Division of Health Services Research and Management, School of Health Sciences, City, University of London, United Kingdom.
Soc Sci Med. 2018 Jul;209:104-110. doi: 10.1016/j.socscimed.2018.05.042. Epub 2018 May 25.
Controlled organ donation after circulatory death (DCD) has recently been revived in the UK, as part of attempts to increase organ donation rates. The re-introduction of DCD has subsequently become the focus of bioethical controversy, since it necessitates intervening in the care of dying patients to obtain quality donor organs. Transplant policy responses to these concerns have generated new legal and ethical guidelines to address uncertainties around DCD, producing claims that the UK has overcome' the ethical challenge of DCD. In contrast, by drawing on Lynch's call to 'respecify' ethics, this paper argues that ethics in DCD cannot be reduced to abstract directives for practice, but, instead, are composed and dealt with as an organisational problem. To do this, I utilise data from an ethnographic study examining the production of the 'minority ethnic organ donor' within UK organ donation settings; in particular, the data pertains to a case hospital which was in the process of developing a DCD programme during the period of fieldwork. Findings show that the ethics of DCD are encountered as practical sets of problems, constructed in relation to particular institutional locales. I describe how these issues are worked-around by creating conditions to make DCD organisationally possible, and through the animation of standard procedures into acceptable forms of practice. I argue that ethics in DCD go far beyond normative bioethical principles, to encompass concerns around: the reputation of hospital Trusts, public perceptions of organ donation, the welfare of potential donor families, and challenges to the work of health professionals caring for dying patients. The paper enriches understanding of ethics in science and medicine by showing how ethics are assembled and negotiated as a practical-organisational concern, and calls for further examination of how DCD gets constructed as a potential problem and is made to happen in practice.
在英国，作为提高器官捐献率的尝试之一，最近重新引入了循环死亡（DCD）控制器官捐献。由于需要干预临终患者的护理以获取高质量的捐献器官，因此 DCD 的重新引入成为了生物伦理争议的焦点。鉴于此，移植政策对这些问题的回应制定了新的法律和伦理准则，以解决 DCD 方面的不确定性，这些准则提出了英国已经克服了 DCD 伦理挑战的说法。相比之下，本文通过借鉴 Lynch 提出的“重新定义”伦理的观点，认为 DCD 中的伦理不能简化为实践的抽象指令，而是由组织问题构成并需要加以处理。为此，我利用一项民族志研究的数据，该研究考察了英国器官捐赠环境中“少数民族器官捐献者”的产生；具体而言，这些数据涉及到一家在实地调查期间正在开发 DCD 项目的病例医院。研究结果表明，DCD 的伦理问题被视为实际的问题集，与特定的机构环境有关。我描述了如何通过创造条件使 DCD 在组织上变得可行，并通过将标准程序转化为可接受的实践形式来解决这些问题。我认为，DCD 中的伦理问题远远超出了规范性的生物伦理原则，还包括医院信托机构的声誉、公众对器官捐赠的看法、潜在捐献者家庭的福利以及对照顾临终患者的卫生专业人员工作的挑战。本文通过展示伦理如何作为一个实际的组织问题被组装和协商，丰富了对科学和医学中的伦理理解，并呼吁进一步研究 DCD 如何被构建为一个潜在的问题，并在实践中得以实现。
