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论伤害阈值与活体器官捐献:活体捐献者总体上是否必须从其捐献中获益?

On harm thresholds and living organ donation: must the living donor benefit, on balance, from his donation?

作者信息

Williams Nicola Jane

机构信息

Department of Politics, Philosophy and Religion, County South, Lancaster University, Bailrigg, Lancaster, Lancashire, LA1 4YW, UK.

出版信息

Med Health Care Philos. 2018 Mar;21(1):11-22. doi: 10.1007/s11019-017-9778-x.

Abstract

For the majority of scholars concerned with the ethics of living organ donation, inflicting moderate harms on competent volunteers in order to save the lives or increase the life chances of others is held to be justifiable provided certain conditions are met. These conditions tend to include one, or more commonly, some combination of the following: (1) The living donor provides valid consent to donation. (2) Living donation produces an overall positive balance of harm-benefit for donors and recipients which cannot be obtained in a less harmful manner. (3) Donation is not liable to cause significant and long-term morbidity to, or the death of, the donor. This paper critically examines the suggestion that these criteria are not sufficient to offer a general account of justified living organ donation in the context of competent volunteers and that key to justified living organ donation is that donors receive sufficient benefits from their donation that these outweigh the harms they suffer. However, although this view-termed here 'The Donor Benefit Standard'-directs welcome attention to the many and complex motives which may underlie living organ donation, this paper ultimately concludes that given the threats this position poses to individual autonomy and the lives of those in need of organ transplants 'The Donor Benefit Standard' should ultimately be rejected.

摘要

对于大多数关注活体器官捐赠伦理的学者而言,只要满足特定条件,对有行为能力的志愿者造成适度伤害以挽救他人生命或增加其生存几率被认为是合理的。这些条件通常包括以下一项或更常见的几种组合:(1)活体捐赠者提供有效的捐赠同意书。(2)活体捐赠对捐赠者和接受者产生的总体伤害 - 益处平衡是积极的,且无法通过危害较小的方式实现。(3)捐赠不太可能给捐赠者造成重大的长期发病或死亡。本文批判性地审视了这样一种观点,即在有行为能力的志愿者背景下,这些标准不足以全面解释合理的活体器官捐赠,且合理的活体器官捐赠的关键在于捐赠者从捐赠中获得足够的益处,这些益处超过他们所遭受的伤害。然而,尽管这种观点——这里称为“捐赠者受益标准”——将人们的注意力引向了活体器官捐赠背后可能存在的诸多复杂动机,本文最终得出结论,鉴于这一立场对个人自主性以及器官移植需求者生命构成的威胁,“捐赠者受益标准”最终应被摒弃。

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