 For the contractualist, justification to others provides the standard that determines which considerations count decisively against particular actions. In transplant cases, the contractualist question is whether the possibility of saving lives via transplant justifies an exception to the general duty to aid one’s patients. Scanlon argues that it does not do so, because a principle permitting such an exception could reasonably be rejected by prospective patients. If doctors withhold treatment because they intend to transplant their patients’ organs, then this intention is wrongful because the act intended is wrong, and not vice versa.