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[经典道德两难] 救人问题 抽签问题

(2005-04-05 19:00:04)
分类: 思想与哲学

 

 

参考 《经典道德两难:救人问题》以及
《救人问题 抽签和挂号先后》

以下是关于抽签救人的另一段文章。

Those favouring egalitarian principles often propose a system of random selection of patients. The lottery is defended as most suitable to human dignity, least open to bias, most palliative of anxiety about “qualifying” and most likely to be chosen, if the society was offered a referendum on various selection systems. In principle, the lottery seems to many commentators, the only “fair” system. However, the lottery has also been criticised. Far from seeing a human lottery as appropriate to human dignity, some authors have been repelled by the idea. The Jurisprudent Edmund Cahn considers “the stakes too
high for gambling and the responsibilities too deep for destiny” (Cahn, 1955:71). Joseph Fletcher calls a lottery “literally irresponsible, a rejection of the
burden, refusal to be rational” (Fletcher, 1969). Even Katz and Capron, who ultimately favour a lottery, are critical:

“The lottery is more blind than fair, for an evenhanded approach is desirable only insofar as it deals with like classes of individuals.”

      (Katz and Capron, 1975: 193)

抽签被视为最无偏见的、最尊重个人尊严的、最有可能被公众通过公投决定的选择办法。但
批判者指出,生死攸关的问题过于重要,责任过于重大,不适合交给抽签完成。抽签是”不
负责任的,逃避责任的、拒绝理性的”。Katz和Capron指出,抽签之适合在完全类似的一种人群中进行。

Other authors note the practical problems of a lottery. It requires that a group form before lots can be drawn, a situation that is unrealistic since patients appear serially with a need for help; the patients’ condition can also change during the waiting time. One author has stressed the fact that lotteries can be rigged and, in matters of such import, are likely to be. (Harris, 1975; Willard, 1980). Some authors question the contention of those favouring lotteries that random selection would alleviate anxiety and several authors distinguish between
the “natural” sorts of random selection, such as first-come, first served and artificial ones, such as lotteries. The queue, some note, is more in accord with
the realities of illness and the traditions of health care, but the queue can be “jumped” (Fried, 1974; Willard, 1980) At the same time, all systems of random
selection make it possible for certain socially disreputable and dangerous persons to receive the scarce gift of life, a prospect that critics of the lottery find unpalatable, but proponents consider the price of fairness.

抽签有很多实践中的问题。抽签需要把病人组成一个group。而实际情况里,病人分先后到
达,有不同的状况和需要,而且病情会在等待的时候发生变化。

最后,提及了先到先得原则。但作者认为,所有的随机选择程序,都会导致一些品质恶劣或
危险的人可能获得极珍贵而有限的救命资源。

Jonsen, Albert R. “Ethical issues in organ transplantation” in Veatch, Robert M. (ed) “Medical Ethics” (Boston: Jones and Bartlett Publishers, 1989) pp229-252

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