—While Dr Iserson urges us to "stop dancing around society's ethical constraints on organ donation," Dr Kunin's moving story demonstrates just how complex and subtle those "constraints" can be. Iserson fails to recognize that autonomy is not the only value patients, their families, and health professionals deem important. Family authority over the fate of the newly dead, about to be dead, or probably dead bodies of their children, parents, and spouses (even if they have previously expressed a wish to be donors) is a cultural value that will be difficult to obliterate by government regulation. Ignoring these issues increases the likelihood that passage of new regulations, such as presumed consent and mandated choice, will backfire and alienate more persons from the process. If our experience with required request serves as an example, pressuring people to do things about which they are uncomfortable simply doesn't work.1There are
Arnold RM, Youngner SJ. Voluntary Organ Donation: Autonomy... Tragedy-Reply. JAMA. 1993;270(16):1930–1931. doi:10.1001/jama.1993.03510160048016
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