Smith Charles B, Battin Margaret P, Jacobson Jay A, Francis Leslie P, Botkin Jeffrey R, Asplund Emily P, Domek Gretchen J, Hawkins Beverly
Division of Medical Ethics, University of Utah, Salt Lake City, Utah 84112 USA.
Dev World Bioeth. 2004 May;4(1):1-16. doi: 10.1111/j.1471-8731.2004.00064.x.
This paper examines the characteristics of infectious diseases that raise special medical and social ethical issues, and explores ways of integrating both current bioethical and classical public health ethics concerns. Many of the ethical issues raised by infectious diseases are related to these diseases' powerful ability to engender fear in individuals and panic in populations. We address the association of some infectious diseases with high morbidity and mortality rates, the sense that infectious diseases are caused by invasion or attack on humans by foreign micro-organisms, the acute onset and rapid course of many infectious diseases, and, in particular, the communicability of infectious diseases. The individual fear and community panic associated with infectious diseases often leads to rapid, emotionally driven decision making about public health policies needed to protect the community that may be in conflict with current bioethical principles regarding the care of individual patients. The discussion includes recent examples where dialogue between public health practitioners and medical-ethicists has helped resolve ethical issues that require us to consider the infected patient as both a victim with individual needs and rights and as a potential vector of disease that is of concern to the community.
本文探讨了引发特殊医学和社会伦理问题的传染病特征，并探索整合当前生物伦理与经典公共卫生伦理关注点的方法。传染病引发的许多伦理问题都与这些疾病在个体中引发恐惧、在人群中引发恐慌的强大能力有关。我们讨论了一些传染病与高发病率和死亡率的关联、传染病是由外来微生物入侵或攻击人类所致的观念、许多传染病的急性发作和快速病程，尤其是传染病的传染性。与传染病相关的个体恐惧和社区恐慌往往导致在制定保护社区所需的公共卫生政策时，基于情感迅速做出决策，而这些决策可能与当前关于个体患者护理的生物伦理原则相冲突。讨论内容包括近期的一些例子，其中公共卫生从业者与医学伦理学家之间的对话有助于解决伦理问题，这些问题要求我们将感染患者既视为有个人需求和权利的受害者，又视为社区所关注的潜在疾病传播源。
