Public Health Sciences Section, Division of Community Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Medical School, Edinburgh, UK.
J Med Ethics. 2009 Nov;35(11):668-71. doi: 10.1136/jme.2009.030171.
The British National Institute for Health and Clinical Excellence (NICE) has recently (28 January 2009) released new guidelines for the diagnosis, treatment and prevention of the psychiatric category antisocial personality disorder (ASPD). Evident in these recommendations is a broader ambiguity regarding the ontology of ASPD. Although, perhaps, a mundane feature of much of medicine, in this case, ontological uncertainty has significant ethical implications as a product of the profound consequences for an individual categorised with this disorder. This paper argues that in refraining from emphasising uncertainty, NICE risks reifying a controversial category. This is particularly problematical given that the guidelines recommend the identification of individuals "at risk" of raising antisocial children. Although this paper does not argue that NICE is "wrong" in any of its recommendations, more emphasis should have been placed on discussions of the ethical implications of diagnosis and treatment, especially given the multiple uncertainties associated with ASPD. It is proposed that these important issues be examined in more detail in revisions of existing NICE recommendations, and be included in upcoming guidance. This paper thus raises key questions regarding the place and role of ethics within the current and future remit of NICE.
英国国家卫生与临床优化研究所（NICE）最近（2009 年 1 月 28 日）发布了针对精神科反社会人格障碍（ASPD）的诊断、治疗和预防的新指南。这些建议明显表明，ASPD 的本体论更加模糊。尽管本体论的不确定性可能是医学的一个普遍特征，但在这种情况下，由于被这种障碍分类的个体所带来的深远后果，它具有重要的伦理意义。本文认为，NICE 避免强调不确定性，可能会使一个有争议的类别变得具体化。鉴于指南建议识别“有风险”养育反社会孩子的个体，这一点尤其成问题。尽管本文并不是说 NICE 的任何建议都是“错误”的，但应更加强调诊断和治疗的伦理影响的讨论，尤其是考虑到与 ASPD 相关的多种不确定性。本文提出，在修订现有的 NICE 建议和即将出台的指南时，应更详细地审查这些重要问题。因此，本文提出了有关当前和未来 NICE 职权范围内伦理的地位和作用的关键问题。
