Abstract
The Catholic position on organ donation rests on several important points. Among them are: (1) the act of donating a life-saving organ is an act of love that is to be praised, (2) organ donation is an act of giving, and (3) to be licit, an organ donation must be made with the full informed consent of the donor. In any system of organ procurement that takes consent seriously, there will inevitably be people whose wishes about organ donation are not known after they die. In such cases we must have a default position. We must either presume non-consent and not take the organs, or presume consent and take the organs. I make a case that a system of presumed consent could be morally permissible within the framework of the Catholic principles stated above. After outlining the Catholic view, I move to a discussion of informed consent and its relationship to autonomy. I explore how different models of autonomy provide different answers to the question of how we should proceed in cases of organ procurement when a person’s wishes are unknown. Finally, I examine the role of personal autonomy in the context of Catholic moral teaching. While autonomy does not have absolute value, it nevertheless plays an important role in human flourishing. Further, even in this limited role, respect for autonomy can ground a good argument that a system of presumed consent would not be wrong in principle from a Catholic perspective.
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Notes
- 1.
The Catholic view on organ procurement is not as defined as some other moral issues, such as abortion . However, as I will show, to the extent it has been discussed by two popes, I think it is appropriate to consider these points as characterizing the prevailing Catholic view.
- 2.
There may be other alternatives as well, such as a policy of mandated choice. Some argue that this would be superior to both presumed consent and presumed non-consent policies. I make no claims about such alternatives or mandated choice specifically here, as my goal is simply to evaluate presumed consent versus presumed non-consent. For a defense of a mandated choice policy, see Chouhan and Draper (2003).
- 3.
The Catechism of the Catholic Church (1997) also speaks favorably of organ donation provided that appropriate safeguards including informed consent are met (n. 2296).
- 4.
For a contemporary treatment of the hylomorphic account, see Oderberg (2005).
- 5.
Beauchamp and Faden (1986) offer a comprehensive account of the view that informed consent is the means by which we respect autonomy . This view is not universally accepted. Franklin Miller and Alan Wertheimer (2010) argue that a “fair transaction model” better captures the general conditions under which consent is morally transformative.
- 6.
Gill does not specify whether he is referring only to individuals who have suffered “whole-brain” death or if he is including individuals who have suffered “higher-brain” death, such as those in a persistent vegetative state. On the Catholic view, the latter group would not be considered dead. Procuring organs from them would violate the dead donor rule and would therefore be impermissible. To avoid confusion about this matter in the remainder of the paper, I will therefore simply refer to potential donors as “deceased” rather than “brain-dead.”
- 7.
I thank Jason Eberl for this insight.
- 8.
- 9.
I thank an anonymous reviewer for this phrasing.
- 10.
According to the United Network for Organ Sharing (UNOS) , there are over 120,000 people on the wait list for life saving organ transplants, and on average 22 people a day die while waiting for a transplant.
- 11.
It should be noted, however, that public shaming could also occur in an opt-in model. So a presumed non-consent will not as a matter of principle prevent this type of coercion.
- 12.
One might find this surprising because, presumably, the primary reason why we are interested in a presumed consent policy to begin with is to increase the supply of organs. Perhaps this too could be defended on Catholic grounds. That, however, has not been my goal in this paper. On the view I have defended, a shift in attitudes would justify a shift from presumed consent to presumed non-consent. If our goal is to respect autonomy in as many cases as possible, this seems to me a perfectly reasonable consequence. So I am not convinced that the only true reason we are interested in presumed consent is to increase the number of organs available for transplant.
- 13.
An earlier version of this paper was given at the PANTC Reading Group’s annual conference (“Plato’s Academy North Tonawanda Campus”). I am grateful for the many helpful comments I received from my colleagues there, especially David Hershenov, Steven Kershnar, Phil Reed, Jason Rourke, Lewis Powell, and Neil Feit.
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Delaney, J.J. (2017). Is Presumed Consent a Morally Permissible Policy for Organ Donation?. In: Eberl, J. (eds) Contemporary Controversies in Catholic Bioethics. Philosophy and Medicine(), vol 127. Springer, Cham. https://doi.org/10.1007/978-3-319-55766-3_30
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