Illes J, Lombera S, Rosenberg J, Arnow B
Stanford Center for Biomedical Ethics, Stanford University, Department of Pediatric, Stanford, CA 94305, United States.
J Psychiatr Res. 2008 Dec;43(2):107-14. doi: 10.1016/j.jpsychires.2008.02.008.
Success in functional neuroimaging has brought the promise of quantitative data in the form of brain images to the diagnosis of disorders of the central nervous system for which only qualitative clinical criteria have previously existed. Even though the translation of research to clinical neuroimaging for conditions such as major depression may not be available yet, rapid innovation along this trajectory of discovery to implementation compels exploration of how such information will eventually affect providers and patients. Clinical neuroethics is devoted to elucidating ethical challenges prior to and during the transfer of new research capabilities to the bedside. Through a model of proactive ethics, clinical neuroethics promotes the development of responsible social and public policies in response to new diagnostic and prognostic capabilities for the benefit of patients and their families, and for providers within the health care systems in which they practice. To examine views about the potential interaction of clinical neuroimaging and depression, we surveyed both mental health providers and outpatients and inpatients diagnosed with major depressive disorder. From responses of 52 providers and 72 patients, we found high receptivity to brain scans for treatment tailoring and choice, for improving understanding of and coping with disease, and for mitigating the effects of stigma and self-blame. Our results suggest that, once ready, roll out of the fully validated technology has significant potential to reduce social burden associated with highly stigmatized illnesses like depression.
功能神经成像技术的成功,为中枢神经系统疾病的诊断带来了以脑图像形式呈现的定量数据的希望,而此前这些疾病只有定性的临床标准。尽管对于重度抑郁症等病症,将研究成果转化为临床神经成像技术可能尚未实现,但沿着从发现到应用这一轨迹的快速创新,促使人们探索此类信息最终将如何影响医疗服务提供者和患者。临床神经伦理学致力于在将新的研究能力应用于临床之前及过程中,阐明所面临的伦理挑战。通过一种主动伦理模式,临床神经伦理学促进制定负责任的社会和公共政策,以应对新的诊断和预后能力,从而造福患者及其家属,以及他们所在医疗系统中的医疗服务提供者。为了研究对临床神经成像与抑郁症潜在相互作用的看法,我们对心理健康服务提供者以及被诊断为重度抑郁症的门诊和住院患者进行了调查。从52名提供者和72名患者的回答中,我们发现他们对脑部扫描用于治疗定制和选择、增进对疾病的理解和应对、减轻耻辱感和自责感的接受度很高。我们的结果表明,一旦完全验证的技术准备就绪,推广该技术有很大潜力减轻与抑郁症等高度污名化疾病相关的社会负担。