Buturovic Zeljka
Institut društvenih nauka, Beograd, Serbia
J Med Ethics. 2021 Oct;47(10):706-708. doi: 10.1136/medethics-2020-106456. Epub 2020 Dec 10.
In the past, a vast majority of medical assistance in dying (MAiD) patients were elderly patients with cancer who are not suitable for organ donation, making organ donation from such patients a rare event. However, more expansive criteria for MAiD combined with an increased participation of MAiD patients in organ donation is likely to drastically increase the pool of MAiD patients who can serve as organ donors. Previous discussions of ethical issues arising from these trends have not fully addressed difficulties involved in separating decision to end one's life from the one to donate one's organs. However, realities of organ donation logistics and human decision making suggest that this separation can be extraordinary difficult. The need to maximise quality of donated organs complicates dying experience of the donor and is likely in tension with the dying experience the patient envisioned when first considering MAiD. Furthermore, the idea that patients will think about MAiD first, and only when firmly decided to end their life, consider organ donation, runs contrary to organ donation policies in some countries as well as end of life and everyday decision making. This opens the door for organ donation to serve as an incentive in MAiD decisions. Dispensing with the simplistic assumption that organ donation can never be a factor in MAiD decisions is, therefore, essential first step to properly addressing ethical issues at hand.
过去，绝大多数接受医学协助死亡（MAiD）的患者是不适合器官捐赠的老年癌症患者，因此这类患者进行器官捐赠的情况很少见。然而，MAiD标准的扩大，加上MAiD患者对器官捐赠参与度的提高，可能会大幅增加可作为器官捐赠者的MAiD患者群体。此前关于这些趋势引发的伦理问题的讨论，尚未充分解决将结束生命的决定与捐赠器官的决定区分开来所涉及的困难。然而，器官捐赠后勤工作的实际情况和人类决策表明，这种区分可能极其困难。最大化捐赠器官质量的需求使捐赠者的临终体验变得复杂，并且可能与患者最初考虑MAiD时所设想的临终体验相冲突。此外，患者会先考虑MAiD，只有在坚定决定结束生命时才考虑器官捐赠的想法，与一些国家的器官捐赠政策以及临终和日常决策相悖。这为器官捐赠成为MAiD决策中的一个激励因素打开了大门。因此，摒弃器官捐赠绝不可能成为MAiD决策因素这一简单假设，是妥善解决当前伦理问题的关键第一步。
