Łuków Paweł
Instytut Filozofii, Uniwersytet Warszawski, Krakowskie Przedmieście 3, 00-927, Warsaw, Poland.
Med Health Care Philos. 2019 Jun;22(2):221-230. doi: 10.1007/s11019-018-9862-x.
The paper argues that the idea of gift-giving and its associated imagery, which has been founding the ethics of organ transplants since the time of the first successful transplants, should be abandoned because it cannot effectively block arguments for (regulated) markets in human body parts. The imagery suggests that human bodies or their parts are transferable objects which belong to individuals. Such imagery is, however, neither a self-evident nor anthropologically unproblematic construal of the relation between a human being and their body. The paper proposes an alternative conceptualization of that relation, the identity view according to which a human being is identical with their living body. This view, which offers a new ethical perspective on some central concepts of transplant medicine and its ethical and legal standards and institutions, supports widely shared intuitive ethical judgments. On this proposal, an act of selling a human body or one of its parts is an act of trade in human beings, not in owned objects. Transfers of human body parts for treatment purposes are to be seen as sharing in another human being's misfortune rather than as giving owned objects. From the perspective of policy-making, the proposal requires, first, that informed consent for removal of transplant material be obtained from the potential benefactor. Secondly, explicit consent by the prospective benefactor is obligatory in the case of removal of transplant material from a living benefactor. Thirdly, in the case of posthumous retrieval, informed consent by the potential benefactor during their life is not ethically indispensable. Additionally, while refusal of posthumous retrieval expressed by a potential benefactor during their life must be respected, such a refusal needs ethical justification and explanation.
该论文认为，自首次成功进行器官移植以来，一直支撑着器官移植伦理的礼物赠送观念及其相关意象应该被摒弃，因为它无法有效阻止支持（受监管的）人体器官市场的论点。这种意象表明人体或其部分是属于个人的可转移对象。然而，这种意象对于人与身体之间的关系而言，既不是不言而喻的，在人类学上也并非毫无问题的解释。该论文提出了对这种关系的另一种概念化理解，即同一观点，根据这一观点，人与其活体身体是同一的。这种观点为移植医学的一些核心概念及其伦理和法律标准与制度提供了新的伦理视角，支持了广泛共享的直观伦理判断。根据这一提议，出售人体或其部分的行为是一种人口交易行为，而非对所属物品的交易。出于治疗目的进行人体器官转移应被视为分担他人的不幸，而非给予所属物品。从政策制定的角度来看，该提议首先要求从潜在捐赠者那里获得对摘除移植材料的知情同意。其次，在从活体捐赠者身上摘除移植材料的情况下，潜在捐赠者的明确同意是必须的。第三，在死后获取的情况下，潜在捐赠者生前的知情同意在伦理上并非必不可少。此外，虽然必须尊重潜在捐赠者生前表达的死后拒绝获取的意愿，但这种拒绝需要伦理上的正当理由和解释。
