Health Care Analysis

, Volume 8, Issue 3, pp 297–308 | Cite as

Presuming Consent, Presuming Refusal: Organ Donation and Communal Structure

  • Erich H. Loewy


Donating, distributing and ultimately transplantingorgans each has distinct ethical problems. In thispaper I suggest that the first ethical question is notwhat should be done but what is a fair way in whicheach of these problems can be addressed. Experts –whether these be transplant surgeons, policy analysts,political scientists or ethicists – can help guidebut cannot by themselves make such decisions. Inmaking these decisions the difference betweenidentified and non-identified lives is crucial. Isuggest that an approach in which reason is temperedby compassion (``compassionate rationality'') whendealing with identified lives and in whichcompassion is controlled by reason (``rationalcompassion'') in dealing with unidentified lives mustserve us well. Ultimately decisions of this sort areprone to sturdy democratic process which is possibleonly when the preconditions of person, economic andeducational democracy are met.

presumed consent presumed refusal identified lives unidentified lives rational compassion compassionate rationality democracy preconditions of democracy 


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Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • Erich H. Loewy
    • 1
  1. 1.University of CaliforniaDavisUSA

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