Brain dead, brain absent, brain donors: human subjects or human objects?
Brain dead, brain absent, brain donors: human subjects or human objects?
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脑死亡、大脑缺失、大脑捐赠者：人类受试者还是人类物体？
DOI：
10.1136/jme.20.2.124-a
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发表时间：
1994
影响因子：
4.1
通讯作者：
T. Oppé
中科院分区：
文献类型：
--
作者：
T. Oppé
关于配给医疗保健的辩论通常是以一种假设我们能够衡量群体和个人的医疗保健需求的方式进行的。正如本书所明确指出的，我们才刚刚开始建立一个框架，在这个框架内，我们可以衡量健康需求，预测治疗结果，并确定影响资源分配的相互冲突的优先事项。这本书是一位哲学家试图组织我们对这些复杂问题的思考。卫生保健需要是林雪平大学发表的一篇博士论文的修订版。本报告旨在探讨一项经常被建议的准则，用以分配医护资源。在许多国家，资源与需求之间的联系并不明确，但在瑞典，《公共卫生法》规定，卫生保健系统的政策只能由病人的需求决定。这本书借鉴了欧洲、英国和北美的广泛工作。这本书是按照逻辑顺序写的。它审视了医疗保健指标的使用，并指出，不太完美的健康指标并不能确定一种需要。对服务的既定使用也不表明有此需要。三种可能的定义的健康需要进行了讨论：供应的概念，其中的健康需要取决于存在一个合适的治疗;规范的概念，指出存在的医疗保健需要是一个意见问题;和工具的概念，它定义的医疗保健系统内的设备和设施的可用性方面的健康需要。这些定义是密切争论，并导致进一步的章节讨论的概念，需要，概念的健康状况不佳，并排名卫生保健需求。本书的结尾部分提出了一个评估医疗保健的模型。需求评估应包括确定个人的实际健康状况，设定医疗保健目标，并确定是否有一种治疗方法可以实现实际状态和目标之间的过渡。以这种方式定义的健康需求与帮助人们实现自己的目标有关，这些目标将使他们感到快乐。卫生保健目标可以选择，正是这些选择的作出，使卫生保健需求的存在。在社会中确定这些目标需要专业人员和公民参与代表机构，无论是民主选举的机构还是卫生当局。这本书没有达到解决卫生服务研究人员、临床医生或管理人员在确定需求、分配资源或在个人之间做出选择时所面临的问题的实际水平。这些领域仍然很复杂，很难开展工作。许多人已经在讨论的离散领域工作，尽管一些应用研究可以从清晰的思路中受益，以制定一个有序的方法来解决这个问题。NHS研究和发展战略等倡议支持确定有效治疗的概念，但不太清楚分配资源支持这些治疗的标准。这本书并没有给出一系列简单的答案。临床医生和管理人员都将与之斗争。然而，它将为那些阅读它的人提供一个挑战。安德鲁法默卫生服务研究单位，公共卫生和初级保健系，牛津大学，拉德克利夫医院，牛津OX 2 6 HE
The debate about rationing health care is often conducted in a way that assumes we are able to measure the health care needs of groups and individuals. As this book makes clear, we are only just starting to develop a framework within which to measure health needs, predict the outcomes of treatments and define the conflicting priorities that influence resource allocation. This book is the attempt of a philosopher to organise our thinking about these complex issues. Health care need is a revised version of a doctoral thesis published by Linkoping University. It sets out to explore one frequently suggested criterion for allocating resources for health care. In many countries the link between resources and need is not explicit, but in Sweden the Public Health Act lays down that the policies of the health care system should be determined only by the needs of patients. The book draws on a wide range of work across Europe, the United Kingdom and North America. The book follows a logical progression. It looks at the use of health care indicators and points out that indicators of less than perfect health do not establish a need. Neither does the established use of services indicate a need. Three possible definitions of health need are discussed: the supply notion, in which a health need depends on the existence of a suitable treatment; the normative notion, which states that the existence of a health care need is a matter of opinion; and the instrumental notion, which defines health need in terms of the availability of equipment and facilities within the health care system. These definitions are closely argued and lead on to further chapters discussing the concept of need, concepts of ill health, and ranking health care needs. The closing section of the book suggests a model for assessing health care. Need assessment should involve establishing the actual health state of individuals, setting the goals of health care, and determining whether there is a treatment that will bring about a transition between the actual state and the goal. Health needs, defined in this way, are linked to helping people reach their own goals the things that will make them happy. Health care goals may be chosen, and it is the making of these choices that brings health care needs into existence. Defining these goals within society requires the involvement of professionals and citizens within representative bodies, whether these are democratically elected or health authorities. The book does not reach the practical level of tackling the problems faced by health service researchers, clinicians or managers in defining needs, allocating resources or making choices between individuals. These are areas that remain complicated and difficult to work in. Many people are already working in the discrete areas discussed, although some applied research could benefit from the clarity of thought in developing an ordered approach to the subject. Initiatives such as the NHS Research and Development Strategy have supported the concept of identifying effective treatments, but are less clear about criteria for allocating resources to support these treatments. The book does not give a list of easy answers. Clinicians and managers alike will struggle with it. However, it will provide a challenge to those who read it. ANDREW FARMER Health Services Research Unit, Department of Public Health and Primary Care, Oxford University, Radcliffe Infirmary, Oxford OX2 6HE