Dickenson D L
Imperial College School of Medicine, Department of Primary Health Care and General Practice, Medical Ethics Unit, Norfolk Place, London W2 1PG, UK.
Health Care Anal. 1999;7(2):131-7. doi: 10.1023/A:1009432903439.
Medical criteria rooted in evidence-based medicine are often seen as a value-neutral 'trump card' which puts paid to any further debate about setting priorities for treatment. On this argument, doctors should stop providing treatment at the point when it becomes medically futile, and that is also the threshold at which the health purchaser should stop purchasing. This paper offers three kinds of ethical criteria as a counterweight to analysis based solely on medical criteria. The first set of arguments concerns futility, probability and utility; the second, justice and fairness; the third, consent and competence. The argument is illustrated by two recent case studies about futility and priority-setting: the U.S. example of 'Baby Ryan' and the U.K. case of 'Child B'.
基于循证医学的医学标准常常被视为一张价值中立的“王牌”，它终结了任何关于治疗优先级设定的进一步争论。按照这种观点，当治疗在医学上变得无效时，医生就应该停止提供治疗，而这也是医疗购买者应该停止购买的临界点。本文提出了三种伦理标准，作为仅基于医学标准的分析的平衡力量。第一组论点涉及无效性、可能性和效用；第二组涉及正义和公平；第三组涉及同意和能力。通过两个最近关于无效性和优先级设定的案例研究对这一论点进行了说明：美国的“小瑞安”案例和英国的“儿童B”案例。
