弱勢群體捐獻器官的倫理問題: 對一個個案的分析

Ethical Issues in Organ Donation by the Weak Population: A Case Analysis

Abstract

LANGUAGE NOTE | Document text in Chinese; abstract also in English.

在我國目前，弱勢群體或弱勢人群主要是指低收入階層和殘疾人。從倫理學的角度看，弱勢群體是一個需要保護、需要幫助的社令弱者群體，弱勢群體在維護自身生活和幫助社會的能力方面總體上是低於非弱勢群體的。如果這樣的人反過來要去救助他人的時候，就可能導致倫理難題，甚至難以得到社會的理解（如對其動機產生懷疑）。長沙《當代商報》在今年早些時候報道了一個個案：一位殘疾人家屬、一位下崗工人願意為尿毒症患者捐獻自己的腎臟，並因此進行了公證。我們這裏對該器官捐獻者進行了德性分析和責任倫理分析，從而對其動機的正當性作出了有限的辯護，也對其責任能力的有限性作出了討論。我們建議，應該有限制地勸而不是禁止弱勢群體的器官捐獻。同時，我們也希望通過德性分析和責任分析導向一種關注個體的倫理學。

From an ethical view, the weak population is a group of people that need protection and assistance by society. Generally, their capacity for survival and supporting society is weaker than the others. It may cause an ethical dilemma when they want to succor the others. For one thing, their moral motive for the succor can be suspicious.

Modern Business, a local newspaper in Changsha, reported such a case in the early 2002. A divorcer, without a formal job but with a seriously disabled daughter, would desire to donate his kidney to a woman contracting uremia. He stated that he wanted to help others since he had been receiving assistance from society. He even signed a notarization with the woman for the donation.

Some people raised four questions regarding the donating arrangement: (1) Did they sign an alternative and secret contract involving economic benefits for the donation? (2) Did they desire to have the aid of the media for extra benefits? (3) Can rewarding society, as the donator declared, be an adequate account of the donating? (4) Did the donator lose his courage to survive and want to get rid of the pressure on his life by the donating, i.e. wishing to die in the operation?

I think these questions are all misleading. They are also discriminative, because they are ethically against the weak. I attempt to offer a justification for the donation. Firstly, the notarization made the alternative contract ineffective by law; secondly, the media had nothing directly to do with the donation-acceptance notarization, because the event was reported after the notarization; thirdly, rewarding society shouldn't be morally censurable, even if one does not admire it highly in ethics.

Taken together, all the questions (especially the fourth) concern with the motive of the donation. The motive must have something to do with the virtues of the actor, while the virtues are reflected in a series of behavior in the everyday life of the actor. Through analyzing the donator's everyday behavior, we have found that he possessed some important virtues, such as optimism, enthusiasm, helpfulness and so on. So it looks impossible for him not to enjoy his life any more and want to die.

On the other hand, I don't think courage and forbearance are the appropriate ethical strategies for supporting the weak population to donate their organs. The weak should be dissuaded to donate organs. From the Confucian view (for instance, Mencius taught that "you should make yourself good when you are poor, and you should succor the world when you are wealthy"), it is the first responsibility of the weak to make themselves good instead of attempting to succor society.

Finally, the essay suggests that we should move towards an individual ethics through carefully made ethical analysis of individual virtues and responsibilities.

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