Center for Ethics in Health Care, Oregon Health and Science University, 3181 SW, Sam Jackson Park, RD (UHN-86) Portland, OR 97239, USA.
J Med Ethics. 2011 Sep;37(9):563-6. doi: 10.1136/jme.2010.038943. Epub 2011 May 7.
Researchers and ethicists have long been concerned about the expectations for direct medical benefit expressed by participants in early phase clinical trials. Early work on the issue considered the possibility that participants misunderstand the purpose of clinical research or that they are misinformed about the prospects for medical benefit from these trials. Recently, however, attention has turned to the possibility that research participants are simply expressing optimism or hope about their participation in these trials. The ethical significance of this therapeutic optimism remains unclear. This paper argues that there are two distinct phenomena that can be associated with the term 'therapeutic optimism'-one is ethically benign and the other is potentially worrisome. Distinguishing these two phenomena is crucial for understanding the nature and ethical significance of therapeutic optimism. The failure to draw a distinction between these phenomena also helps to explain why different writers on the topic often speak past one another.
研究人员和伦理学家一直以来都对参与早期临床试验的患者对直接医学获益的期望表示关注。早期在这个问题上的研究工作考虑了这样一种可能性，即参与者误解了临床研究的目的，或者他们对从这些试验中获得医学益处的前景存在误解。然而，最近，人们的注意力转向了研究参与者只是对他们参与这些试验表达乐观或希望的可能性。这种治疗性乐观的伦理意义尚不清楚。本文认为，与“治疗性乐观”一词相关的有两种不同的现象，一种在伦理上是良性的，另一种则可能令人担忧。区分这两种现象对于理解治疗性乐观的性质和伦理意义至关重要。未能区分这两种现象也有助于解释为什么这个话题的不同作者经常各说各话。
