Martin D K, Meslin E
University of Toronto, Center for Bioethics, Ontario, Canada.
J Med Philos. 1994 Feb;19(1):61-78. doi: 10.1093/jmp/19.1.61.
Scientific developments of the last 20 years have made the transplantation of cadaveric solid organs a viable and expected treatment alternative for patients suffering from various forms of End Stage Organ Disease. Of the number of organs that could be utilized for this, only a small percentage of them are actually made available. North American legislation explicitly categorizes the transfer of cadaveric organs as an anatomical or tissue "gift". The concept of the gift is mediated by transculturally consistent unwritten, but powerfully felt, rules of conduct. Among the most profound elements of the concept is the obligatory gift-exchange which is central to the gift-relationship. Obviously, neither of these are permitted by the organ transplant scenario. As a result, dissonance is created within the thought process of the individual which cannot be easily resolved, paralyzing many into inaction. We maintain that the present legal framework, designed to facilitate the transfer of organs, clashes with the human phenomenon of giving, and may actually prevent organs from being made available. In a search for a solution to this gift-relationship dilemma, giving organs is contrasted with taking organs as a basis upon which to ground ethically sound public policy. Liberty-limiting principles and the concept of harm are considered within this context.
过去20年的科学发展使尸体实体器官移植成为患有各种终末期器官疾病患者可行且预期的治疗选择。在可用于此目的的器官数量中，实际上只有一小部分可供使用。北美立法明确将尸体器官的转移归类为解剖学或组织“捐赠”。捐赠的概念由跨文化一致的不成文但强烈感受到的行为规则所调节。该概念中最深刻的要素之一是义务性的礼物交换，这是礼物关系的核心。显然，器官移植场景中这两者都不被允许。结果，个体的思维过程中产生了无法轻易解决的不和谐，使许多人陷入不作为的状态。我们认为，旨在促进器官转移的现行法律框架与人类的捐赠现象相冲突，实际上可能会阻止器官的提供。在寻求解决这种礼物关系困境的方法时，将捐赠器官与摘取器官进行对比，以此作为制定符合道德的公共政策的基础。在此背景下考虑限制自由的原则和伤害的概念。
