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Medical Ethics Questions: Worked Example

Medical Ethics: Presumed Consent for Organ Donation

At the end of last year, the Welsh government announced that it will bring in a system of presumed consent for organ donation into effect on the 15th of December 2015. This blog will provide a step-by-step guide on the medical ethics arguments surrounding this law change. Why do some people want this new ‘opt-out’ law? Why do others want to keep the current ‘opt-in’ law?

1. Define the terms of the debate

Medical Ethics: define the terms
Medical Ethics: define the terms

Organ donation is the process of surgically removing an organ or tissue from one person (the organ donor) and placing it into another person (the recipient).

Presumed consent is the assumption that a particular action would have been approved by a person  if permission had been sought.

Opt‐in systems only take organs from those who have specifically consented to donation.

Opt‐out systems treat everyone as a willing donor unless they object.

2. Build your ‘for’ arguments using the four pillars of medical ethics

Medical Ethics: for 'opt-out'
Medical Ethics: for ‘opt-out’

Arguments for presumed consent…

From beneficence:

From autonomy:

From non-maleficence

3. Build your ‘against’ arguments using the four pillars of medical ethics

Medical Ethics: against 'opt-out'
Medical Ethics: against ‘opt-out’

From beneficence:

From autonomy

From non-maleficence:

4. Consider the legal position

Whilst Wales has the opt-out system, the opt-in system operates for the rest of the UK. The BMA is advocating a ‘soft’ opt-out system, where the relatives would still make the ultimate decision. This means that transplant teams would be unlikely to remove organs if living relatives find it too distressing.

5. Make your conclusion

There are two options to consider here:  

1. You believe you have the right to decide what is to be done with your body after you have died. Therefore it is therefore morally wrong to take organs without consent

2. You believe that the overall benefits to recipients and relatives outweighs the above concern. A default position to save lives is better than a default position to respect the autonomy of people who no longer exist.

Your conclusion must based on your personal and genuine opinion on which side you think has more weight – good luck!

Uploaded by Beth on 28th January 2016

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