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Normative and prescriptive criteria: the efficacy of organ transplantation allocation protocols. 规范和规定性标准:器官移植分配方案的有效性。
Pub Date : 1996-03-01 DOI: 10.1007/BF00489742
T Koch

Normative criteria adopted to assure just, equitable, and efficient allocation of donor organs to potential recipients has been widely praised as a model for the allocation of scarce medical resources. Because the organ transplantation program relies upon voluntary participation by potential donors, all such programs necessarily rely upon public confidence in allocation decision making protocols. Several well publicized cases have raised questions in North America about the efficacy of allocation procedures. An analysis of those cases, and the relevant technical literature, suggest consistent structural deficits exist in the organ allocation process as it is applied by many individual transplantation centres. These irregularities are based upon both the failure of rank waiting as a method to guarantee just treatment and a general failure to recognize the extent to which prescriptive criteria--social values--are commonly used to screen potential organ transplant candidates. Resulting idiosyncratic determinations, and a devaluation of rank waiting as a criterion, raise fundamental questions regarding justice, fairness, and equability in the application procedure at large. To correct these structural problems in organ allocation procedures, a multicriterion model defining prescriptive criteria through the Analytic Hierarchy Process (AHP) is proposed.

为确保将捐赠器官公正、公平和有效地分配给潜在受者而采用的规范标准被广泛称赞为分配稀缺医疗资源的典范。由于器官移植项目依赖于潜在捐赠者的自愿参与,所有此类项目都必须依赖于公众对分配决策协议的信任。几个广为人知的案例在北美引起了对分配程序有效性的质疑。对这些病例和相关技术文献的分析表明,在许多个体移植中心应用的器官分配过程中存在一致的结构性缺陷。这些不规范行为的基础是,没有将排队等待作为一种保证公正治疗的方法,也没有认识到通常用于筛选潜在器官移植候选人的规范性标准——社会价值观——的程度。由此产生的特殊决定,以及等级等待作为标准的贬值,引发了有关整个申请程序中正义、公平和平等的根本问题。为了纠正器官分配过程中的这些结构性问题,提出了一种通过层次分析法(AHP)定义规范性标准的多准则模型。
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引用次数: 28
Introduction: Organ transplantation — Defining the boundaries of personhood, equity and community 简介:器官移植-界定人格、公平和社区的界限
Pub Date : 1996-03-01 DOI: 10.1007/BF00489736
P. Marshall
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引用次数: 2
Introduction: Adolescent medicine 简介:青少年医学
Pub Date : 1995-12-01 DOI: 10.1007/BF00995478
M. Sheldon
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引用次数: 2
Genetic research, adolescents, and informed consent. 基因研究,青少年和知情同意。
Pub Date : 1995-12-01 DOI: 10.1007/BF00995481
R F Weir, J R Horton

The participation of adolescents in genetic research engenders unusual problems concerning the nature of their informed consent. In this study we analyze 70 consent documents collected from genetics investigators in the United States who conduct research with children and adolescents. We find that many consent documents do not reflect either the current or the developing ethical and legal standards for research with adolescents and that in many cases the documents are simply confusing or unclear. We make recommendations for change to reflect more adequately the changing perspective concerning the autonomous decision-making capacity of adolescents.

青少年参与基因研究在其知情同意的性质方面产生了不同寻常的问题。在这项研究中,我们分析了70份来自美国遗传学研究人员的同意文件,他们对儿童和青少年进行了研究。我们发现,许多同意文件没有反映当前或正在发展的青少年研究的伦理和法律标准,而且在许多情况下,这些文件只是令人困惑或不清楚。我们提出改革建议,以更充分地反映关于青少年自主决策能力的不断变化的观点。
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引用次数: 4
Reflections on segregating and assessing areas of competence. 关于区分和评估能力领域的思考。
Pub Date : 1995-12-01 DOI: 10.1007/BF00995482
D Checkland, M Silberfeld

Various complexities that arise in the application of legal and/or clinical criteria to the actual assessment of competence/capacity are discussed, and a particular way of understanding the nature of such criteria is recommended.

讨论了将法律和/或临床标准应用于能力/能力的实际评估时出现的各种复杂性,并推荐了一种理解此类标准性质的特殊方法。
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引用次数: 9
The elusive goal of informed consent by adolescents. 青少年知情同意这一难以实现的目标。
Pub Date : 1995-12-01 DOI: 10.1007/BF00995479
S E Zinner

While parents have traditionally provided proxy consent for minors to participate in research, this has proven inadequate for adolescents who are mentally and emotionally capable of making their own decisions. Research has proven that even young children, and certainly most adolescents, are developmentally prepared to make such decisions for themselves. The author challenges the assumption that both consent and assent are static concepts, and proposes that a sliding scale of competence be created to ascertain the adolescent's comprehension of the proposed research by shifting the burden of proof to those who believe a particular adolescent is unable to provide informed consent.

虽然父母传统上为未成年人参与研究提供代理同意,但事实证明,对于在精神和情感上都有能力自己做决定的青少年来说,这是不够的。研究已经证明,即使是年幼的孩子,当然还有大多数青少年,也已经为自己做出这样的决定做好了发育准备。作者对“同意”和“同意”都是静态概念的假设提出了挑战,并建议通过将举证责任转移到那些认为特定青少年无法提供知情同意的人身上,创建一个滑动的能力尺度,以确定青少年对拟议研究的理解。
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引用次数: 22
Adolescent decision-making: giving weight to age-specific values. 青少年决策:赋予年龄特定价值的权重。
Pub Date : 1995-12-01 DOI: 10.1007/BF00995480
R E Ladd, E N Forman

Adults who give proxy consent for medical treatment for adolescents must decide how much weight to give to adolescents' own preferences. There is evidence that some adolescents choose treatments different from what adults see as most reasonable. It is argued that adolescents choose according to age-specific values, i.e. values they hold, as adolescents, and which fulfil important developmental needs. Because not fulfilling these needs may do serious psychological damage, it is urged that proxies give weight to these values, up to the limit where it would endanger or profoundly limit future life.

为青少年的医疗提供代理同意的成年人必须决定在多大程度上重视青少年自己的喜好。有证据表明,一些青少年选择的治疗方法与成年人认为最合理的治疗方法不同。有人认为,青少年根据年龄特定的价值观进行选择,即他们作为青少年所持有的价值观,这些价值观满足了重要的发展需要。由于不满足这些需求可能会造成严重的心理伤害,因此我们敦促代理机构对这些价值观给予重视,直到危及或严重限制未来生活的限度。
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引用次数: 14
Moral growth in medical students. 医学生的道德成长。
Pub Date : 1995-09-01 DOI: 10.1007/BF00998145
J A Knight

Although students bring to medical school a fairly well established value system, the potential for moral growth through the medical school environment and experience is substantial. The educational environment poses a succession of developmental and adaptive tasks to be accomplished. Several of these tasks are discussed her, tasks that are value-laden and involve, directly or indirectly, the interplay of ethical theory and practice. During the past quarter century, the two influences that have had the greatest impact on the moral growth and moral reasoning capacity of medical students have been the incorporation into the medical school curriculum of courses in medical humanities and the admission to medical school of an increasing number of female students. The female students have brought to medical school a level or dimension of moral reasoning (morality as care or responsibility for others) to augment the male students' focus on rights and justice considerations.

虽然学生给医学院带来了相当完善的价值体系,但通过医学院的环境和经历,道德成长的潜力是巨大的。教育环境提出了一系列需要完成的发展和适应性任务。她讨论了其中的几个任务,这些任务是有价值的,直接或间接地涉及伦理理论和实践的相互作用。在过去的25年里,对医学生的道德成长和道德推理能力影响最大的两个因素是医学人文学科被纳入医学院课程和越来越多的女学生进入医学院。女学生给医学院带来了道德推理的一个层次或维度(道德是对他人的关心或责任),以增强男学生对权利和正义考虑的关注。
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引用次数: 11
Empirical and normative aspects of medical technology assessment. The case of reduced-size liver transplantations with living donors. 医学技术评估的经验和规范方面。活体供体小尺寸肝移植病例。
Pub Date : 1995-09-01 DOI: 10.1007/BF00998147
G J Van der Wilt

Medical technology assessment deals with the evaluation of novel or existing health care procedures. This paper addresses the interdependence between factual and normative issues, using the controversies about acceptability and desirability of reduced-size liver transplantations with living donors as example.

医疗技术评估涉及对新的或现有的卫生保健程序的评估。本文讨论了事实和规范问题之间的相互依存关系,以活体供体的小尺寸肝移植的可接受性和可取性为例。
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引用次数: 2
Commentary: Moral growth in medical students 评论:医学生的道德成长
Pub Date : 1995-09-01 DOI: 10.1007/BF00998146
H. Brody, H. A. Squier, J. Foglio
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引用次数: 7
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Theoretical medicine
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