Dickenson D, Widdershoven G
University of Birmingham, England.
Bioethics. 2001 Apr;15(2):110-24. doi: 10.1111/1467-8519.00219.
On one view, limb transplants cross technological frontiers but not ethical ones; the only issues to be resolved concern professional competence, under the assumption of patient autonomy. Given that the benefits of limb transplant do not outweigh the risks, however, the autonomy and rationality of the patient are not necessarily self-evident. In addition to questions of resource allocation and informed consent, limb, and particularly hand, allograft also raises important issues of personal identity and bodily integrity. We present two linked schemas for exploring ethical issues in limb transplants. The first, relying on conventional concepts in biomedical ethics, asks whether the procedure is research or therapy, whether the costs outweigh the benefits, and whether it should be up to the patient to decide. The second introduces more speculative and theoretically challenging questions, including bodily integrity, the argument from unnaturalness, and the function of the hand in expressing personal identity and intimacy. We conclude that limb transplants are not ruled out a priori, unlike some procedures that are prima facie wrong to perform, such as amputation of healthy limbs to relieve body dysmorphic disorders. However, their legitimacy is not proven by appeals to the interests of scientific research, cost-benefit, or patient autonomy.
有一种观点认为，肢体移植跨越了技术前沿，但并未跨越伦理前沿；在假定患者自主性的情况下，唯一需要解决的问题涉及专业能力。然而，鉴于肢体移植的益处并不大于风险，患者的自主性和理性不一定是不言而喻的。除了资源分配和知情同意问题外，肢体移植，尤其是手部异体移植，还引发了个人身份和身体完整性的重要问题。我们提出了两个相互关联的模式来探讨肢体移植中的伦理问题。第一个模式依赖于生物医学伦理学中的传统概念，询问该手术是研究还是治疗，成本是否超过收益，以及是否应由患者来决定。第二个模式引入了更具推测性和理论挑战性的问题，包括身体完整性、非自然性的论点，以及手在表达个人身份和亲密关系方面的作用。我们得出的结论是，与某些乍一看就不应该进行的手术不同，比如为缓解身体畸形障碍而截肢健康肢体，肢体移植并非先验地被排除在外。然而，通过诉诸科学研究利益、成本效益或患者自主性，并不能证明其合理性。
