ACHLR and HEAL Webinar

Making ethical sense of the “family veto”: when families decline deceased donation on behalf of a registered donor

In this webinar, co-hosted by the Australian Centre for Health Law Research and HEAL, Professor Dominique E. Martin will discuss the ethical and legal implications of "family vetoes" in the case of deceased registered organ donors.

Abstract

In many countries, including Australia, a small but increasing proportion of families decline deceased donation of organs or tissues on behalf of a potential donor who has previously registered their wish to donate. This phenomenon is often referred to as the “family veto” or “override” in deceased donation decision-making. References to family vetoes typically provoke anger and frustration among those who express disbelief that such vetoes are respected by donation professionals despite the negative impact they appear to have on opportunities for transplants.

However, family vetoes are usually more complicated than a simple discordance between the donation preferences of potential donors and those of their families. Several factors may influence family decisions to decline donation on behalf of a registered donor as well as the responses of donation professionals to such decisions. In exploring these factors, I will argue that respecting a proposed “veto” may be ethically – and legally – appropriate in many cases.

When family vetoes are debated, it is also often assumed that family preferences are being prioritised at the expense of a legally binding directive made by the potential donor. However, donor registration in Australia is not a legally binding directive, although it plays an important role in guiding donation decision-making. Rather than seeking to strengthen protections for registered donors against the alleged risk of family vetoes, I will argue that we ought to focus more on improving the quality of decision-making about donation during people’s lives to better support definitive donation decision-making at the time of their death.

Speaker Biography - Dominique E. Martin, MBBS, BA(Hons. Phil.), PhD (Applied Ethics)

Dominique is a Professor of Health Ethics and Professionalism in the School of Medicine at Deakin University in Australia, where she leads the Ethics, Law and Professionalism team. She is also an adjunct professor at the Australian Centre for Health Law Research (ACHLR) at QUT. Dominique’s research focuses on ethical issues in nephrology, organ and tissue donation and transplantation, and on professionalism in healthcare. She currently represents Oceania on the Council of the international Transplantation Society (TTS) and is co-chair of the Education Committee of TTS. She is also an Associate Editor of Transplantation and has served as an ethics consultant to the World Health Organization and the Australian Organ and Tissue Authority.