Social Acceptability, Personal Responsibility, and Prognosis in Public Judgments and Transplant Allocation
Social Acceptability, Personal Responsibility, and Prognosis in Public Judgments and Transplant Allocation
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公共判断和移植分配中的社会可接受性、个人责任和预后
DOI：
10.1111/1467-8519.00131
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发表时间：
1999
期刊：
影响因子：
2.2
通讯作者：
D. Asch
中科院分区：
文献类型：
--
作者：
P. Ubel;J. Baron;D. Asch
一些普通公众认为，由于吸烟、酗酒或吸毒而导致自身器官衰竭的患者不应获得同等优先的稀缺可移植器官。这可能反映了一种信念，即这些患者（1）导致自己的疾病，（2）移植效果不佳，或者（3）根本不值得。我们探讨了社会可接受性、个人责任和预后在人们对移植分配的判断中所起的作用。方法采用随机抽样的方法，对费城县283名准陪审员进行5种问卷调查。在所有的问卷调查中，受试者被要求在有和没有3种有争议的行为史的患者之间分配可移植的心脏（违反医生的建议吃高脂肪饮食，吸烟或静脉注射毒品）。在5个问卷版本中，我们改变了移植候选人的相对预后以及他们的行为是否导致了他们的主要器官衰竭。结果受试者对静脉吸毒者器官分配的意愿显著低于吸烟者和高脂饮食者（p <0.05）。结论人们不愿意将稀缺的可移植器官分配给有争议行为的患者，不能完全用这些行为导致原发器官衰竭或使其移植效果更差来解释。相反，许多人认为，这样的病人只是不值得稀缺的可移植器官。
Background Some members of the general public feel that patients who cause their own organ failure through smoking, alcohol use, or drug use should not receive equal priority for scarce transplantable organs. This may reflect a belief that these patients (1) cause their own illness, (2) have poor transplant prognoses or, (3) are simply unworthy. We explore the role that social acceptability, personal responsibility, and prognosis play in people's judgments about transplant allocation. Methods By random allocation, we presented 283 prospective jurors in Philadelphia county with one of five questionnaire versions. In all questionnaires, subjects were asked to distribute transplantable hearts between patients with and without a history of 3 controversial behaviors (eating high fat diets against doctors' advice, cigarette smoking or intravenous drug use). Across the 5 questionnaire versions, we varied the relative prognosis of the transplant candidates and whether their behavior caused their primary organ failure. Results Subjects were significantly less willing to distribute organs to intravenous drug users than to cigarette smokers or people eating high fat diets (p Conclusion People's unwillingness to give scarce transplantable organs to patients with controversial behaviors cannot be explained totally on the basis of those behaviors either causing their primary organ failure or making them have worse transplant prognoses. Instead, many people believe that such patients are simply less worthy of scarce transplantable organs.