对我国脑死亡立法问题的反思

在对1999年以来我国脑死亡问题的研究成果进行初步梳理的基础上,针对我国学者主张脑死亡立法的主要论据,提出并分析了脑死亡问题的三个主要问题：（1）脑死亡是真正的死亡吗？（2）能否以经济效率的考量来定义生死？（3）器官移植和脑死亡到底有什么关系？还提出,脑死亡立法需要在我国现实的医疗卫生条件下进行讨论。     

认识脑死亡

脑死亡是指脑功能永久性不可逆的完全丧失,而不考虑呼吸心跳是否停止。目前脑死亡临床诊断标准已具有高度准确性。脑死亡的确立对树立新的道德观念、节约社会资源、促进器官移植发展意义重大,但要在中国立法可能还需要一个漫长的过程。     

脑死亡立法的若干法律问题探讨

因为关系到基本人权,脑死亡立法应当由全国人民代表大会立法通过。制定科学的脑死亡标准和严谨的脑死亡判定程序是保障其接近正义的必需。在脑死亡判定方面应充分地保障患者生命权、自主选择权,尊重患者以及家属的知情同意权,保障患者的基本权利是脑死亡立法的核心所在。器官移植不是脑死亡立法的理由。     

When festinger fails: Prophecy and the watch tower

Within its history, the Watch Tower has often set dates for the coming of Christ's millennial reign. The ability of Jehovah's Witnesses to endure the failure of these interpretations of Biblical prophecy reveals the power of the Watch Tower to withstand what would seem to be fatal challenges to its system of belief. In what has become a classic study, the social psychologist Leon Festinger has argued that such disconfirmations of prophecy lead only to deepened conviction and increased proselytism to persuade others that the original belief was correct. Applying Festinger's hypothesis to the prophetic speculation of the Watch Tower, I argue that his model fails to recognize how complex organizations and systems of belief shape responses to disconfirmed prophecy. Indeed, the history of Jehovah's Witnesses demonstrates that organizational structure and ideology constitute crucial variables for any analysis of reaction to prophetic failure. It is the very power of the Watch Tower as a millenarian movement that allows not only the rationalization of disconfirmation but the retrospective denial of the prophecy itself.     

Magic feathers, Wittgensteinian boxes and the politics of deeming

Religious Experience Reconsidered offers an “attribution theory of religion” which builds out from Emile Durkheim’s intuition that the sacred is just some aspect of the world that has been set apart. Despite this theoretical pedigree, however, the book violates the central Durkheimian insight when it goes on to ask whether some things are more likely to be set apart than others. I argue that this impulse is motivated by an unfortunate metaphysical desire to determine if some things really are special. Throwing my hat in with Durkheim, I maintain that the academic study of religion should rest content with analyzing the contested politics of “deeming” something special.     

Legal and Ethical Considerations for Requiring Consent for Apnea Testing in Brain Death Determination

Abstract

The past decade has witnessed escalating legal and ethical challenges to the diagnosis of death by neurologic criteria (DNC). The legal tactic of demanding consent for the apnea test, if successful, can halt the DNC. However, US law is currently unsettled and inconsistent in this matter. Consent has been required in several trial cases in Montana and Kansas but not in Virginia and Nevada. In this paper, we analyze and evaluate the legal and ethical bases for requiring consent before apnea testing and defend such a requirement by appealing to ethical and legal principles of informed consent and battery and the right to refuse medical treatment. We conclude by considering and rebutting two major objections to a consent requirement for apnea testing: (1) a justice-based objection to allocate scarce resources fairly and (2) a social utility objection that halting the diagnosis of brain death will reduce the number of organ donors.     

The ‘redefinition of death’ debate: Western concepts and western bioethics

Biomedicine is a global enterprise constructed upon the belief in the universality of scientific truths. However, despite huge scientific advances over recent decades it has not been able to formulate a specific and universal definition of death: In fact, in its attempt to redefine death, the concept of death appears to have become immersed in ever increasing vagueness and ambiguity. Even more worrisome is that bioethics, in the form of principlism, is also endeavouring to become a global enterprise by claiming neutrality. It appears that the discourse within both disciplines have similarly manipulated the boundaries of death to include the “dying”. This paper argues that the redefinition of death debate in biomedicine reveals a concept of personhood which is profoundly western in origin and which is in accordance to the concept adhered to within principlism. Biomedicine and bioethics do not appear to acknowledge the limitations of their own world view and hence lack an understanding of their applicability and appropriateness in diverse social and cultural contexts; a situation which adds credence to claims as to the hegemonic and imperialistic nature of all such global enterprises. Ms. Jones is an intensive care clinical nursing specialist. Dr. Kessel is a public health physician and medical ethicist.     

BRAIN DEATH AND ITS ENTANGLEMENTS

The Islamic philosophical, mystical, and theological sub‐traditions have each made characteristic assumptions about the human person, including an incorporation of substance dualism in distinctive manners. Advances in the brain sciences of the last half century, which include a widespread acceptance of death as the end of essential brain function, require the abandonment of dualistic notions of the human person that assert an immaterial and incorporeal soul separate from a body. In this article, I trace classical Islamic notions of death and the soul, the modern definition of death as “brain death,” and some contemporary Islamic responses to this definition. I argue that a completely naturalistic account of human personhood in the Islamic tradition is the best and most viable alternative for the future. This corporeal monistic account of Muslim personhood as embodied consciousness incorporates the insights of pre‐modern Muslim thinkers yet rehabilitates their characteristic mistakes and thus has the advantages of neuroscientific validity and modern relevance in trans‐cultural ethical discourse; it also helps to alleviate organ shortages in countries with majority Muslim populations, a serious ethical impasse of recent years.     

ICU医务人员在心脏死亡器官捐献中面临的伦理问题及对策

心脏死亡器官捐献是目前解决器官移植工作器官短缺的关键性举措,参与器官捐献过程的ICU的医务人员需要直接面临对潜在捐献者的治疗照护、临终护理、死亡判定等诸多伦理问题.应加强ICU医务人员器官捐献伦理知识的普及教育并完善相关法律制度,以保证器官捐献工作的健康、可持续发展.     

死亡的判定

死亡是生命的终结.死亡判定的标准在历史上经历了一个逐步深化的过程.1959年2位法国医学家首先提出了脑死亡的概念.但是什么是脑死亡,以及如何判定脑死亡是一个有争议的问题.1981年美国总统委员会提出了一个脑死亡的判定指标体系,并被一些国家立法接受.回顾了对死亡判定认识的历史过程.     

国内外器官捐献立法的比较研究

基于国内外器官移植供体的来源、捐献的同意原则、器官的获取与分配、法律基础、供体的死亡标准这五大方面的对比,总结了器官移植发达国家相关法律法规的闪光点。完善我国的器官捐献立法可以考虑从扩大器官移植供体来源、引进相对适合我国国情的“柔性推定同意模式”、加快推进具有更高法律效力的“器官移植法”的出台并将脑死亡写入法案,以及培养具有良好职业素养和较强沟通能力的器官移植协调员等多方面出发,以推动我国器官捐献事业的可持续、健康发展。

     

"脑死亡=死亡"生物医学定律的逻辑论证

心脏具有顽固自律性、可多次复苏性、功能可人工替代性、可多次置换性四大特点,因而已失去作为死亡判定权威器官的地位.而大脑由于具有统领性、损坏后不可恢复性、功能不可替代性、全脑不可置换性四大特点,已替代心脏成为死亡判定的靶器官."脑死亡=死亡"在相当长时期内都将是一个严格的科学定义.     

人体器官“有偿”获取机制的伦理依据与法律观照

人体器官、组织无偿捐献是当今获取器官的主流模式, 有偿模式 (含经济补偿、捐赠激励) 被排斥在体制之外。创建符合国情的器官捐献和移植体系, 既遵循我国社会的普遍伦理法则, 又符合国际通行的器官移植伦理标准, 提倡无偿、允许有偿 (补偿、激励) 获取人体器官模式和机制可能成为一种切合实际的选择。这既是对多年来关于人体器官“无偿”还是“有偿”获取讨论的回应, 也是对器官捐献机制的一个重大改进。为使这一机制真正发挥效力, 需要法律与伦理的融通和观照。     

人体器官买卖成因和对策的法学思考

器官供需严重不平衡导致了人体器官买卖的产生,器官买卖对供体和受体均存在潜在风险,对社会危险性也不容忽视.分析了器官买卖链条中供体、受体和中介各自的角色和地位,并提出了立法推动尸体器官捐献、加强医院和医务人员承担的法律责任、打击买卖中介和加强网络监管等建议.     

NATURE AS THE IMAGE OF GOD: REFLECTIONS ON THE SIGNS OF THE SACRED

Abstract. This is a brief survey of aspects of the modern scientific view of nature to see if implied therein are signs or traces of the sacred–as early religious apprehension surely supposed. Nature's power and order are discussed as is the strange dialectic of death and life, evident in modern biology as it also is in all early religion.     

技术之后是法规和观念的更新--中国器官移植的重大进展

从我国器官移植的历史和现状出发,在器官移植的技术和基础研究有了理观念的更新.这种更新应建立在对器官移植的伦理思考和讨论的基础之上.2003年我国关于器官移植的法规和观念有了新的突破,有关的管理办法和条例也在草拟之中.中国政府和医学界对器官移植始终持积极和慎重的态度,所谓"中国移植和买卖死刑犯器官"完全是别有用心的捏造.     

移植协调员在DCD工作中的角色和作用

器官捐献是器官移植事业发展的基石,而协调员在器官捐献工作中则有着举足轻重的地位和作用。自2010年3月我国推行人体器官捐献试点工作以来,适合中国国情的DCD工作成为器官捐献工作的重中之重。如何充分发挥协调员在DCD工作中的作用,提高DCD捐献率和供体转化率,以有效地促进和推动DCD工作,是急待探讨和解决的问题。本文结合...     

Lifelong minority religion: routines and reflexivity: A Bourdieuan perspective on the habitus of elderly Finnish Orthodox Christian women

Applications of the concept of habitus to research on religion have increased in recent decades. At present, Pierre Bourdieu's interpretation of the concept is perhaps the most well known. Nevertheless, it has also met with criticism. This article utilizes Bourdieuan theorizations to discuss the habitus of elderly Finnish Orthodox Christian women. The author examines the women's dispositions in relation to their changing minority position within Finnish society, and identifies the dynamic between reflexivity and routine practice as being central to their religion. The analysis demonstrates the value of Bourdieu's understanding of habitus when studying the long-term effects of social power on subjectivity – as reflected, for instance, in lifelong minority religion. The author argues, moreover, that contrary to the claims of many critics, Bourdieu's approach is suitable for inquiries into the conscious dimensions of practicing, in so far as these are conceived of as grounded in individuals’ past and present conditions of religious practice.     

我国公民逝世后器官捐献工作影响因素分析

探讨我国公民逝世后器官捐献工作的影响因素,为提高器官捐献率,推动器官捐献事业的发展,提供决策参考。通过文献查阅等方法,从政治、经济、社会和技术四个方面对影响公民逝世后器官捐献工作的因素进行深入分析。器官捐献与移植工作是一项系统工程,影响因素众多,为做好器官捐献与移植工作,需要政府、医疗机构和社会公众等多方面的努力和配合,从政治、经济、社会、技术等多个层面采取针对性的策略,以进一步提高器官捐献成功率。     

“人体器官移植工作体系”框架的初步构想及其伦理使命

借鉴国内外相关成功经验,结合我国实际情况,对“人体器官移植工作体系”的构成以及各系统职能进行初步探讨。研究了该体系在阻止人体器官商业化、提高人体移植器官分配的公平高效性等方面发挥的作用。