English V, Sommerville A
Department of Medical Ethics, British Medical Association, Tavistock Square, London WC1H 9JP, UK.
J Med Ethics. 2003 Jun;29(3):147-52. doi: 10.1136/jme.29.3.147.
In the wake of scandals about the unauthorised retention of organs following postmortem examination, the issue of valid consent (or the lack of it) has returned to the forefront. Emphasis is put on obtaining explicit authorisation from the patient or family prior to any medical intervention, including those involving the dead. Although the controversies in the UK arose from the retention of human material for education or research rather than therapy, concern has been expressed that public mistrust could also adversely affect organ donation for transplantation. At the same time, however, the British Medical Association (BMA) continues to call for a shift to a system of presumed consent for organ transplantation. This apparent inconsistency can be justified because valid distinctions exist between the reasons requiring explicit consent for retention and the acceptability of presumed consent for transplantation. This paper argues for introducing a system of presumed consent for organ donation, given the overwhelming expressions of public support for transplantation. Ongoing legislative review in the UK provides an ideal chance to alter the default position to one where potential donors can simply acquiesce or opt out of donation. Combined with consultation with their relatives, this could be a much better method of realising individuals' wishes. It would also achieve a better balance between the duties owed to the deceased and those owed to people awaiting a transplant.
在验尸后未经授权保留器官的丑闻曝光后，有效同意（或缺乏有效同意）的问题再度成为焦点。重点在于在任何医疗干预之前，包括涉及死者的干预，都要获得患者或其家属的明确授权。尽管英国的争议源于为教育或研究而非治疗目的保留人体组织，但有人担心公众的不信任也可能对移植器官捐赠产生不利影响。然而，与此同时，英国医学协会（BMA）仍在呼吁转向器官移植的推定同意制度。这种明显的不一致是有道理的，因为在需要明确同意保留的原因与推定同意移植的可接受性之间存在有效的区别。鉴于公众对移植的大力支持，本文主张引入器官捐赠的推定同意制度。英国正在进行的立法审查提供了一个理想的机会，将默认立场转变为潜在捐赠者可以简单地默认或选择不捐赠的立场。再加上与他们亲属的协商，这可能是实现个人意愿的更好方法。这也将在对死者的责任与对等待移植者的责任之间实现更好的平衡。
