Justman Stewart
Liberal Studies Program, University of Montana, Missoula, MT 59812, USA.
Perspect Biol Med. 2012;55(2):291-8. doi: 10.1353/pbm.2012.0012.
The principle of avoiding harm, though still cited here and there in the literature, is regarded by many as a bit of antiquarianism with no relevance to actual medical practice and decision-making. But while treatment necessarily entails trading off risks against benefits, it is not so easy to defend harm caused in the name of prevention. Drugs intended for preventive use by the general population must meet high standards of safety-that is, they should not harm. This principle came to the fore in a recent meeting of an FDA Advisory Committee tasked with deciding whether or not to recommend two drugs for the prevention of prostate cancer. As the transcript of this charged meeting shows, the principle of avoiding harm is far from an inert doctrine without application to medicine.
避免伤害的原则，尽管在文献中仍不时被提及，但许多人认为它有点像古董，与实际的医疗实践和决策无关。然而，虽然治疗必然需要在风险和益处之间进行权衡，但要为以预防之名造成的伤害进行辩护却并非易事。供普通人群预防性使用的药物必须符合高标准的安全性——也就是说，它们不应造成伤害。这一原则在食品药品监督管理局（FDA）一个咨询委员会最近的一次会议上凸显出来，该委员会的任务是决定是否推荐两种预防前列腺癌的药物。正如这次气氛紧张的会议记录所示，避免伤害的原则远非一项与医学无关的惰性学说。
