Herrera Christopher
Department of Philosophy, Montclair State University, Montclair, NJ 07043, USA.
J Med Philos. 2009 Apr;34(2):181-94. doi: 10.1093/jmp/jhp017. Epub 2009 Feb 25.
A well-known thought experiment has us ponder a lottery system that selects one person as the source of transplantable organs for two others. The organs are forcibly harvested and the "donor" dies, whereas the other two patients live. The Survival Lottery is supposed to get at the distinction between killing and letting die, but it is also a challenge to beliefs about moral duties: what are my obligations if my life could be used to save yours and another person's as well? A less extreme version of this thought experiment might have us imagining that officials of the public healthcare system would devise a similar lottery in the aftermath of a large-scale medical emergency. We could imagine that a natural disaster or an attack using biological weapons, for example, has so diminished the ability to provide public health care that in some communities, officials might consider implementing a lottery. To avoid the concerns about outright killing of selectees, officials might offer a wide range of participation in medical practice and research, not just organ allocation. Officials could ensure that no significant risks are involved, and selectees could in various ways be compensated. Would it be possible to ethically justify this "Healthcare Lottery" on the grounds that it was a temporary, yet necessary, infringement on autonomy?
一个著名的思想实验让我们思考一种抽签系统，该系统会挑选出一个人作为另外两个人可移植器官的来源。器官被强行摘取，“捐赠者”死亡，而另外两名患者存活。生存抽签旨在区分杀人与听任死亡，但它也是对道德义务观念的一种挑战：如果我的生命可以用来拯救你和另一个人的生命，我的义务是什么？这个思想实验的一个不那么极端的版本可能会让我们想象，公共医疗系统的官员会在大规模医疗紧急情况发生后设计出类似的抽签。例如，我们可以想象一场自然灾害或一次生物武器袭击极大地削弱了提供公共医疗服务的能力，以至于在一些社区，官员们可能会考虑实施抽签。为了避免对被选中者直接杀人的担忧，官员们可能会提供广泛参与医疗实践和研究的机会，而不仅仅是器官分配。官员们可以确保不涉及重大风险，并且可以以各种方式对被选中者进行补偿。以这是对自主权的一种临时但必要的侵犯为由，从伦理上为这种“医疗抽签”辩护是否可行？
