Philosophy Department, Bloomsburg University, Bloomsburg, Pennsylvania, USA.
Bioethics. 2023 Nov;37(9):831-837. doi: 10.1111/bioe.13218. Epub 2023 Aug 28.
I shall argue, first, that potential kidney donors may be subject to harmful pressure to donate. This pressure may take almost any form; people have diverse interests, and anything that could set them back may qualify as pressure. Given features of the context-the high stakes, the involvement of family, and the social meaning of donation-such pressure may be especially harmful. This problem is less tractable than the more familiar worry that pressure may compromise consent. Screening may ensure donors validly consent, but it provides no protection against harmful pressure. I shall argue, second, that the use of such pressure is the predictable consequence of the prohibition on kidney sales. Potential donors have something-a transplantable kidney-that is both valuable and scarce. Many of them, informed about donation, decide against it. Those in need of a transplant may seek to persuade the unwilling. Given the prohibition, the donation cannot be made more attractive in absolute terms by, say, the addition of money. However, it can be made more attractive in relative terms. If declining the option is made worse, then, by comparison, accepting it is made better. The application of harmful pressure has the desired effect. With so much at stake, and no good alternatives, its use is predictable. I conclude that potential donors' interests should figure more prominently in the discussion of transplant policy. Those who defend the prohibition have made virtually no attempt to account for its impact on that group.
我将首先论证，潜在的肾脏捐赠者可能会受到捐赠的有害压力。这种压力可能采取任何形式；人们有不同的利益，任何可能使他们倒退的事情都可能构成压力。鉴于背景的特点——高风险、家庭的参与以及捐赠的社会意义——这种压力可能特别有害。这个问题比更熟悉的担忧更难解决，即压力可能会损害同意。筛选可以确保捐赠者有效地同意，但它不能防止有害压力。我将其次论证，这种压力的使用是禁止肾脏销售的可预见后果。潜在的捐赠者拥有有价值且稀缺的东西——可移植的肾脏。他们中的许多人在了解了捐赠后决定不捐赠。那些需要移植的人可能会试图说服不愿意的人。由于禁止销售，不能通过添加金钱等方式使捐赠在绝对意义上更具吸引力。然而，它可以在相对意义上更具吸引力。如果拒绝选择会变得更糟，那么相比之下，接受选择会变得更好。施加有害压力会产生预期的效果。由于利害关系重大，又没有其他好的选择，这种做法是可以预见的。我得出结论，潜在捐赠者的利益应该在移植政策的讨论中更加突出。那些捍卫禁令的人几乎没有试图解释其对该群体的影响。
