我国器官移植中的伦理困境及解决思路

我国的器官移植近10年来有了发展,无论从技术层面、移植数量和质量、临床管理以及法规建设上都有了长足的进步。然而,由于我们在开展器官移植方面的先天不足,例如从事器官移植的技术队伍主要是来自海外学成归来的专家;技术主要靠引进西方的临床技术,在基础研究和创新方面相对薄弱;在法律和管理制度的建设方面相对滞后,没有建立一个从制度上保证器官移植健康开展的系统,使得在器官供体来源和器官的公正分配上存在许多欠缺。因此有必要对我国的器官移植历史进行回顾和总结,对我国在器官移植中存在的错误观念和伦理困境进行剖析,寻找适合我国开展器官移植的正确途径,促进我国的器官移植事业健康发展。     

Research into Plant Invasions in a Crossroads Region: History and Focus

The Czech Republic is a central European country whose geographical location, natural conditions, history of human settlement, and present land-use management make it relatively prone to plant invasions, hence it represents a convenient model for their study. Research in plant invasions, which date to the late 19th century, is reviewed in the present paper. A long-term floristic tradition allowed for the accumulation of a large body of floristic data on alien plants. During the 1960s–1970s, the main research focus was on their distribution. In this period, attempts were also made to predict potential invasiveness of weeds of arable land. The success rate of this prediction was about 39%. Considerable effort was put into a detailed classification of human-accompanying plants and the terminology associated with the issue. There is a high level of taxonomic research conducted in the country, and the new Flora of the Czech Republic treats the immigration status of taxa with reasonable care and detail. A complete, serious catalogue of the alien plants of the country has been published recently: there are currently 1378 alien plants (33.4% of the total flora). The core of present research in plant invasions is in ecological, biological, and biogeographical studies, focussed on (i) the history of invasion of particular species since their introduction, (ii) the role and importance of alien species in vegetation, including their participation in succession, and (iii) the major invasive species of the Czech flora and comparison of congeners. Reynoutria spp., Heracleum mantegazzianum, Oenothera spp., Pinus strobus, and Bidens frondosa are among the taxa most intensively studied in recent time. A complete list of 69 invasive plants in the Czech flora introduced after the year 1500 [following the definition of Richardson et al. (2000a) Diversity and Distributions 6: 93–107] is given. The available legal instruments relevant to the issue are reviewed. This revised version was published online in July 2006 with corrections to the Cover Date.     

Over-exploitation of a broadcast spawning marine invertebrate: Decline of the white abalone

Marine invertebrates have long been consideredto be resistant to overfishing. However, agrowing number of exploited taxa have declinedsubstantially and even disappeared from partsof their former range. We consider the case ofthe white abalone (Haliotis sorenseni);the first marine invertebrate proposed for theUS endangered species list. This high-valuespecies was one of five abalones targeted inthe California and Mexico fisheries; it is nowrare and protected from fishing. The biologicalcharacteristics of this deep-living abaloneindicate that it was particularly vulnerable toover-exploitation; reduction of density orgroup size is now known to lead to declines infertilization success and recruitment failure.Warning signs of potential problems existedboth pre- and post-exploitation but were notrecognized. In particular, serial depletion wasnot detected because catch was not analyzedspatially, perhaps because total landings werereasonably stable for the short period ofexploitation. Recent submersible surveys led toestimates that white abalone now number lessthan 2,600 animals or 0.1% of the estimatedpre-exploitation population size. Densities andestimated population sizes are less than 100animals, at all but one location. Alternateexplanations for the decline in abundance wereconsidered and only exploitation-linkedfactors, such as sub-legal mortality andillegal fishing, were likely contributors.Episodic recruitment appears to be acharacteristic of broadcast-spawning,long-lived species and may make themparticularly vulnerable to over-exploitation.Management strategies based on size limits thatallow a few years of spawning prior to reachingminimum legal size are insufficient.Sustainable fisheries will require multipleprotected areas to preserve brood stockaggregations necessary for successfulfertilization.     

What Role Should Government Regulation Play in Ecological Restoration? Ongoing Debate in São Paulo State,Brazil

Around the world, there is growing desire and momentum for ecological restoration to happen faster, with better quality, and in more extensive areas. The question we ask is how can laws and governmental regulations best contribute to effective, successful, and broad‐scale restoration? In the state of São Paulo, Brazil, there is a legal instrument (SMA 08‐2008) whose aim is to increase the effectiveness of tropical forest restoration projects in particular. It establishes, among other things, requirements regarding the minimum number of native tree species to be reached within a given period of time in restoration projects and the precise proportion of functional groups or threatened species to be included when reforestation with native species is used as a restoration technique. There are, however, two differing perspectives among Brazilian restoration ecologists on the appropriateness of such detailed legal rules. For some, the rules help increase the chances that mandatory projects of ecological restoration will succeed. For the other group, there is no single way to achieve effective ecosystem restoration, and the existing science and know‐how are far from sufficient to establish standardized technical and methodological norms or to justify that such norms be imposed. Both points of view are discussed here, aiming to help those developing new legislation and improving existing laws about ecological restoration. The precedents established in São Paulo, and at the federal level in Brazil, and the ongoing debate about those laws are worth considering and possibly applying elsewhere.     

The double bind of DACA: exploring the legal violence of liminal status for undocumented youth

This qualitative study explores how undocumented immigrant youth navigate the uncertainty of an ambiguous, or liminal, legal status. By focusing on the case of Deferred Action for Childhood Arrivals (DACA), I build on the concept of liminal legality to advance our understanding of how transitioning from “illegal” to quasi-legal shapes social inclusion. Using a modified grounded theory approach, I analyse data from in-depth interviews with 39 DACA recipients in the state of South Carolina. A constant comparative approach is used while completing open and focused coding, and multiple steps are taken to support the trustworthiness of the study. I show how liminal legality presents a double bind for youth because DACA communicates two different and contradictory messages simultaneously. I argue that this is a form of legal violence: beneficiaries are given the hope of social inclusion without the possibility of fully attaining it.     

DNA profiling: Social, legal, or biological parentage

DNA profiling in forensic casework is based on comparison of the results of biological evidence with direct reference samples of the individual concerned or with indirect references of his close blood relatives. The selection of reference samples for analysis is crucial to the success of a case; it not only depends on the authenticity of the reference samples, but also on the authenticity of the biological relation of the donors with the person in question. There are situations when the social or legal relationship is not the biological one and there is a need to educate investigating officers, forensic analysts, and the judiciary about the associated problems.     

Medical confidentiality: legal and ethical aspects in Greece

Respect for confidentiality is firmly established in codes of ethics and law. Medical care and the patients' trust depend on the ability of the doctors to maintain confidentiality. Without a guarantee of confidentiality, many patients would want to avoid seeking medical assistance The principle of confidentiality, however, is not absolute and may be overridden by public interests. On some occasions (birth, death, infectious disease) there is a legal obligation on the part of the doctor to disclose but only to the appropriate authorities. Permissible disclosure can be granted by the patients' consent, for example, for the purpose of insurance they may wish to take out. Moreover, there are some ambivalent situations (such as criminal acts, or notification of sexual partner in case of a patient with AIDS) for which Greek law does not include relevant provisions, and the Codes of Medical Ethics do not offer clear guidelines. Therefore, the Greek doctor is called to estimate the situation and assume full responsibility for his decision. Finally, new considerations have arisen in the context of the recent advances in the field of telemedicine and electronic archiving. The paper discusses the current situation and legislation in Greece.     

Afterword to "Anthropology and Human Rights in a New Key": The Social Life of Human Rights

In this article, I argue for an ethnographic approach to human rights that recognizes the plural and fragmentary nature of the international rights regime and the ideological promiscuity of rights talk. Instead of determining in advance the social or political character of rights, anthropologists could profitably draw from the insights of early-20th-century "legal realists" and look closely at the underlying assumptions and hidden practices of political and legal processes. Studying the "social life of human rights" would involve focusing on, inter alia, the performative dimensions of human rights, the dynamics of social mobilization, and the attitudinal changes of elite and nonelite social actors towards formulations of "rights" and "justice," both inside and outside the legal process. I conclude with a review of recent anthropological research on human rights epistemology and evaluate its implications for human rights policy.     

公立医院社会责任与法律保障关系探讨

随着公立医院改革试点的指导意见确立,公立医院发展面临前所未有的挑战。围绕公立医院社会责任以及运用法律保障公立医院更好地履行社会责任等方面进行分析,具有探讨性地提出一些观点。同时对如何保障公立医院的合法权益,如何为公立医院、医务人员提供良性的执业环境等方面从法律角度,结合我国目前新医改方案出台、公立医院面临新一轮改革的形势,提出一些建议与意见。深化医药卫生体制改革是确保公立医院履行社会责任的有效途径之一,目的是建立中国特色的基本医疗卫生制度,保证城乡居民公平,享有安全、有效、方便、价廉的基本医疗卫生服务。这不仅是解决当前医患矛盾也是确保公立医院履行职责的治本之策、久安之道。