Richter Elihu D, Laster Richard
Unit of Occupational and Environmental Medicine, Hebrew University-Hadassah School of Public Health and Community Medicine, Jerusalem, Israel.
Int J Occup Med Environ Health. 2004;17(1):9-16.
Ethics tells us: do good and do no harm and invokes the norms of justice, equity and respect for autonomy in protecting and promoting health and well-being. The Precautionary Principle, a contemporary re-definition of Bradford Hill's case for action, gives us a common sense rule for doing good by preventing harm to public health from delay: when in doubt about the presence of a hazard, there should be no doubt about its prevention or removal. It shifts the burden of proof from showing presence of risk to showing absence of risk, aims to do good by preventing harm, and subsumes the upstream strategies of the Driving Forces Pressure Stress Exposure Effect Action model and downstream strategies from molecular epidemiology for detection and prevention of risk. The Precautionary Principle has emerged because of the ethical import of delays in detection of risks to human health and the environment. Ethical principles, the Precautionary Principle, the DPSEEA model and molecular epidemiology all imply re-emphasizing epidemiology's classic role for early detection and prevention. Delays in recognizing risks from past exposures and acting on the findings (e.g., cigarette smoking and lung cancer, asbestos, organochlorines and endocrine disruption, radiofrequency, raised travel speeds) were examples of failures that were not only scientific, but ethical, since they resulted in preventable harm to exposed populations. These may delay results from, among other things, external and internal determinants of epidemiologic investigations of hazard and risk, including misuse of tests of statistical significance. Furthermore, applying the Precautionary Principle to ensure justice, equity, and respect for autonomy raises questions concerning the short-term costs of implementation to achieve long-term goals and the principles that guide compensation.
行善且不伤害，在保护和促进健康与福祉方面援引正义、公平和尊重自主权的规范。预防原则是对布拉德福德·希尔行动理由的当代重新定义，它为我们提供了一条常识性规则，即通过防止对公众健康的伤害来行善：当对危害的存在存在疑问时，对其预防或消除不应有疑问。它将举证责任从证明风险的存在转移到证明风险不存在，旨在通过预防伤害来行善，并纳入了驱动力-压力-应激-暴露-效应-行动模型的上游策略以及分子流行病学用于检测和预防风险的下游策略。预防原则的出现是因为检测对人类健康和环境风险的延迟具有伦理意义。伦理原则、预防原则、DPSEEA模型和分子流行病学都意味着重新强调流行病学在早期检测和预防方面的经典作用。过去接触所带来的风险识别以及根据调查结果采取行动的延迟（例如吸烟与肺癌、石棉、有机氯与内分泌干扰、射频、提高出行速度），这些不仅是科学上的失败，也是伦理上的失败，因为它们导致了对暴露人群的可预防伤害。这些延迟可能源于流行病学危害和风险调查的外部和内部决定因素等诸多方面，包括对统计显著性检验的滥用。此外，应用预防原则以确保正义、公平和尊重自主权，引发了关于实现长期目标的实施短期成本以及指导赔偿的原则等问题。
