Death, organ transplantation and medical practice.
Death, organ transplantation and medical practice.
复制标题
死亡，器官移植和医疗实践。
DOI：
10.1186/1747-5341-3-5
复制
发表时间：
2008-02-04
期刊：
影响因子：
--
通讯作者：
Bos MA
中科院分区：
文献类型：
--
作者：
Huddle TS;Schwartz MA;Bailey FA;Bos MA
《医学哲学、伦理学和人文科学》（PEHM）最近发表了一系列论文，讨论了非心脏跳动器官捐赠者是否活着，以及非心脏跳动器官捐赠（NHBD）是否违反了死亡捐赠者规则。一些认为NHBD涉及从活着的病人身上摘取器官的作者呼吁“强烈的不可逆性”（复苏努力无法恢复生命的死亡）作为病人必须满足的必要标准，医生才能宣布他们死亡。Sam Shemie为我们目前的NHBD实践辩护，他认为事实上，医生根据医生是否复苏的意图来判断病人是否死亡。我们认为一个概念的标准不一定是涉及该概念的断言的真值条件。因此，不跳动的捐献者可能在不符合强不可逆性标准的情况下被宣布死亡，尽管死亡的概念暗示了强不可逆性。我们对一个概念在特定情况下的应用的感知不是由概念本身决定的，而是由我们在使用它时所必需的技能和判断决定的。在决定病人死亡的情况下，这种判断是医生在学习医学实践时学到的，可能会根据情况而有所不同。因此，可以为目前的NHBD实践辩护，而不必像谢米那样，将死亡作为一个经验概念抛弃。我们的结论是，死亡捐献者规则仍然是可行的，应该保留，以保证公众最关心的器官捐赠：医生可以信任，以患者的利益来决定器官捐赠的资格，而不是为了其他目的，如增加器官的可用性。
A series of papers in Philosophy, Ethics and Humanities in Medicine (PEHM) have recently disputed whether non-heart beating organ donors are alive and whether non-heart beating organ donation (NHBD) contravenes the dead donor rule. Several authors who argue that NHBD involves harvesting organs from live patients appeal to "strong irreversibility" (death beyond the reach of resuscitative efforts to restore life) as a necessary criterion that patients must meet before physicians can declare them to be dead. Sam Shemie, who defends our current practice of NHBD, holds that in fact physicians consider patients to be dead or not according to physician intention to resuscitate or not. We suggest that criteria for a concept are not necessarily truth conditions for assertions involving the concept. Hence, non-heart beating donors may be declared dead without meeting the criterion of strong irreversibility even though strong irreversibility is implied by the concept of death. Our perception that a concept applies in a given case is determined not by the concept itself but by our necessary skill and judgment when using it. In the case of deciding that a patient is dead, such judgment is learned by physicians as they learn the practice of medicine and may vary according to circumstances. Current practice of NHBD can therefore be defended without abandoning death as an empirical concept, as Shemie appears to do. We conclude that the dead donor rule continues to be viable and ought to be retained so as to guarantee what the public most cares about as regards organ donation: that physicians can be trusted to make determinations of eligibility for organ donation in the interests of patients and not for other purposes such as increasing the availability of organs.