The ghost of donor passed

Listen to the ghosts

This ghostly example shows how ethically problematic the family over-rule can be, by reducing families’ and health professionals’ moral distance from the consequences of their actions.1 Ghosts are omniscient; they don’t experience moral distance and see all the moral ramifications of over-ruling donation for all the patients and family members involved. Use of the family veto is not rare: in the past year 120 UK families over-ruled the recorded wish of their dying family member to donate,2 despite the family having no legal right to veto.3 The veto is also commonly used in other countries.

It’s understandable that the ghost’s wife was too upset to permit donation. It’s also understandable to some extent that the medical team wanted to give this deeply distressed relative what she wanted; continuing with donation despite objections from a family can be traumatic for doctors and nurses. They did not want to upset the ghost’s wife further, but they did, just not while she was in the hospital where they could see her distress. The ghost’s wife was not a patient but they put her wishes before his; they failed in their duty to him and to the other patients who were in need of the organs that he wanted to donate.

Professionals dealing with families of registered donors have a clear obligation to ask families to reconsider a veto. Relatives should be reminded that the wishes of the deceased should be respected, people might die if they do not receive organs, and families often come to regret over-ruling donation.4 Sometimes families will still wish to veto donation, and allowing an over-rule might be permissible in some cases—but normally only if the deceased had changed his mind since registering as a donor.

Ghosts come back to right wrongs, and the ghosts of would-be organ donors have clearly been wronged. Allowing families to over-rule donation without challenging them not only risks making the ghost of their loved one angry but risks creating other ghosts by contributing to the early deaths of other patients. If such ghosts really existed to haunt medical teams and family members, it seems unlikely that the family over-rule would be so respected. The problem with the real world is that medical staff fear the living, not the dead. Hopefully, this ghost will haunt clinicians to the extent that they strive to exercise their moral imaginations and fully consider all the consequences of their decisions.