By Caroline Song
Lawmakers in Vermont recently filed a bill for presumed consent to organ donation. H. 57 states that “
The bill, if passed, would give the organ transplant system explicit ownership of deceased citizens’ organs. If individuals do not want to be organ donors, they will have to affirmatively opt out. This policy would turn the reigning paradigm on its head: currently, law in every US state requires people to affirmatively choose to become an organ donor.
The bill provides a number of ways for individuals to opt out. They can make their intentions known in an advanced directive, file an anatomical gift refusal form, write specific provisions into their wills, establish written records that indicate their unwillingness to make anatomical gifts, or communicate their wishes via any method to at least two adults (at least one of whom must be a disinterested witness) during terminal illness or injury.
While presumed consent laws have worked in other countries, some worry that such legislation would be disastrous in Vermont. Wesley J. Smith, author of “Grim Harvest: In Vermont, a Push for Organ Conscription,” believes that presumed consent laws constitute unlawful and unethical government and/or medical bureaucratic ownership claims to human remains. He believes that passing H. 57 would lead to the following consequences:
1. Presumed consent would sow greater distrust in the already profoundly distrusted health care system.
2. Presumed consent could impact how medical professionals view the moral value of the most seriously ill or disabled patients.
3. The impact of presumed consent legislation coupled with futile care theory, in which doctors and hospital bioethics committees are empowered to withdraw wanted life-extended care based on “quality of life” and financial considerations, might be problematic.
4. Presumed consent would lead to contentious litigation.
5. Presumed consent would couple assisted suicide with non-consensual organ harvesting.
Whether or not Smith’s claims are correct, they raise interesting points that should be discussed by policymakers and the public prior to passing any new organ donation legislation.
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