Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees最新文献

{"title":"Notes from an Organ Recipient: Once is Enough.","authors":"Annie Klebahn Condon","doi":"10.1017/S0963180121001092","DOIUrl":"https://doi.org/10.1017/S0963180121001092","url":null,"abstract":"<p><p>In this paper, the author describes her personal experiences with liver disease and the challenges both before and after receiving an organ transplant. She describes how organs are currently allocated and offers her perspective on what fairness entails in situations where organs fail and patients need multiple organs.</p>","PeriodicalId":520577,"journal":{"name":"Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees","volume":" ","pages":"400-402"},"PeriodicalIF":1.8,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40638561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cases Abusing Brain Death Definition in Organ Procurement in China.","authors":"Norbert W Paul,&nbsp;Kirk C Allison,&nbsp;Huige Li","doi":"10.1017/S0963180121001067","DOIUrl":"https://doi.org/10.1017/S0963180121001067","url":null,"abstract":"<p><p>Organ donation after brain death has been practiced in China since 2003 in the absence of brain death legislation. Similar to international standards, China's brain death diagnostic criteria include coma, absence of brainstem reflexes, and the lack of spontaneous respiration. The Chinese criteria require that the lack of spontaneous respiration must be verified with an apnea test by disconnecting the ventilator for 8 min to provoke spontaneous respiration. However, we have found publications in Chinese medical journals, in which the donors were declared to be brain dead, yet without an apnea test. The organ procurement procedures started with initiating \"intratracheal intubation for mechanical ventilation after brain death,\" indicating that a brain death diagnosis was not performed. The purpose of the intubation was not to resuscitate the patient but rather was directly related to facilitating the explantation of organs. Moreover, it was unmistakably stated in two of these publications that the cardiac arrest was induced in these patients without brain death determination by cold St. Thomas cardioplegic solution or other cold myocardial protection solutions. This means that the condition of these donors neither met the criteria of brain death nor that of cardiac death. In other words, the \"donor organs\" may well have been procured in these cases from living human beings. Thus, brain death definition is abused in China by some individuals for organ harvesting, and a systematic investigation is needed to clarify the situation of organ donation after brain death in China.</p>","PeriodicalId":520577,"journal":{"name":"Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees","volume":" ","pages":"379-385"},"PeriodicalIF":1.8,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40641065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balancing Equity and Efficiency in Kidney Allocation: An Overview.","authors":"Amir Elalouf,&nbsp;Joseph S Pliskin","doi":"10.1017/S0963180121001018","DOIUrl":"https://doi.org/10.1017/S0963180121001018","url":null,"abstract":"<p><p>Organs for transplantation are a scarce resource. Markedly, the transplant community's primary challenge is the stark disparity between the number of patients awaiting deceased donor organ transplants and the rate at which organs become available. However, the allocation of a limited number of organs poses another constant challenge: maintaining an equilibrium between renal transplant utility and equity, that is, striking a balance between the utilitarian argument of medical efficiency and the principle of equity. In this comprehensive overview, the authors delve into the challenge of maintaining an acceptable balance between equity and efficiency and elaborate on some of the factors that might inform a decisionmaker's evaluation of the extent to which a given allocation scheme is efficient or equitable.</p>","PeriodicalId":520577,"journal":{"name":"Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees","volume":" ","pages":"321-332"},"PeriodicalIF":1.8,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40638559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Vignettes in Transplant Psychiatry Ethics.","authors":"H Paul Chin","doi":"10.1017/S0963180121001079","DOIUrl":"https://doi.org/10.1017/S0963180121001079","url":null,"abstract":"<p><p>The demand for liver transplants continues to far exceed the number of available viable donor organs; hence, it is of utmost importance to determine those individuals who are best able to care for these valuable, limited resources as potential recipients. At the same time, psychiatric comorbidity is common in the course of end-stage liver disease and can be mutually complicating. This article focuses on liver transplant candidacy from a psychiatric perspective, using illustrative cases to underscore the foundational facets of medical ethics that serve as the guide to these complex medical and ethical decisions.</p>","PeriodicalId":520577,"journal":{"name":"Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees","volume":" ","pages":"386-394"},"PeriodicalIF":1.8,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40641066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Duty to Protect, Abortion, and Organ Donation.","authors":"Emily Carroll,&nbsp;Parker Crutchfield","doi":"10.1017/S096318012100102X","DOIUrl":"https://doi.org/10.1017/S096318012100102X","url":null,"abstract":"<p><p>Some people oppose abortion on the grounds that fetuses have full moral status and thus a right to not be killed. We argue that special obligations that hold between mother and fetus also hold between parents and their children. We argue that if these special obligations necessitate the sacrifice of bodily autonomy in the case of abortion, then they also necessitate the sacrifice of bodily autonomy in the case of organ donation. If we accept the argument that it is obligatory to override a woman's bodily autonomy for the sake of an unborn child's survival, we must continue to override the bodily autonomy of parents to ensure the survival of their living children, until the parent no longer has a special obligation to their child to the same degree as their special obligation to the fetus. And if the life of a child is truly more important than the bodily autonomy of its parents, as must be the case to force women to carry unwanted pregnancies to term, this should remain true until such a time that their children are no longer considered their responsibility. Thus, parity of reasoning suggests that policies compelling the gestation of a fetus should be accompanied by policies compelling organ donation.</p>","PeriodicalId":520577,"journal":{"name":"Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees","volume":" ","pages":"333-343"},"PeriodicalIF":1.8,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40638553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Transplant Trolley Problem.","authors":"Robert Osorio,&nbsp;Guillermo Palchik","doi":"10.1017/S0963180121000980","DOIUrl":"https://doi.org/10.1017/S0963180121000980","url":null,"abstract":"Since being introduced by Philippa Foot in 1967, The Trolley Problem has generated somuch debate and discussion that it has earned its own droll designation “Trolleyology.”However, the circumstances differ, and the dilemmas in these scenarios involve a trolley going down the tracks on course to run down helpless persons in their way. An observer is forced to choose the levers to pull in order to save which lives. The dilemma posed is whether and when it is permissible to knowingly and intentionally sacrifice a life in order to save more. There has been criticism of the Trolley Problem as a remote from reality philosopher’s thought experiment with little real-world context.12 However, from the perspective of those of us in the trenches of organ transplantation, those dilemmas are real, and being routinely faced when life and death decisions are part of our daily struggles. In the transplant world, we have a mismatch of supply and demand. The demand for organs is the runaway trolley, and the transplant community must decide which levers to pull. Until the supply issue is addressed by breakthroughs in technology, we have to deal with things as they are. Currently, organ transplantation is like having a car in which the carburetor or piston is not working and, instead of changing those parts, the whole engine must be taken out and replaced with a new one. Someday such a procedure will seem barbaric. If a patient’s liver or heart has a deficiency, wemay be able to inject stem cells that will differentiate themselves and fix the failing organ.3 Alternatively, if someone is born with an enzyme deficiency, why replace the whole organ when replacing the enzyme4 will do? We are not technologically there yet, but eventually we are going to know how to repair an organ’s function. Similarly, compared to what will be available in the future, our treatment of kidney disease is very rudimentary. Instead of a huge machine, we will be able to make a dialysis filter so small that it will be implantable and replace your kidney.5 Furthermore, in the future, advancing technology will develop perfusion machines that may allow nontransplantable organs to heal outside the body and become transplantable.6 Organs will be able to be perfused on amachine and pumpedwith the right nutrients and oxygen to keep it alive as it heals.Maybe, with preservation, multiplemore organs could be saved,making for a broader sharing of organs for those on waiting lists and have supply come closer to meeting demand. Lately, we are hearing more about resurrecting the question of using xenografts.7 Could this be an acceptable source of organs to help solve the supply problem? What would be the cost benefit analysis? An obvious possible risk would be Zoonosis—the introduction of a whole new set of viruses and other infections from other species into humans. We need only to be reminded of COVID-19 and multiple hypotheses possibly stemming from bats8 to ring alarm bells—and those are only the prac","PeriodicalId":520577,"journal":{"name":"Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees","volume":" ","pages":"281-284"},"PeriodicalIF":1.8,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40638556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Restrictivism, Abortion, and Organ Donation.","authors":"William Simkulet","doi":"10.1017/S0963180121001043","DOIUrl":"https://doi.org/10.1017/S0963180121001043","url":null,"abstract":"Introduction Restrictivism1 is the view that abortion is immoral and should be illegal in most cases with rare exceptions, such as when the mother’s life is at risk. Restrictivist opposition to abortion is grounded in two beliefs that (1) human fetuses are persons, broadly construed, with a right to life, and (2) that parents have special moral obligations to protect their children. Judith Jarvis Thomson2 argues that even if we assume fetuses are persons with a right to life, this alone would not entitle the fetus to use the mother’s body against her will. However, restrictivists can meet this challenge if they can show that gestational mothers, qua parents, have special moral obligations to protect their fetuses. Restrictivists believe these special obligations necessitate parents to sacrifice their bodily autonomy and take on significant medical risks and burdens to protect their children. In a recent article, Emily Carrol and Parker Crutchfield3 argue that if (1) and (2) justify restricting women’s rights to bodily autonomy, it creates a similarly burdensome obligation for parents to donate blood, tissues, marrow, and organs to their children. Nicholas Colgrove, Bruce Philip Blackshaw, and Daniel Rodger4 call this kind of argument an inconsistency argument, dilemmas that share the following form: either restrictivists ought to (1) abandon their opposition to abortion or (2) do more—in this case, restrictivists ought to advocate for legislation that forces all parents to sacrifice their bodily autonomy to protect their children and donate. Carrol and Crutchfield argue that such legislation, in addition to restricting abortion, would require parents to donate blood, tissue, marrow, and even organs to their children. In this paper, I argue that Carroll and Crutchfield fail to show that restrictivism requires such legislation. My argument turns on safehaven laws—laws that allow parents to surrender their parental obligations to the state. The rationale for safehaven laws is clear: safehaven laws promote child welfare by giving parents a way to provide for their children without personal sacrifice. Struggling parents unable to provide for their children can be assured the state will provide for them, whereas unwilling parents can legally offload their children on the state, avoiding personal sacrifice while assuring their children are taken care of. However, should restrictivist legislation require parents to donate, this would incentivize parents to neglect their children’s medical care, or abandon their children using safehaven laws. Rather than promote the child’s welfare, restrictivist donation legislation would hinder it.","PeriodicalId":520577,"journal":{"name":"Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees","volume":" ","pages":"348-354"},"PeriodicalIF":1.8,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40638557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Full Reciprocity: An Essential Element for a Fair Opt-Out Organ Transplantation Policy.","authors":"Leonard Fleck","doi":"10.1017/S0963180121001006","DOIUrl":"https://doi.org/10.1017/S0963180121001006","url":null,"abstract":"<p><p>In this paper, I argue for the following points. First, all of us have a presumptive moral obligation to be organ donors if we are in the relevant medical circumstances at the time of death. Second, family members should not have the right to interfere with the fulfillment of that obligation. Third, the ethical basis for that obligation is reciprocity. If we want a sufficient number of organs available for transplantation, then all must be willing donors. Fourth, that likelihood is diminished if individuals are entirely free to refuse to be organ donors but still would demand to be organ recipients. Fifth, although individuals would be ethically obligated to be organ donors, we still need to permit them to refuse to be organ donors. Sixth, to encourage individuals to stay within the organ donation system, we should have as a just and ethically justified policy denying individuals an organ transplant in the relevant medical circumstances if they have chosen to exit the organ donation system. Individuals would not be permitted to be organ recipients if they were unwilling to be organ donors. This is what it means to be part of what Rawls in <i>Political liberalism (15-22)</i> would refer to as a \"fair system of social cooperation.\" We refer to this as the \"reciprocity requirement.\"</p>","PeriodicalId":520577,"journal":{"name":"Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees","volume":" ","pages":"310-320"},"PeriodicalIF":1.8,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40638558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Philosophy for Choosing Doctors.","authors":"Jacob M Appel","doi":"10.1017/S0963180121001110","DOIUrl":"https://doi.org/10.1017/S0963180121001110","url":null,"abstract":"<p><p>This essay advocates for the wholesale reevaluation of the process used by American medical schools for selecting physicians, examining fundamental questions such as the purpose of physicians and the nature of meritocracy. It raises questions about the size of medical school classes, the specific academic requirements, and the inadequacy of current efforts to increase diversity. Ultimately, the essay argues for consideration of a range of reforms that will focus on the community-empowering aspects of medical admissions decisions.</p>","PeriodicalId":520577,"journal":{"name":"Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees","volume":" ","pages":"407-410"},"PeriodicalIF":1.8,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40638555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organ Trafficking: Why Do Healthcare Workers Engage in It?","authors":"Trevor Stammers","doi":"10.1017/S0963180121000931","DOIUrl":"https://doi.org/10.1017/S0963180121000931","url":null,"abstract":"<p><p>Organ trafficking in all its various forms is an international crime which could be entirely eliminated if healthcare professionals refused to participate in or be complicit with it. Types of organ trafficking are defined and principal international declarations and resolutions concerning it are discussed. The evidence for the involvement of healthcare professionals is illustrated with examples from South Africa and China. The ways in which healthcare professionals directly or indirectly perpetuate illegal organ transplantation are then considered, including lack of awareness, the paucity of both undergraduate and postgraduate education on organ trafficking, turning a blind eye, advocacy of organ commercialism, and the lure of financial gain.</p>","PeriodicalId":520577,"journal":{"name":"Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees","volume":" ","pages":"368-378"},"PeriodicalIF":1.8,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40638554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}