Centre for Health, Law, and Society, University of Bristol, Bristol, UK
39 Essex Chambers, London, UK.
J Med Ethics. 2023 Nov 23;49(12):803-807. doi: 10.1136/jme-2022-108746.
In February 2022, the Court of Protection was faced with the question of whether a kidney transplant was in the best interests of William Verden. The case highlighted the legal, ethical and clinical complexities of treating potential kidney transplant patients with impaired decision-making. Above all, it exposed the potential risk of discrimination on the basis of disability when treatment decisions in relation to potential kidney recipients with impaired capacity are being made. In this paper, we draw on the Verden case to (1) examine the role of the Court of Protection in cases relating to patients with impaired decision-making capacity who require a transplant, (2) to highlight the lack of empirical data on patients who have faced inequitable access to transplant and (3) highlight the shortcomings of the existing legal and regulatory framework in England and Wales guiding clinical decision making for patients in William's position. We consequently argue that there is a clear need for action to ensure equitable access to transplant for those in William's position. Furthermore, we suggest that there is a responsibility incumbent on policy makers and clinicians alike to develop a meaningful, and meaningfully operational, framework centred on preventing discrimination against potential organ recipients based on their decision-making capacity.
2022 年 2 月，保护法院面临着一个问题，即肾移植是否符合威廉·费登的最佳利益。此案突出了治疗有决策障碍的潜在肾移植患者的法律、伦理和临床复杂性。最重要的是，它暴露了在对有能力障碍的潜在肾接受者进行治疗决策时，基于残疾进行歧视的潜在风险。在本文中，我们借鉴 Verden 案（1）审查保护法院在涉及需要移植且决策能力受损的患者的案件中的作用，（2）强调缺乏关于面临不平等移植机会的患者的经验数据，以及（3）强调指导英格兰和威尔士指导威廉处境患者的临床决策的现有法律和监管框架的缺点。因此，我们认为，显然需要采取行动，确保像威廉这样的人能够公平地获得移植。此外，我们认为，政策制定者和临床医生都有责任制定一个有意义的、切实可行的框架，该框架以防止基于潜在器官接受者的决策能力对其进行歧视为中心。
