佛教對於器官捐贈倫理爭議的解決方案── 以《雜阿含經》和《大般若經》為依據

Abstract

本文站在佛教倫理學的立場，分析並檢討當代器官捐贈倫理的爭議。器官捐 贈倫理議題橫跨醫療、倫理、法律、哲學和宗教共五大領域。由於涉及面向廣泛， 加之牽連利益甚鉅，器官捐贈的各個環節都被加以放大討論。然而，即便各界投 入許多心力，仍然未有一普遍的共識。本文試圖通過佛教的觀點，化解當代器官 捐贈倫理中的諸多爭議，並嘗試提供一套佛教系統下的器官捐贈倫理理論。 回顧佛學界和應用倫理學界過去的相關研究，其中的爭議焦點都有特殊的預 設。本文運用佛教的理論加以一一檢視，並將不相應於世間的預設刪除，藉此解 消眾爭議。在佛學界中，爭議的核心有：佛教可否容受死後器官捐贈、佛教有無 積極理由支持器官捐贈、佛教研究器官捐贈倫理應有的進路；在應用倫理學界中 討論的則是腦死判準之疑慮、捐贈意願判定之疑慮、器官歸屬之爭議以及器官販 賣。本文分別在佛教解脫道和佛教菩提道系統中，搭配｢非我｣、｢布施｣等觀念， 逐一解消各爭議中不適當的預設。 在解消爭議之後，本文採取佛教的｢布施｣觀念，應用於器官捐贈的系統中。 將捐贈過程區分為：捐贈者、受贈者、醫療及社工人員等三部分，並加以探討各 個部分所處的心理狀態或認知。以佛教的｢無所見｣為方法，化解器官捐贈流程中 不適的心態和見解，在爭議和衝突產生前將之消彌於無形。

It is said that a lot of incurable patients can be saved by means of organ donation. Indeed, it is one of the most popular surgical operations. Being popular, however, does not entail its ammunition to moral criticism. Hence, I shall propose a Buddhist account of organ donation and oppose the contemporary view of organ donation. There are many controversies related to organ donation, such as brain death, donation card, presuming donation, and organ market. From Buddhist point of view, these controversies are caused because of people ignoring the reality of the world. According to Buddhist path to liberation, treating everything as impermanent makes people understand that this co-arising world is produced by related conditions. It is based on ignorance of the reality that people presume the ideas of control, possession and self. If these ideas are replaced by “impermanence” and “non-self”, the controversies related to organ donation will be ceased. In contrast to contemporary medical mechanism, living and dying are both empty and equal in Buddhist perspective. It is incorrect to save recipients at any price while ignoring donators’ need. In Buddhist path to enlightenment, dāna-pāramitā, which means perfection of giving, could provide us guides to donate skillfully. Applying to organ donation, it is important to benefit donators, recipients and doctors at the same time, while not any immoral thing being caused or implemented. Since there are big differences between contemporary and Buddhist idea of donation, Buddhism shall not endorse organ donation.