Transitions in decision-making authority at the end of life: a problem of law, ethics and practice in deceased donation

Where a person is unable to make medical decisions for themselves, law and practice allows others to make decisions on their behalf. This is common at the end of a person's life where decision-making capacity is often lost. A further, and separate, decision that is often considered at the time of death (and often preceding death) is whether the person wanted to act as an organ or tissue donor. However, in some jurisdictions, the lawful decision-maker for the donation decision (the 'donation decision-maker') is different from the person who was granted decision-making authority for medical decisions during the person's life. To date, little attention has been given in the literature to the ethical concerns and practical problems that arise where this shift in legal authority occurs. Such a change in decision-making authority is particularly problematic where premortem measures are suggested to maximise the chances of a successful organ donation. This paper examines this shift in decision-making authority and discusses the legal, ethical and practical implications of such frameworks.

Automated summary

When a person is unable to make medical decisions for themselves, others are allowed to make decisions on their behalf. This is often the case at the end of a person's life where decision-making capacity is lost. The decision of whether to act as an organ or tissue donor is often considered around the time of death, and the person making this decision may be different from the one who had the authority for medical decisions during their life.