PDF(Pubmed)
Abstract：
Under what circumstances, is it ethical to perform tumor surgery on a brain-dead individual? The neurosurgeons at Brigham and Women\'s Hospital were recently faced with such a question when asked to operate on a 28-year-old man who was pronounced brain-dead secondary to a severe brain-stem injury. His advanced directives clearly documented a desire for organ donation. During his transplant work-up, cranial imaging suggested a possible cerebellar mass of unknown etiology that was concerning for metastatic disease. Despite negative full body imaging, the neurosurgical team was asked to perform an open biopsy of the intracranial lesion to rule out occult systemic cancer. This case invites many nuanced questions related to the decisions surgeons and the broader medical community must make in the face of pursuing viable organs for the many in need. What is the moral standing and personhood eligibility of brain-dead individuals? What is the scope of medical interventions and procedures that surgeons are ethically bound to carry out? How ought the desire for increased medical intervention to try to save organs be balanced with practical limitations given limited medical resources?
摘要：
在什么情况下,对脑死亡的人进行肿瘤手术是否符合道德？最近，当被要求对一名28岁的男子进行手术时，布莱根妇女医院的神经外科医生面临这样一个问题，该男子因严重的脑干损伤而被宣布为脑死亡。他的高级指示清楚地记录了对器官捐赠的渴望。在他的移植检查中,头颅成像提示可能存在病因不明的小脑肿块，与转移性疾病有关。尽管全身成像阴性，神经外科团队被要求对颅内病变进行开放活检，以排除隐匿性系统性癌症。此案引发了许多与外科医生和更广泛的医学界有关的决定有关的细微差别问题，这些问题必须面对为许多有需要的人寻求可行的器官。脑死亡个体的道德地位和人格资格是什么？外科医生在道德上必须执行的医疗干预和程序的范围是什么？鉴于有限的医疗资源，如何平衡增加医疗干预以试图挽救器官的愿望？
