Anesthésie Réanimation Chirurgicale, Centre Hospitalier Universitaire de Nancy, Nancy 54000, France.
J Med Ethics. 2013 Mar;39(3):139-42. doi: 10.1136/medethics-2012-100990. Epub 2013 Jan 26.
The chronic worldwide lack of organs for transplantation and the continuing improvement of strategies for in situ organ preservation have led to renewed interest in elective non-therapeutic ventilation of potential organ donors. Two types of situation may be eligible for elective intensive care: patients definitely evolving towards brain death and patients suitable as controlled non-heart beating organ donors after life-supporting therapies have been assessed as futile and withdrawn. Assessment of the ethical acceptability and the risks of these strategies is essential. We here offer such an ethical assessment using the four principles of medical ethics of Beauchamp and Childress applying them in their broadest sense so as to include patients and their families, their caregivers, other potential recipients of intensive care, and indeed society as a whole. The main ethical problems emerging are the definition of beneficence for the potential organ donor, the dilemma between the duty to respect a dying patient's autonomy and the duty not to harm him/her, and the possible psychological and social harm for families, caregivers other potential recipients of therapeutic intensive care, and society more generally. Caution is expressed about the ethical acceptability of elective non-therapeutic ventilation, along with some proposals for precautionary measures to be taken if it is to be implemented.
慢性全球范围内器官移植的缺乏和原位器官保存策略的不断改进，使得人们重新关注潜在器官捐献者的选择性非治疗性通气。有两种情况可能适合选择性重症监护：一种是肯定会发展为脑死亡的患者，另一种是在生命支持治疗被评估为无效并被撤回后，适合作为控制性非心跳器官供体的患者。评估这些策略的伦理可接受性和风险至关重要。我们在这里使用 Beauchamp 和 Childress 的医学伦理四原则进行这种伦理评估，将其应用于最广泛的意义，以包括患者及其家属、他们的护理人员、其他可能接受重症监护的人，甚至整个社会。出现的主要伦理问题是为潜在器官捐献者定义善行，尊重垂死患者自主权的义务与不伤害他/她的义务之间的困境，以及对家庭、护理人员和其他可能接受治疗性重症监护的人，甚至更广泛的社会可能产生的心理和社会伤害。对选择性非治疗性通气的伦理可接受性表示谨慎，并提出了一些预防措施的建议，如果要实施的话。
