Issues surrounding organ transplantation are hotly and publicly debated: for it raises unique ethical questions regarding the rights and responsibilities of donors. Leading moral philosopher Janet Radcliffe Richards provides a sharp analysis, dissecting the commonly raised arguments concerning organ procurement from the living and the dead.