Testa Giuliano, Carlisle Erica, Simmerling Mary, Angelos Peter
Living Donor Liver Transplantation, Annette C. and Harold C. Simmons Transplant Institute at Baylor University Medical Center, Dallas, Texas, USA.
J Clin Ethics. 2012 Summer;23(2):110-7.
The commitment of transplant physicians to protect the physical and psychological health of potential donors is fundamental to the process of living donor organ transplantation. It is appropriate that strict regulations to govern an individual's decision to donate have been developed. Some may argue that adherence to such regulations creates a doctor-patient relationship that is rooted in paternalism, which is in drastic contrast with a doctor-patient relationship that is rooted in patients' autonomy, characteristic of most other operative interventions. In this article we analyze the similarities between cosmetic plastic surgery and living donor surgery as examples of surgeries governed by different ethical principles. It is interesting that, while the prevailing ethical approach in living donor surgery is based on paternalism, the ethical principle guiding cosmetic surgery is respect for patients' autonomy. The purpose of this article is not to criticize either practice, but to suggest that, given the similarities between the two procedures, both operative interventions should be guided by the same ethical principle: a respect for patients' autonomy. We further suggest that if living organ donation valued donors' autonomy as much as cosmetic plastic surgery does, we might witness a wider acceptance of and increase in living organ donation.
移植医生致力于保护潜在供体的身心健康，这是活体供体器官移植过程的根本所在。制定严格的法规来管理个人的捐赠决定是恰当的。有些人可能会认为，遵守这些法规会产生一种基于家长式作风的医患关系，这与基于患者自主权的医患关系形成了鲜明对比，而患者自主权是大多数其他手术干预的特点。在本文中，我们分析了整形美容手术和活体供体手术之间的相似之处，将其作为受不同伦理原则支配的手术示例。有趣的是，虽然活体供体手术中普遍的伦理方法基于家长式作风，但指导整形手术的伦理原则是尊重患者的自主权。本文的目的不是批评任何一种做法，而是表明，鉴于这两种手术的相似性，两种手术干预都应以相同的伦理原则为指导：尊重患者的自主权。我们进一步建议，如果活体器官捐赠像整形美容手术那样重视供体的自主权，我们可能会看到活体器官捐赠得到更广泛的接受并有所增加。
