Ashley事件から生命倫理を考える

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前のエントリーの続きです。

生命倫理系のサイト、BioEdgeの Caplanインタビュー。

BioEdge: How dependent are Chinese transplant surgeons on the organs of executed prisoners?
Arthur Caplan: They are heavily dependent. While there are living donors of kidneys and once in a while a lobe of liver the Chinese have no cadaver organ procurement system. So the vast majority of transplanted organs according to their own numbers of transplants carried out must come from prisoners. For hearts and livers those certainly are executed prisoners.
Are Chinese doctors and hospitals actively marketing organ transplant services?
Yes, they are. They promote transplant tourism on the internet. And they are making plans to expand their ability to do transplants and to attract more non-Chinese cash customers by creating what they call "medical cities".
How have doctors, journals, and scientists reacted to your proposal? Has there been any resistance?
It is too soon to tell. So far the reaction has been a bit disappointing--no ringing endorsements from any journals or professional societies.
How have the Chinese reacted?
No reaction at all.
The Chinese government has vowed to end the practice of using organs from executed prisoners. Why haven't they stopped? Do you think that they will stop?
I think many Chinese health care professionals do want the practice to end. But they are sceptical about whether they can get the public to support cadaver organ donation. And I believe the military, which appears to play a key role in running prisons and some of the transplant hospitals, is less concerned about execution as a key source of transplantable organs.
As in other Asian countries, there is great resistance to organ donation in China. If they cannot rely upon executed prisoners, what would you advise them to do?
They must create a cadaver organ donor system. Period. There is always resistance when these programs are launched--there was in the USA decades ago and more recently in Denmark and Israel. A strong campaign with clear explanations of rights and safeguards is the key to public acceptance.
What if a prisoner did give his consent? A prisoner on Oregon's death row recently published an op-ed in the New York Times volunteering his organs.
"Prisoners" in China come in all forms--political, religious, criminal. I doubt we can take 'consent' at face value. Nor do I think we can trust consent to donation from persons being executed in the USA. The hope of commutation of a death sentence is a hugely coercive factor even if it does not come to pass. See my just published article in the American Journal of Bioethics for more on using prisoners as sources of organs.


中国では、刑務所も移植病院も運営は軍部だとのこと。

また、まだどうこういうには早いけれど、
今のところLancetでのCaplanらの呼びかけに対して
どこかの学会や団体から賛同の声が上がったということも
中国からのリアクションもない、と。

最後の質問で話題になっている
NYTで自己決定により臓器提供を申し出た死刑囚については、こちらのエントリーに ↓


この時にCaplanがMSNBCに書いた論説がこちら ↓
Organs from inmates? That idea should be DOA
MSNBC, April 21, 2011


なお、最後に触れられているAJOBのCaplan論文は以下に(全文が読めます) ↓

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