Causal Responsibility and Rationing in Medicine

The article addresses the issue of rationing health care services, a topic currently being hotly debated in many countries. The author argues that the aspect of causal responsibility ought to play a decisive role in the allocation of limited medical resources. Starting out from Ronald Dworkin's distinction between option luck and brute luck, the appropriate and meaningful uses of the term causal responsibility are clarified first. A discussion of the conditions which might justify giving lower priority to patients whose illnesses are the result of unhealthy behavior, like e.g. alcohol abuse, follows. Causal responsibility is then viewed in the context of private health insurance and the club model of organ donation. It is argued that individuals themselves are basically responsible for their decisions regarding insurance coverage and membership in organ donors' clubs. Causal responsibility is shown to be a more suitable criterion for rationing scarce medical resources than other criteria which might alternatively be considered, such as patients' age.     

Cultural Diversity and Patients with Reduced Capacity: The Use of Ethics Consultation to Advocate for Mentally Handicapped Persons in Living Organ Donation

Theoretical Medicine and Bioethics - Living organ donation will soon become the source of the majority of organs donations for transplant. Should mentally handicapped people be allowed to donate,...     

有偿献血HIV感染者的情绪障碍

考察有偿献血HIV感染者的情绪状况,探讨他们面临的艾滋病压力和对感染HIV的认知评价对其情绪的影响。方法：采用Beck抑郁量表、焦虑自评量表、艾滋病压力量表、认知评价量表作为测查工具,测查了185名有偿献血HIV感染者,并收集了人口学资料、症状资料和其它信息。结果：（1）92%的有偿献血HIV感染者有中、重度抑郁障碍,他们的焦虑程度高于神经衰弱者和焦虑症者;（2）艾滋病压力不仅通过认知评价而且会直接对情绪障碍产生影响;（3）认知评价在艾滋病压力和情绪障碍之间起部分中介作用。结论：有偿献血HIV感染者抑郁、焦虑情绪障碍严重,艾滋病压力和认知评价对情绪障碍的产生都有直接或间接的影响     

An “Opting In” Paradigm for Kidney Transplantation

Almost 60,000 people in the United States with end stage renal disease are waiting for a kidney transplant. Because of the scarcity of organs from deceased donors live kidney donors have become a critical source of organs; in 2001, for the first time in recent decades, the number of live kidney donors exceeded the number of deceased donors. The paradigm used to justify putting live kidney donors at risk includes the low risk to the donor, the favorable risk-benefit ratio, the psychological benefits to the donor, altruism, and autonomy coupled with informed consent; because each of these arguments is flawed we need to lessen our dependence on live kidney donors and increase the number of organs retrieved from deceased donors.

An “opting in” paradigm would reward people who agree to donate their kidneys after they die with allocation preference should they need a kidney while they are alive. An “opting in” program should increase the number of kidneys available for transplantation and eliminate the morally troubling problem of “organ takers” who would accept a kidney if they needed one but have made no provision to be an organ donor themselves. People who “opt in” would preferentially get an organ should they need one at the minimal cost of donating their kidneys when they have no use for them; it is a form of organ insurance a rational person should find extremely attractive.

An “opting in” paradigm would simulate the reciprocal altruism observed in nature that sociobiologists believe enhances group survival. Although the allocation of organs based on factors other than need might be morally troubling, an “opting in” paradigm compares favorably with other methods of obtaining more organs and accepting the status quo of extreme organ scarcity. Although an “opting in” policy would be based on enlightened self-interest, by demonstrating the utilitarian value of mutual assistance, it would promote the attitude that self-interest sometimes requires the perception that we are all part of a common humanity.     

The emotional consequences of donation opportunities

Charities often circulate widespread donation appeals, but who is most likely to donate and how do appeals impact the well-being of individual donors and non-donors, as well as the entire group exposed to the campaign? Here, we investigate three factors that may influence donations (recent winnings, the presence of another person, and matched earnings) in addition to the changes in affect reported by individuals who donate in response to a charitable opportunity and those who do not. Critically, we also investigate the change in affect reported by the entire sample to measure the net impact of the donation opportunity. Results reveal that people winning more money donate a smaller percentage to charity, and the presence of another person does not influence giving. In addition, large donors experience hedonic boosts from giving, and the substantial fraction of large donors translates to a net positive influence on well-being for the entire sample.     

Who shall be Allowed to Give? Living Organ Donors and the Concept of Autonomy

Free and informed consent is generally acknowledged as the legal andethical basis for living organ donation, but assessments of livingdonors are not always an easy matter. Sometimes it is necessary toinvolve psychosomatics or ethics consultation to evaluate a prospectivedonor to make certain that the requirements for a voluntary andautonomous decision are met. The paper focuses on the conceptualquestions underlying this evaluation process. In order to illustrate howdifferent views of autonomy influence the decision if a donor's offer isethically acceptable, three cases are presented – from Germany, theUnited States, and India. Each case features a person with questionabledecision-making capacity who offered to donate a kidney for a siblingwith severe renal insufficiency. Although the normative framework issimilar in the three countries, different or sometimes even contraryarguments for and against accepting the offer were brought forward. Thesubsequent analysis offers two explanations for the differences inargumentation and outcome in spite of the shared reference to autonomyas the guiding principle: (1) Decisions on the acceptability of a livingdonor cannot simply be deducted from the principle of autonomy but needto integrate contextual information; (2) understandings of the wayautonomy should be contextualized have an important influence on theevaluation of individual cases. Conclusion: Analyzing the conceptualassumptions about autonomy and its relationship to contextual factorscan help in working towards more transparent and better justifieddecisions in the assessment of living organ donors.     

Social representations of organ donors and non‐donors

This paper illustrates the empirical investigation of social representations by means of photographs as stimulus material and the technique of correspondence analysis to study the resulting data. The research was part of a campaign carried out to promote organ donation in Malta. The study tries to find out whether a public communication campaign could change perceptions. Five focus groups were held before the campaign and another five, two months after the campaign. Part of the data collected through these focus groups was analysed using correspondence analysis. The results showed that before the campaign, donors were generally perceived to be either young or important people or public personalities. After the campaign, donors were perceived more to be ordinary family people, educated, generous and religious. On the other hand, before the campaign, non‐donors were seen as conservative, uncouth and uncaring, whereas after the campaign non‐donors were generally perceived to be older, uninformed and uneducated people. Copyright © 2005 John Wiley & Sons, Ltd.     

What motivates men to offer sperm donation via the internet?

To investigate why men offer sperm donation via the internet, a questionnaire was disseminated via 39 Dutch-language websites thought to be visited by potential sperm donors. Nine internet donors completed the survey, men who typically knew the women they were donating to. Their responses were compared with those of a control group of 35 general sperm bank donors who were recruited using flyers in Dutch sperm banks, and who were typically unaware of the identity of the eventual recipients. The findings shed light on the motives and attitudes of internet donors. Both groups of donors indicated that their primary motivation for donating was altruism (>80% of all respondents). However, internet donors had a more pronounced desire to procreate than sperm bank donors (6 out of 9, i.e. 66 vs. 22%, respectively) and more often felt that they had good genes they wished to pass on (5 out of 9, i.e. 55 vs. 31%, respectively). The main reason internet donors gave for donating via the internet was that they wanted to know the prospective parents and be kept up to date on the progress of the offspring conceived from their donations. This distinguishes them significantly from sperm bank donors. A further finding was that they were not prompted to avoid the formal donation circuit for which, by law in the Netherlands, pregnancies resulting from donations have to be registered in a central database. This study is subject to several, in some cases inevitable, limitations, but it provides an interesting starting point that future studies can seek to confirm and extend.     

国外器官捐献评估方法介绍

器官移植已成为医学上应用越来越广泛的手段之一。器官移植中器官捐献的分析评估体系作为成熟器官移植系统不可或缺的一部分,能够对器官捐献水平和做出客观的评估,包括捐献潜力,即潜在捐献者率（Potential Donors rate,,PDr）和捐献有效力,即实际捐献者率（Actual Donors rate,ADr）（单位：per million population,pmp）。本文将介绍通过对多国器官捐献评估方法进行分析、总结得出器官捐献中供体评估的主体方法,包括流程、分析方法、适用范围及其积极意义等,希望可以利于我国研究。