Malmqvist Erik
Department of Thematic Studies, Linköping University, 581 83, Linköping, Sweden.
Med Health Care Philos. 2016 Sep;19(3):463-73. doi: 10.1007/s11019-016-9705-6.
The idea of paying donors in order to make more human bodily material available for therapy, assisted reproduction, and biomedical research is notoriously controversial. However, while national and international donation policies largely oppose financial incentives they do not treat all parts of the body equally: incentives are allowed in connection to the provision of some parts but not others. Taking off from this observation, I discuss whether body parts differ as regards the ethical legitimacy of incentives and, if so, why. I distinguish two approaches to this issue. On a "principled" approach, some but not all body parts are inherently special in a way that proscribes payment. On a "pragmatic" approach, the appropriateness of payment in relation to a specific part must be determined through an overall assessment of e.g. the implications of payment for the health and welfare of providers, recipients, and third parties, and the quality of providers' consent. I argue that the first approach raises deep and potentially divisive questions about the good life, whereas the second approach invokes currently unsupported empirical assumptions and requires difficult balancing between different values and the interests of different people. This does not mean that any attempt to distinguish between body parts in regard to the appropriateness of payment necessarily fails. However, I conclude, any plausible such attempt should either articulate and defend a specific view of the good life, or gather relevant empirical evidence and apply defensible principles for weighing goods and interests.
为了获取更多人体物质用于治疗、辅助生殖和生物医学研究而向捐赠者支付报酬的想法，向来备受争议。然而，尽管国家和国际捐赠政策在很大程度上反对经济激励措施，但它们对身体各部位的对待并不平等：在提供某些身体部位时允许有激励措施，而在提供其他部位时则不允许。基于这一观察结果，我探讨了身体各部位在激励措施的伦理合法性方面是否存在差异，如果存在差异，原因是什么。我区分了处理这个问题的两种方法。一种是“原则性”方法，即某些但并非所有身体部位在本质上具有特殊性，因而禁止支付报酬。另一种是“务实性”方法，即必须通过对例如支付报酬对提供者、接受者和第三方的健康与福利的影响以及提供者同意的质量等进行全面评估，来确定针对特定身体部位支付报酬是否合适。我认为，第一种方法引发了关于美好生活的深刻且可能存在分歧的问题，而第二种方法援引了目前尚无依据的实证假设，并且需要在不同价值观和不同人的利益之间进行艰难的权衡。这并不意味着任何试图在支付报酬的合适性方面区分身体各部位的尝试必然会失败。然而，我得出的结论是，任何合理的此类尝试都应该要么阐明并捍卫一种关于美好生活的特定观点，要么收集相关的实证证据，并应用合理的原则来权衡利益和好处。
