Saso L, Silvestrini B
Dipartimento di Farmacologia delle Sostanze Naturali e Fisiologia Generale, Università degli Studi di Roma La Sapienza, Roma.
Minerva Med. 2000 Oct;91(10):255-65.
Human experimentation in order to develop new medical therapies creates very complex ethical problems: when is it possible to test a new therapy on a human subject? Is it always necessary his/her consent? Which information should be given to the subject before requesting his/her consent? How to behave in the case of minors, psychiatric patients and other subjects not perfectly free or able to understand the information provided? Is it right to subject a person to an experimentation from which he/she will not get any direct advantage? Which results can be published? In other words, which are the ethical limits of human experimentation? These are difficult questions, to which the authors tried to answer referring to some ethically significant human experimentations, such as those performed by Lind and Jenner in the XVIII century, and those carried out by the nazi doctors, from whose trial derived the Nuremberg Code, which introduced for the first time, at an international level, the principle of the informed consent. Some of the limits of this document, including the impossibility of doing research on subjects not able to give their informed consent, such as minors and psychiatric patients, were overcome by the Declaration of Helsinki, whose current version resulted from several subsequent revisions. According to this document, a major role is played by the Institutional Review Boards or Institutional Ethical Committees that have the heavy responsibility of evaluating the ethical connotations of human experimentations.
何时可以在人体受试者身上测试新疗法?受试者的同意是否始终必要?在请求受试者同意之前应向其提供哪些信息?对于未成年人、精神病患者和其他不完全自由或无法理解所提供信息的受试者应如何处理?让一个人接受不会从中获得任何直接益处的实验是否正确?哪些结果可以公布?换句话说,人体实验的伦理界限是什么?这些都是难题,作者试图通过参考一些具有伦理意义的人体实验来回答,比如18世纪林德和詹纳所进行的实验,以及纳粹医生所开展的实验,从对纳粹医生的审判中衍生出了《纽伦堡法典》,该法典首次在国际层面引入了知情同意原则。《赫尔辛基宣言》克服了该文件的一些局限性,包括无法对无法给出知情同意的受试者(如未成年人和精神病患者)进行研究的问题,其当前版本是经过多次后续修订而来的。根据这份文件,机构审查委员会或机构伦理委员会发挥着重要作用,它们肩负着评估人体实验伦理内涵的重任。