Parker William F, Chin Marshall H
Instructor of pulmonary and critical care medicine, senior fellow at the MacLean Center for Clinical Medical Ethics at the University of Chicago in Illinois.
Richard Parrillo Family Professor of Healthcare Ethics in the Department of Medicine, associate director of the MacLean Center for Clinical Medical Ethics at the University of Chicago in Illinois.
AMA J Ethics. 2020 May 1;22(5):E408-415. doi: 10.1001/amajethics.2020.408.
acknowledges respect for a patient's knowledge claims, an important manifestation of patient autonomy that facilitates shared decision making in medicine. Given the scarcity of deceased donor organs, transplantation programs state that patient promises of compliance cannot be taken at face value and exclude candidates deemed untrustworthy. This article argues that transplant programs frequently lack the data to make this utilitarian calculation accurately, with the result that, in practice, the psychosocial evaluation of potential transplant candidates is discriminatory and unfair. Historically excluded candidates, such as patients suffering from alcohol use, have turned out to benefit highly from transplantation. Transplant programs should tend to trust patients when they claim to be good potential organ stewards, thereby respecting patient autonomy, advancing justice, and saving more lives.
承认尊重患者的知识主张，这是患者自主性的一个重要表现，有助于在医学中进行共同决策。鉴于已故捐赠者器官的稀缺性，移植项目表示，不能仅凭表面价值接受患者遵守规定的承诺，并将被认为不可信的候选人排除在外。本文认为，移植项目往往缺乏准确进行这种功利主义计算的数据，结果是，在实践中，对潜在移植候选人的心理社会评估具有歧视性且不公平。历史上被排除在外的候选人，如患有酒精使用障碍的患者，结果证明从移植中获益匪浅。当患者声称自己是良好的潜在器官管理者时，移植项目应该倾向于信任他们，从而尊重患者的自主性，促进公平，并挽救更多生命。
