Ustun Cagatay, Ceber Esin
Ege University, Izmir Ataturk School of Health, Bornova IZMIR 35100 / TURKEY.
Asian Pac J Cancer Prev. 2003 Aug-Dec;4(4):373-6.
In recent years medical ethics has become an undisputed part of medical studies. Many people believe that modern advances in medical technology - such as the development of dialysis machines, respirators, magnetic resonance imaging and genetic testing and types of cancer screenings - have created bioethical dilemmas that confront physicians in the 21st century. Debates over research and screening ethics have until recently revolved around two related questions: the voluntary, informed consent of subjects, and the appropriate relationship between risk and benefit to subjects. Every patient has a right to full and accurate information about his or her medical condition. This legal principle arose primarily through court decisions concerning informed consent, but over time physicians recognized that most patients prefer to learn the truth about their condition and use the information well. To screen is to search for disease in the absence of symptoms or, in other words, to attempt to find disease in someone not thought to have a disease. Examples of screening include routine mammography to detect breast cancer, routine pap smears to detect cervical cancer, and routine Prostate Specific Antigen (PSA) testing to detect prostate cancer. Ethical principles to be followed in cancer screening programmes are intended mainly to minimize unnecessary harm for the participating individuals. Numerous ethical questions can be raised about the practice of screening for disease. Here, we examine four leading cancer killers worldwide and we review the screening of protocols of these cancer types and their possible ethics.
近年来，医学伦理学已成为医学研究中无可争议的一部分。许多人认为，现代医学技术的进步——如透析机、呼吸机、磁共振成像、基因检测以及各类癌症筛查技术的发展——引发了生物伦理困境，这些困境在21世纪困扰着医生们。直到最近，关于研究和筛查伦理的争论主要围绕两个相关问题展开：受试者的自愿、知情同意，以及受试者风险与受益之间的适当关系。每位患者都有权获得关于其病情的全面、准确信息。这一法律原则主要源于有关知情同意的法庭判决，但随着时间的推移，医生们认识到大多数患者更愿意了解自己病情的真相并妥善利用这些信息。筛查是指在没有症状的情况下寻找疾病，换句话说，就是试图在被认为没有疾病的人身上发现疾病。筛查的例子包括用于检测乳腺癌的常规乳房X光检查、用于检测宫颈癌的常规巴氏涂片检查，以及用于检测前列腺癌的常规前列腺特异性抗原（PSA）检测。癌症筛查项目应遵循的伦理原则主要旨在尽量减少对参与个体的不必要伤害。关于疾病筛查的实践可以提出许多伦理问题。在这里，我们研究全球四种主要的癌症杀手，并回顾这些癌症类型的筛查方案及其可能涉及的伦理问题。
