ETHICAL ISSUES: THE ORGAN SHORTAGE--论文代写范文精选

在过去,不少尸体器官来自车祸的受害者。器官分配资源存在一定的问题,因为没有足够的器官。平等的支持者认为,器官移植是一个有价值的医疗过程，提供给需要它的人。每个人都应该一视同仁。下面的paper代写范文进行详述。

Introduction 
  The primary ethical dilemmas surrounding organ transplantation arise from the shortage of available organs.25 Not everyone who needs an organ transplant gets one and in fact, the scales tip quite heavily in the opposite direction. The United Network for Organ Sharing (UNOS) maintains a comprehensive, upto-date website that gives the status of people awaiting organ transplants. According to their website over 83,000 people are currently awaiting transplants in the United States. The UNOS website reports that in 2003 more than 19,000 organ transplants were performed. The organs were taken from approximately 9,800 donors both living and deceased. While 19,000 transplants may seem like a large number, 83,000 people remain on the waiting list for an organ and the gap between the number of available donor organs and the number of people who need organs grows daily.

  The number of donated organs has stayed fairly constant over the last few years while the number of people needing organs continues to increase.27 Many explanations are offered to explain the length of the list – such as the number of new medical technological advances and the aging population. One possible explanation as to why the number of donated organs from cadavers remains static concerns the increasing effectiveness of seat belt campaigns and air bag use. In the past, a large source of healthy cadaveric organs came from victims of car crashes.28 With static or declining numbers of car crash fatalities, there are also declining sources of healthy human organs for transplant.29

  Distribution of available organs The concept of distributive justice – how to fairly divide resources – arises around organ transplantation because there are not enough organs available for everyone who needs one. Distributive justice theory states that there is not one “right” way to distribute organs, but rather many ways a person could justify giving an organ to one particular individual over someone else.30 This list of possible distributive justice criteria comes from the University of Washington School of Medicine website: 
  1. To each person an equal share 
  2. To each person according to need 
  3. To each person according to effort 
  4. To each person according to contribution 
  5. To each person according to merit 
  6. To each person according to free-market exchanges31

  Equal access supporters believe that organ transplantation is a valuable medical procedure and worth offering to those who need it. They also argue that because the procedure is worthy, everyone should be able to access it equally.32 To encourage equality in organ transplantation, the equal access theory encourages a distribution process for transplantable organs that is free of biases based on race, sex, income level and geographic distance from the organ.33 Some who believe in equal access distribution would also like to have an organ distribution process free of medical or social worthiness biases. Medical “worthiness” biases could exclude patients from reaching the top of the transplant waiting list if lifestyle choices like smoking and alcohol use damaged their organs. Social “worthiness” biases would factor in a patient’s place in society or potential societal contribution before giving them an organ. This would affect, among others, prisoners being punished for offenses against society. 

  The primary reasons for wanting to prevent individual worth from factoring into organ distribution include: a) the argument that individual worth does not determine medical need; b) the dilemma involved in deciding who will make decisions of who is worthy or not worthy to receive an organ, and; c) the slippery slope of determining an individual’s worth and whether or not it is fair to label someone worthy of a medical procedure.34 On the other hand, some ethicists argue that individual worth is important to consider during organ distribution. They argue that distribution is biased against worthy individuals when individual worthiness factors are not included. One example of this argument comes from a 1990s article in the Canadian Medical Association Journal by E. Kluge. Kluge argues that equal access distribution of organs is not fair and just if it includes people whose lifestyle choices, namely tobacco and alcohol use, ruined their organs. Kluge’s argument states that people who engage in poor lifestyle choices are behaving irresponsibly and could have prevented their illness and are, in essence, increasing the need for organs and depriving people who, “have no control over their need,” of necessary treatment.35

  People who support the maximum benefit philosophy believe organ transplants are medically valuable procedures and wish to avoid the wasting of organs because they are very scarce.36 To avoid waste, they support ranking transplant candidates by taking Recent research shows that when given scenarios of two people who both need an organ transplant, the general public’s organ distribution preferences are influenced by whether or not a person made behavioral lifestyle choices that caused their illness. 1Ubel PA, Jepson C, Baron J, et.al. Allocation of transplantable organs: do people want to punish patients for causing their illness? Liver Transplant, 2001; 7(7):600-7. 17 SUPPORTERS OF MAXIMUM BENEFIT DISTRIBUTION SAY… Organs should be distributed so that the greatest benefit is derived from every available organ into account how sick the patient is and how likely it is that the patient will live after he or she receives a transplant. Successful transplants are measured by the number of life years gained. Life years are the number of years that a person will live with a successful organ transplant that they would not have lived otherwise. 

  This philosophy allows organ procurement organizations to take into account several things when distributing organs that the equal access philosophy does not – like giving a second organ transplant to someone who’s already had one or factoring in the probability of a successful medical outcome.37,38 Three primary arguments oppose using the maximum benefit distribution criteria. First, predicting medical success is difficult because a successful outcome can vary. Is success the number of years a patient lives after a transplant? Or is success the number of years a transplanted organ functions? Is success the level of rehabilitation and quality of life the patient experiences afterward? These questions pose challenges to those attempting to allocate organs using medical success prediction criteria.39 

  The second argument against maximum benefit distribution is that distributing organs in this way could leave the door open for bias, lying, favoritism and other unfair practices more so than other forms of distribution due to the subjective nature of these criteria.40 Third, some ethicists argue against using age and maximizing life years as criteria for distributing organs because it devalues the remaining life of an older person awaiting a transplant. Regardless of how old someone is, if that person does not receive a transplant they will still be losing “the rest of his or her life,” which is valuable to everyone.41

 Current organ distribution policy 
  The current organ distribution method in the United States relies on each transplant center to determine which criteria they will use to fairly allocate organs.42 UNOS encourages transplant centers to consider the following criteria for distributing organs: 1) medical need; 2) probability of success, and; 3) time on the waiting list.43 According to a 2001 article by James Childress, most experts agree that these three criteria are relevant. Childress states that ethical conflicts arise both when specifying what the criteria mean, and when weighing the criteria in cases of conflict.44

  Not everyone believes in the need to increase the number of organ transplants. There are some who believe that organ transplantation inappropriately encourages the medicalization of society. In fact, one on-line website suggests that organ transplants are merely one way in which United States citizens attempt to transcend death.46 A second point of view that questions increasing the practice of organ transplantation relies on the assumption that resources for health care are scarce and organ transplants are costly. The questions this raise include – what is the social worth of organ transplants and are they diverting money from other necessary medical care?47 Finally, a recent article suggested that not enough research has been conducted on poor transplant outcomes. The authors suggest that unsuccessful transplant patients continue to receive aggressive, curative treatment when they should be receiving more caring and holistic treatment.48(paper代写)

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