Sibling Obligations in Health Care

项目摘要/摘要 这个项目的目标是写一本书，阐述 医疗保健行业的兄弟姐妹。关心兄弟姐妹的原因是他们可能是我们最长久的关系 活着。这种关系(通常但不总是)包括共同的教养、共同的基因和共同的 秘密，它们往往是我们心理和情感上最重要的关系 发展。关心兄弟姐妹在医疗保健方面的责任和义务的原因是 一个兄弟姐妹的健康问题会对其他兄弟姐妹的健康产生影响。有时这可能意味着另一个 兄弟姐妹患同样疾病或疾病的风险增加(由于遗传或环境原因)。其他时候，它 可能意味着家庭资源和精力不成比例地集中在家庭成员身上 使其他兄弟姐妹失望的混乱或状况。它还可能导致请求或要求 兄弟姐妹的帮助-从信息共享到组织或器官捐赠，再到身体护理或代理决定- 制作。 “我们对兄弟姐妹有什么义务？”这个问题在很大程度上仍然没有得到回答。 哲学文献和生物伦理学文献，而不仅仅是在医疗保健方面，尽管 我们中的大多数人在有一个以上孩子的家庭中出生和长大(至少在美国是这样 (美国)以及这些关系持续存在的事实，尽管强度、接近和 生命中的相互性。为了写这本书，我需要建立一个规范的框架，用来思考 关于兄弟姐妹关系、义务和责任，以适应极大的变异性和多样性 在家庭和家庭结构中。然后，需要对该框架在各种临床应用中的实用性进行评估。 与亲密度、亲缘关系和年龄接近程度不同的兄弟姐妹的环境。我会用 五个保健领域的病例：1)实体器官和组织移植；2)辅助生殖；3) 遗传学；4)人体实验；5)为残疾兄弟姐妹或与残疾兄弟姐妹一起做决定。这个 方法论将涉及对案例研究和经典问题的伦理分析，这些问题将被分析到 在规范性理论和对案例的判断之间实现反思平衡。案例和经典 问题是这本书的一个重要组成部分，因为它们有助于理解复杂的事物 问题，并强调家庭内部保健责任和义务的社会背景；和2)呼吁 面向广大卫生保健专业人员、生物伦理学家和其他对兄弟姐妹感兴趣的社会科学家 两性关系。

PROJECT SUMMARY/ABSTRACT The goal of this project is to write a book that addresses the responsibilities and obligations between siblings in health care. The reason to care about siblings is that they may be the longest relationship of our lives. It is a relationship that (usually but not always) involves a shared upbringing, shared genes and shared secrets, and they are often the most significant relationships with respect to our psychological and emotional development. The reason to care about sibling responsibilities and obligations in health care is that a diagnosis of a health problem in one sibling has health implications for the others. Sometimes it may mean that the other siblings are at increased risk for the same disorder or condition (due to genetics or environment). Other times it may mean that family resources and energy are disproportionately focused on the family member with the disorder or condition to the disappointment of the other siblings. It may also lead to a request or demand for sibling help—from information sharing to tissue or organ donation to physical care giving or proxy decision- making. The question, “What are our obligations to our siblings?”, remains largely unanswered in the philosophical literature and in the bioethics literature generally, and not just specifically in health care, despite the fact that most of us are born and raised in families with more than one child (at least in the United States (US) and the fact that these relationships persist, albeit with changing degrees of intensity, proximity, and mutuality across the lifespan. To write this book, I need to develop a normative framework with which to think about sibling relationships, obligations and responsibilities that can accommodate great variability and diversity in families and family structures. Then, the utility of this framework needs to be evaluated in various clinical settings with siblings of different degrees of intimacy, biological relatedness and proximity of age. I will use cases in five areas of health care: 1) solid organ and tissue transplantation; 2) assisted reproduction; 3) genetics; 4) human experimentation; and 5) decision making for and with siblings with disabilities. The methodology will involve an ethical analysis of case studies and classic problems that will be analyzed to achieve reflective equilibrium between the normative theory and judgments about the cases. Cases and classic problems are an important component of the book because they facilitate 1) comprehension of the complex issues and highlight the social context of intrafamilial health care responsibilities and obligations; and 2) appeal to a broad audience of health care professionals, bioethicists and other social scientists interested in sibling relationships.