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Robert Veatch’s transplantation ethics: obtaining and allocating organs from deceased persons 罗伯特·维奇的移植伦理:从死者身上获取和分配器官
IF 1.4 3区 哲学 Q3 ETHICS Pub Date : 2022-06-10 DOI: 10.1007/s11017-022-09574-3
J. Childress
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引用次数: 2
A defense of surgical procedures regulation. 对外科手术规程的辩护。
IF 1.4 3区 哲学 Q3 ETHICS Pub Date : 2022-06-01 DOI: 10.1007/s11017-022-09569-0
Mattia Andreoletti, Federico Bina

Since the advent of drug regulation in 1962, regulatory agencies have been in the practice of using strict standards to test the safety and efficacy of medical treatments and products. Regulatory agencies, such as the FDA, demand two full-fledged Randomized Clinical Trials demonstrating the safety and effectiveness of drugs to grant its marketing authorization. On the contrary, surgical treatments are left completely unregulated. There are several reasons explaining this difference, and all of them point to the difficulty of conducting well-designed RCTs in surgery. However, we argue that none of these arguments is decisive and that, under certain conditions, surgical RCTs can be morally justified and methodologically sound. Although ethical constraints restrict the number of testable surgical procedures, and surgical trials might not be as dependable as pharmaceutical RCTs, our analysis suggests that, in certain cases, it is possible to obtain high-quality evidence about the safety and efficacy of surgical procedures. Untested surgical treatments may prove to be ineffective and harm patients. Therefore, regulation of surgical procedures seems not only morally acceptable and able to provide reliable scientific evidence, but also desirable and justified from an ethical-political standpoint.

自1962年药品监管出现以来,监管机构一直采用严格的标准来检验医疗和产品的安全性和有效性。监管机构,如FDA,要求两项成熟的随机临床试验证明药物的安全性和有效性,以批准其上市许可。相反,手术治疗完全不受监管。有几个原因可以解释这种差异,所有这些原因都指向在手术中进行精心设计的随机对照试验的困难。然而,我们认为这些论点都不是决定性的,在某些条件下,外科随机对照试验在道德上是合理的,在方法上是合理的。尽管伦理约束限制了可测试外科手术的数量,并且外科试验可能不如药物随机对照试验可靠,但我们的分析表明,在某些情况下,有可能获得关于外科手术安全性和有效性的高质量证据。未经检验的手术治疗可能被证明是无效的,并伤害病人。因此,对外科手术的管制似乎不仅在道德上可以接受,能够提供可靠的科学证据,而且从伦理-政治的角度来看也是可取的和合理的。
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引用次数: 2
Relational autonomy and the clinical relationship in dementia care 关系自主与痴呆护理的临床关系
IF 1.4 3区 哲学 Q3 ETHICS Pub Date : 2022-05-17 DOI: 10.1007/s11017-022-09580-5
E. Klein
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引用次数: 2
Thomas Boggatz (ed.): Quality of life and person-centered care for older people : Springer, Cham (Switzerland), 2020, 466 pp, $45, ISBN: ISBN 978-3-030-29989-7. Thomas Boggatz(编):老年人的生活质量和以人为中心的护理:Springer, Cham(瑞士),2020,466页,45美元,ISBN: ISBN 978-3-030-29989-7。
IF 1.4 3区 哲学 Q3 ETHICS Pub Date : 2022-04-16 DOI: 10.1007/s11017-022-09568-1
Nunziata Comoretto
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引用次数: 0
Defending secular clinical ethics expertise from an Engelhardt-inspired sense of theoretical crisis 从恩格尔哈特启发的理论危机意识中捍卫世俗临床伦理学专业知识
IF 1.4 3区 哲学 Q3 ETHICS Pub Date : 2022-04-02 DOI: 10.1007/s11017-022-09566-3
Abram Brummett

The national standards for clinical ethics consultation set forth by the American Society for Bioethics and Humanities (ASBH) endorse an “ethics facilitation” approach, which characterizes the role of the ethicist as one skilled at facilitating consensus within the range of ethically acceptable options. To determine the range of ethically acceptable options, ASBH recommends the standard model of decision-making (informed consent, advance directives, surrogates, best interests), which is grounded in the values of autonomy, beneficence, nonmaleficence, and justice. H. Tristram Engelhardt Jr. has sharply criticized the standard model for presuming contentful moral claims in circumscribing the range of ethically acceptable options, which, he argues, cannot be rationally justified in a pluralistic context. Engelhardt’s solution is a secular clinical ethics based on a contentless principle of permission. The first part of this article lays out Engelhardt’s negative claim, that reason cannot establish contentful moral claims, and his positive claim, that secular clinical ethics ought to be based on a contentless principle of permission. The second part critiques these negative and positive claims. The purpose of this paper is to defend secular clinical ethics expertise—defined as the ability of ethicists to offer justified moral recommendations grounded in consensus positions endorsed by the American Society for Bioethics and Humanities—from the radical critiques of Engelhardt, who argues that no moral or metaphysical claims, and hence no bioethical consensus, can be rationally justified. Engelhardt’s critiques have caused some to worry that secular clinical ethics is in a state of theoretical crisis; this article concludes that Engelhardt’s view is an unstable basis for that worry.

美国生命伦理与人文学会(ASBH)制定的临床伦理咨询国家标准支持“伦理促进”方法,该方法将伦理学家的角色描述为善于在伦理可接受的选择范围内促进共识的人。为了确定道德上可接受的选择范围,ASBH推荐了决策的标准模型(知情同意、预先指示、代理人、最佳利益),它以自主、仁慈、无害和正义的价值观为基础。小特里斯特拉姆·恩格尔哈特(H. Tristram Engelhardt Jr.)尖锐地批评了标准模型,认为它在限定道德上可接受的选择范围时假定了有内容的道德主张,他认为,这在多元化的背景下是不合理的。恩格尔哈特的解决方案是建立在无内容的许可原则基础上的世俗临床伦理学。本文的第一部分阐述了恩格尔哈特的消极主张,即理性不能建立有内容的道德主张,以及他的积极主张,即世俗临床伦理学应该建立在无内容的许可原则基础上。第二部分对这些消极和积极的主张进行了批判。本文的目的是捍卫世俗的临床伦理学专业知识——定义为伦理学家提供基于美国生命伦理学与人文学会认可的共识立场的合理道德建议的能力——从恩格尔哈特的激进批评中,他认为没有道德或形而上学的主张,因此没有生物伦理学共识,可以合理地证明。恩格尔哈特的批评使一些人担心世俗临床伦理学正处于理论危机状态;本文的结论是,恩格尔哈特的观点是这种担忧的不稳定基础。
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引用次数: 2
To harvest, procure, or receive? Organ transplantation metaphors and the technological imaginary 收获、获得或接受?器官移植隐喻和技术想象
IF 1.4 3区 哲学 Q3 ETHICS Pub Date : 2022-04-01 DOI: 10.1007/s11017-022-09563-6
Jordan Mason

One must technologize bodies to conceive of organ transplantation. Organs must be envisioned as replaceable parts, serving mechanical functions for the workings of the body. In this way, it becomes possible to imagine exchanging someone’s organs without changing anything essential about the selfhood of the person. But to envision organs as mechanical parts is phenomenologically uncomfortable; thus, the terminology used to describe the practice of organ retrieval seems to attempt other, less technological ways of viewing the human body. In this paper, I analyze three common metaphors that currently contextualize the process of organ retrieval in English-speaking communities: harvesting the agrarian body, procuring the commodified body, and receiving the gifted body. These powerful images constrain the gaze toward the body in important ways. Every gaze both obscures and reveals. While each of these three metaphors makes sense of some aspects of organ retrieval, each of them is ultimately subject to being overtaken by what Jeffrey Bishop calls the technological imaginary. This imaginary deploys a gaze that obscures important elements of what it means to be human and does violence to parts of the phenomenological experience of transplantation and bodily existence. I argue that no matter how hard one tries to avoid the technological aspect of transplantation practices by embracing nonviolent metaphors—even the metaphor of gifting, which seems the most promising—it will never be possible to fully resist organ transplantation’s violence toward our phenomenological sense of embodiment.

一个人必须把身体技术化才能设想器官移植。器官必须被设想为可替换的部件,为身体的运作提供机械功能。通过这种方式,可以想象交换某人的器官而不改变这个人本质上的任何东西。但是把器官想象成机械部件在现象学上是不舒服的;因此,用来描述器官摘取实践的术语似乎是在尝试用其他更少技术含量的方式来观察人体。在本文中,我分析了目前英语社区中器官摘取过程的三种常见隐喻:收获农业身体,获取商品化身体和接受天赋身体。这些强有力的图像在重要方面限制了人们对身体的关注。每一次凝视既模糊又揭示。虽然这三个隐喻中的每一个都对器官回收的某些方面有意义,但它们最终都会被杰弗里·毕晓普(Jeffrey Bishop)所说的技术想象所取代。这种想象的凝视模糊了作为人类的重要元素,并对移植和身体存在的部分现象学经验施加了暴力。我认为,无论一个人多么努力地试图通过拥抱非暴力的隐喻来避免移植实践的技术方面——甚至是礼物的隐喻,这似乎是最有希望的——它永远不可能完全抵制器官移植对我们现象学意义上的体现的暴力。
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引用次数: 0
The inviolateness of life and equal protection: a defense of the dead-donor rule 生命的不可侵犯性与平等保护:对死亡捐赠者规则的辩护
IF 1.4 3区 哲学 Q3 ETHICS Pub Date : 2022-03-04 DOI: 10.1007/s11017-022-09557-4
Adam Omelianchuk

There are increasing calls to reject the dead-donor rule and permit organ donation euthanasia in organ transplantation. I argue that the fundamental problem with this proposal is that it would bestow more worth on the organs than on the donor who possesses them. What is at stake is the basis of human equality, which, I argue, should be based on an ineliminable dignity that each of us has in virtue of having a rational nature. To allow mortal harvesting would be to make our worth contingent upon variable quality-of-life judgments that can be based only on properties that come in degrees. Thus, rejecting the dead-donor rule comes at the expense of egalitarian principles with respect to the value each individual human life has in relation to the protections against killing.

越来越多的人呼吁废除“死亡捐献者”规则,允许器官捐献,允许器官移植中的安乐死。我认为,这一提议的根本问题在于,它将赋予器官比赋予拥有器官的捐赠者更多的价值。利害攸关的是人类平等的基础,我认为,这种平等应该建立在我们每个人都具有理性天性的不可剥夺的尊严之上。允许人类的收获将会使我们的价值取决于各种各样的生活质量判断,而这些判断只能基于以程度为单位的属性。因此,拒绝死亡捐赠者规则是以牺牲平等主义原则为代价的,即尊重每个人的生命与防止杀戮有关的价值。
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引用次数: 1
Maureen L. Condic: Untangling twinning: what science tells us about the nature of human embryos 莫琳·l·康迪克:解开双胞胎之谜:科学告诉我们人类胚胎的本质
IF 1.4 3区 哲学 Q3 ETHICS Pub Date : 2022-02-01 DOI: 10.1007/s11017-022-09560-9
F. Beckwith
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引用次数: 0
Ilora Finlay and Robert Preston: Death by appointment: a rational guide to the assisted dying debate Ilora Finlay和Robert Preston:预约死亡:辅助死亡辩论的理性指南
IF 1.4 3区 哲学 Q3 ETHICS Pub Date : 2022-01-03 DOI: 10.1007/s11017-021-09555-y
John Keown
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引用次数: 7
Philosophy of medicine in 2021. 2021 年的医学哲学。
IF 1.1 3区 哲学 Q3 ETHICS Pub Date : 2021-12-01 DOI: 10.1007/s11017-022-09562-7
Jeremy R Simon, Maël Lemoine
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引用次数: 0
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Theoretical Medicine and Bioethics
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