Consent and the opt-out scheme of organ donation

This journal has a long tradition of promoting reasoned debate on key questions in medical ethics. In this and future issues, we hope to continue this tradition by introducing a new type of article. Feature articles will provide a longer, in-depth discussion of an original ethical idea or argument, or of an important empirical finding. These articles will be accompanied by several short commentaries by leading experts in the area who will offer their critical perspective on the article, followed by a brief reply by the author.

Our first such debate is a lively exchange on organ donation. In his feature article, Ben Saunders offers a new argument for an ‘opt-out’ scheme for organ procurement (see page 69, Editor's choice). The idea of an opt-out scheme has of course been defended before. But Saunders claims that the common understanding (and defence) of this system in terms of ‘presumed consent’ is mistaken. After reminding us that our primary concern should be to save more lives, not to increase people's opportunities to be virtuous or altruistic, Saunders argues that consent needs to be understood as an action, not a mental attitude such as intention, and therefore not something that can be simply presumed. But the relevant action can be implicit, signified, for example, by failure to register one's objection against the background of a system of social conventions such as those associated with an opt-out scheme. Against such a background, failure to register one's objection amounts to implicit consent—whether or not it expresses one's intention to consent. Familiar worries about presumed consent, such as that consent must be given and cannot be simply presumed, thus no longer present a problem to the opt-out scheme.

Jurgen De Wispelaere and Timothy Wilkinson offer forceful commentaries on Saunders' proposal. De Wispelaere (see page …