器官捐献的伦理反思与“自主”的重新阐释

An Ethical Reflection on Organ Donation and a Reinterpretation of“Autonomy”

自愿和无偿是有关器官移植与捐献的首要伦理原则,然而,这两个原则之间存在明显的矛盾。这个矛盾体现了当代生命伦理研究中的核心问题。能否恰当地回应这一矛盾取决于我们对自主的理解。生命伦理学领域中的自主原则主要地来自康德,但是长久以来,康德的自主概念并没有在生命伦理研究中得到恰当、充分的阐释。科学技术的发展导致自主原则的应用越发困难。当代康德式建构主义理论通过行动者的自我反思有力地促进了规范伦理学的复兴,推进了康德对于道德义务的论证,同时构建了一个逻辑上更加自洽,并且更加具有实践可操作性的自主概念,即将自主阐释为理解理由并与他人交换理由的能力。这一自主概念的应用不仅能够化解自愿和无偿原则在表面上的矛盾,也能为理解和应对当代各种生命伦理难题提供重要的思想资源,推进道德哲学中对于普遍性道德义务的论证。

Being voluntary and gratuitous are the core ethical principles for organ donation.However,there are obvious contradictions between these two core principles.This contradiction is a very crucial issue in contempo-rary bioethical research.Whether we can properly respond to this contradiction depends on our understanding of au-tonomy.As the primary principle in the field of bioethics,the principle of autonomy mainly comes from Kant's phi-losophy,but for a long time,Kant's concept of autonomy had not been properly and fully explained in the field of bioethical research.With the development of science and technology,the application of the principle of autonomy is more and more difficult.Contemporary Kantian constructivism promotes Kant's argumentation of moral norms through self-reflection of agent,which effectively promotes the revival of normative ethics,and at the same time constructs an autonomous concept which is more self-consistent in logic and more operatable in practice.This con-cept of autonomy interprets autonomy as the ability to understand reasons and exchange them with others.The anal-ysis of this concept of autonomy can not only provide important theoretical resources for understanding and coping with contemporary bioethical problems,but also promote the demonstration of universal moral obligation in moral philosophy.