Barilan Yechiel Michael
Harefuah. 2014 Mar-Apr;153(3-4):223-5, 235.
In 2008 Israel enacted a new law on organ transplantation which granted priority on the waiting list to holders of donor-cards who become patients in need of organ transplantation. This paper offers ethical criticism of the priority system arguing that the "reward" is by necessary also a "punishment". Moreover, because donor-cards have no binding power in Israeli law, the reward/punishment is actually directed at declarations, not actions, and, consequently, violates the freedom of conscience and expression. The reward system is also incompatible with fundamental values of medical ethics and with the very logic of talion, because the law punishes non-signers but not patients who are responsible for the loss of their organs. Lastly, I argue, that because priority on a waiting list is a positional good, it communicates a false message as if donation is an excellence of the few, and it legitimizes a rational choice to prefer wholesomeness of the cadaver to the risk of low rank in the priority list.
2008年，以色列颁布了一项关于器官移植的新法律，该法律给予成为器官移植需求患者的捐赠卡持有者在等候名单上的优先权。本文对这一优先系统提出了伦理批评，认为这种“奖励”必然也是一种“惩罚”。此外，由于捐赠卡在以色列法律中没有约束力，这种奖励/惩罚实际上针对的是声明，而非行为，因此侵犯了良心和表达自由。这种奖励系统也与医学伦理的基本价值观以及报复的逻辑不相容，因为法律惩罚未签署者，却不惩罚那些对自身器官丧失负有责任的患者。最后，我认为，由于等候名单上的优先权是一种地位性物品，它传递了一个错误信息，仿佛捐赠是少数人的美德，并且它使优先选择尸体的完好性而非在优先名单中处于低排名风险的理性选择合法化。
