Zeiler Kristin, Guntram Lisa, Lennerling Anette
Division of Health and Society, Department of Medical and Health Sciences, Linköping University, 581 83, Linköping, Sweden.
Med Health Care Philos. 2010 Aug;13(3):225-36. doi: 10.1007/s11019-010-9238-3.
Free and informed choice is an oft-acknowledged ethical basis for living kidney donation, including parental living kidney donation. The extent to which choice is present in parental living kidney donation has, however, been questioned. Since parents can be expected to have strong emotional bonds to their children, it has been asked whether these bonds make parents unable to say no to this donation. This article combines a narrative analysis of parents' stories of living kidney donation with a philosophical discussion of conditions for parental decision-making. Previous research has shown that parents often conclude that it is "natural" to donate. Our study shows that this naturalness needs to be understood as part of a story where parental living kidney donation is regarded as natural and as a matter of non-choice. Our study also highlights the presence of a parenthood moral imperative of always putting one's child's needs before one's own. On the basis of these results, we discuss conditions for decision-making in the context of parental LKD. We argue that the presence of a parenthood moral imperative can matter with regard to the decision-making process when parents consider whether to volunteer as living kidney donors, but that it need not hamper choice. We emphasise the need for exploring relational and situational factors in order to understand parental decision-making in the context of parental LKD.
自由且知情的选择是活体肾捐赠（包括父母活体肾捐赠）公认的伦理基础。然而，父母活体肾捐赠中选择的存在程度受到了质疑。由于可以预期父母与子女之间存在强烈的情感纽带，有人提出这些纽带是否会使父母无法拒绝这种捐赠。本文将对父母活体肾捐赠故事的叙事分析与关于父母决策条件的哲学讨论结合起来。先前的研究表明，父母常常得出捐赠是“自然的”这一结论。我们的研究表明，这种自然性需要被理解为父母活体肾捐赠被视为自然且是一种非选择事项的故事的一部分。我们的研究还强调了一种亲职道德义务的存在，即总是将孩子的需求置于自己的需求之前。基于这些结果，我们讨论了父母活体肾捐赠背景下的决策条件。我们认为，当父母考虑是否自愿成为活体肾捐赠者时，亲职道德义务的存在可能会对决策过程产生影响，但不一定会妨碍选择。我们强调需要探索关系和情境因素，以便理解父母活体肾捐赠背景下的父母决策。
