University of Toronto, Division of Neurology, Toronto Western Hospital, Toronto, Ontario, Canada.
Mov Disord. 2010 Feb 15;25(3):260-4. doi: 10.1002/mds.22911.
Recent developments in our understanding of psychogenic movement disorders have not yet led to advances in treatment. A potentially beneficial treatment strategy is suggestion, the voluntary use by the physicians of techniques that introduce into the patient's mind a belief that he or she will be healed. Principalism, the dominant school of contemporary medical ethics, holds that the use of suggestion is not ethically justifiable because it undermines patient autonomy and degrades the doctor-patient relationship. However, evidence from a variety of sources (neuroimaging, anecdote, expert opinion, randomized controlled trials, and meta-analysis) supports the efficacy of suggestion as a treatment for psychogenic movement disorders. When issues of choice, consent, deceit, disclosure, and decision-making are analyzed from the perspective of an ethics of care, we see that suggestion may enhance patient autonomy and does not violate the trust between doctors and their patients. I conclude that suggestion is therefore an ethically justifiable treatment for patients with psychogenic movement disorders.
我们对心因性运动障碍的理解虽有新进展，但治疗上仍未有突破。有一个可能有效的治疗策略是暗示，即医生主动运用一些技巧，向患者灌输他或她将会被治愈的信念。当代医学伦理学的主流学派——主要原则论认为，暗示的使用在伦理上是不合理的，因为它会破坏患者的自主性并降低医患关系。然而，来自各种来源的证据（神经影像学、轶事、专家意见、随机对照试验和荟萃分析）支持暗示作为治疗心因性运动障碍的有效性。当从关怀伦理的角度分析选择、同意、欺骗、披露和决策等问题时，我们可以看到，暗示可以增强患者的自主性，并且不会违反医生与患者之间的信任。因此，我得出的结论是，暗示是治疗心因性运动障碍患者的一种合理的治疗方法。
