Throughout the article, Saunders often discusses presumed consent. Presumed consent is the idea that we can assume that a person's organs can be used and that this allows us to remove them as if they had consented to organ donation, unless they have expressed an objection. This is challenging because it implies that consent is a mental attitude – something like approval – rather than an act. Saunders argues that if consent is necessary, then it cannot simply be presumed when no action has been taken.