脑死亡判定的伦理学及实践中的几个问题

脑死亡是临床实践中的常见问题,随着当代医学科学的发展,经过临床严格的判定程序,患者脑死亡即生物学死亡已经成为科学标准,但由于我国在脑死亡立法、公众认知以及医生的各种心理考量,在我国开展脑死亡的判定还存在许多障碍。我们结合自己在判定患者脑死亡后的医患心理变化,以及存在的一些问题,期望引起更多的医学、法学和社会学家关注,使得临床医生对脑死亡的判定,顺应科学发展又能符合患者及其家属的最大利益。     

脑死亡判定的伦理学及实践中的几个问题

脑死亡是临床实践中的常见问题.随着当代医学科学的发展,经过临床严格的判定程序,患者脑死亡即生物学死亡已经成为科学标准,但由于我国在脑死亡立法、公众认知以及医生的各种心理考量,在我国开展脑死亡的判定还存在许多障碍.我们结合自己在判定患者脑死亡后的医患心理变化,以及存在的一些问题,期望引起更多的医学、法学和社会学家关注,使得临床医生对脑死亡的判定,顺应科学发展又能符合患者及其家属的最大利益.     

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.     

脑死亡立法的伦理辩护

"脑死亡"立法是必要的并可以得到充分的伦理辩护:尊重人,特别是尊重人的自主性是"脑死亡"立法的伦理基础."脑死亡"立法符合有利和公平的伦理原则,符合功利主义伦理学追求社会利益最大化的目的.但我们在立法时,应尽量贯彻不伤害原则,注意保护患者及其亲属的利益.     

关于"脑死亡"立法科学与伦理的纷争

我国对脑死亡的研究起步于 2 0世纪 80年代。1980年 ,学者李德祥提出脑死亡应是全脑死亡 ,从而克服了大脑死、脑干死等脑的部分死亡等同于脑死亡的缺陷[1] 。中国医学界开始讨论建立我国自己的脑死亡标准。 1997年在全国第七届卫生立法讲习班上 ,有 2 0多位国内的知名专家 ,联名提出关于脑死亡标准的立法问题。 1999年中华医学会组织了脑死亡标准 (草案 )专家研讨会 ,并提出了脑死亡诊断标准[2 ] 。同年 ,解放军总医院的人大代表李炎唐教授在全国人大会议上提交了关于脑死亡及器官移植的立法提案 ,促使我国脑死亡立法的步伐越来越快。2 0 0 …     

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。     

刑法视域下的人体器官移植

为有效规制我国的人体器官移植犯罪活动,保障公民的生命健康权,维护医疗卫生管理秩序,从我国器官移植的立法现状入手,运用调查法、文献研究法,探讨了我国器官移植刑事立法中的困惑,包括脑死亡标准的确立、刑事处罚范围较窄、法定刑的配置尚待改善几方面。针对该缺陷从刑法视角有效规制人体器官移植方面提出确立脑死亡的死亡标准作为司法认定标准、增设相关器官移植犯罪罪名、完善人体器官移植犯罪的立法模式等建议,促进我国器官移植的立法发展。     

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。     

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.     

器官移植道德反思——兼评器官商品化

自从器官移植技术出现以来,器官移植供体的缺乏就成为了制约其发展的瓶颈问题,而脑死亡临床诊断标准的出台为解决这个问题指明了方向。如何为脑死亡立法和器官移植立法寻求合理的道德支持是立足点,也是现代生命伦理学的热点与难点之一。以器官移植的供体来源短缺为切入点,提出了解决有关立法和寻求新的道德资源支持的一些思路与方向,坚决反对通过器官商品化来解决移植供体短缺的问题。     

脑死亡立法的艰难与中国传统文化

因中国传统伦理文化对人们意识观念的深刻影响导致中国脑死亡立法步履艰难。从中国传统文化视角分析中国的脑死亡及相关伦理问题,提出中国脑死亡诊断标准的制定必须充分考虑民族心理感受,要立足于民族文化理性地探索“中国脑死亡”。     

Privacy and the Human Genome Project

The Human Genome Project has raised many issues regarding the contributions of genetics to a variety of diseases and societal conditions. With genetic testing now easily conducted with lowered costs in nonmedical domains, a variety of privacy issues must be considered. Such testing will result in the loss of significant privacy rights for the individual. Society must now consider such issues as the ownership of genetic data, confidentiality rights to such information, limits placed on genetic screening, and legislation to control genetic testing and its applications. There is often a conflict between individual rights to privacy and the need for societal protection.     

Neuroscience and Brain Death Controversies: The Elephant in the Room

The conception and the determination of brain death continue to raise scientific, legal, philosophical, and religious controversies. While both the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in 1981 and the President’s Council on Bioethics in 2008 committed to a biological definition of death as the basis for the whole-brain death criteria, contemporary neuroscientific findings augment the concerns about the validity of this biological definition. Neuroscientific evidentiary findings, however, have not yet permeated discussions about brain death. These findings have critical relevance (scientifically, medically, legally, morally, and religiously) because they indicate that some core assumptions about brain death are demonstrably incorrect, while others lack sufficient evidential support. If behavioral unresponsiveness does not equate to unconsciousness, then the philosophical underpinning of the definition based on loss of capacity for consciousness as well as the criteria, and tests in brain death determination are incongruent with empirical evidence. Thus, the primary claim that brain death equates to biological death has then been de facto falsified. This conclusion has profound philosophical, religious, and legal implications that should compel respective authorities to (1) reassess the philosophical rationale for the definition of death, (2) initiate a critical reappraisal of the presumed alignment of brain death with the theological definition of death in Abrahamic faith traditions, and (3) enact new legislation ratifying religious exemption to death determination by neurologic criteria.     

Human Rights and the Citizen of the Kingdom of Heaven

This article argues for a new Christian theological rationale for human rights that takes into account serious contemporary critiques of rights language. Human rights derive from our being made in the image of God. But rather than being static metaphysical properties which humanity possesses, they form a moral language about the image of God, which must be constantly refashioned to suit the times. Furthermore, the human community to which these rights belong is not mere created humanity, but instead the humanity of the eschatological kingdom of heaven, of which the ecumenical church is the messenger. The ecumenical task, then, is to articulate a more holistic conception of what the image of God means to ensure that human rights language does not become narrowly sectarian.     

安乐死对象的界定

目前关于安乐死对象的界定,突出了医学要件,忽略了权利要件。为安乐死立法,必须对安乐死对象作出法律界定,应该满足两个条件：一是自然条件,即存在死亡痛苦;二是权利条件,即公民享得并行使安乐死的权利。不规定和具备权利条件,仅存在死亡痛苦,在法律上不能列为安乐死对象。     

Anticruelty care: commentary

The anticruelty policy is a best-interests test for treatment plans including decisions to forgo life-sustaining therapy for certain incompetent patients. In connection with specific proposed therapy, the policy requires no reference to the patient's unknowable values, subjective experiences, or quality of life. The decision to undertake a treatment plan derives from the caregiver's knowledge of burdens and benefits of that treatment when used in caring for the competent or for those incompetents capable of growth or repair. The caregiver should weigh the potentially cruel effects of treatment against the likelihood of reducing suffering or encumbrance with the treatment. The terms "burden" and "benefit," in fact, are replaced by the terms "cruelty" and "beneficence," as the relevant opposing outcomes that must be weighed. Thus, the anticruelty policy shifts our scrutiny from experiences of the patient that we cannot evaluate to the proposed actions of the competent decision makers and caregivers. Notably, it is a protreatment policy when the goals of medicine are attainable; and it is an anticruelty policy when they are not. The policy does evaluate the world of the patient to the extent that it requires a judgment based upon external appearances about patient pleasure or happiness in living. It presumes to universalize larger societal values about cruelty, beneficence, compassionate concern for the helpless, and certain rights of individuals. And it presumes to universalize on the patient's behalf specific medical values about hopeless injury, timely death, the goals of medicine, and cruelty, which should remain open to societal discussion and revision. The presented definition of hopeless injury does not require brain death, coma, or persistent vegetative state. Specifically, the policy holds that death is timely for a patient with hopeless injury, and that prevention of death for such patients is not a goal of medicine but a cruelty.     

诊断脑死亡的伦理思考

随着医学的进步和社会的发展,死亡的定义、诊断标准和医生道德责任有了新的内容,脑死亡就是生命终结已为医学界普遍接受.诊断脑死亡是非常专业的技术性工作,有权进行脑死亡诊断的医疗单位和医生必须达到相应的资质要求.确诊和宣布脑死亡应遵循的伦理准则包含多方面的内容,如家属应有死亡标准选择权、脑死亡的诊断程序、脑死亡诊断结果的宣布和生效等方面的问题.