Fabre J, Allaz A F
Policlinique de médecine, Hôpital cantonal universitaire, Genève.
Schweiz Med Wochenschr. 1990 Dec 15;120(50):1903-11.
Opinions diverge on the ethics of preventive medicine. A balance needs to be struck between nihilism (doing nothing) and fanaticism (doing too much). The authors consider the ethical aspects of preventive medicine from the practising physician's viewpoint. Various aspects can be identified: SCIENTIFIC AND METHODOLOGICAL: Like any medical act, preventive practice relies on good scientific data. The epidemiologic studies should be clinically relevant and their recommendations must be interpreted critically before being incorporated into clinical practice. It should not be forgotten that we are dealing with patients and their behaviour. Tactful dialogue and personalized intervention are essential. DEONTOLOGICAL: Modern medicine is oriented toward health maintenance and promotion, thus including prevention. Although the community has drawn obvious benefits from preventive practices such as the use of vaccines, prevention must not be allowed to become a medical tyranny. Respect for the individual should remain its central concern. ETHICAL: The "meaning of life" must not be forgotten. Factors such as quality of life should always be kept in mind in measuring the benefits of prevention. By providing objective information and tailored counselling, the aim of prevention is to encourage expression of the individual's own responsibility for her/his own health. FINANCIAL: Preventive medicine is not covered by health insurance schemes. Cost-benefit analysis should consider not only the economic aspects of prevention but also its positive impacts on the entire social field. SOCIAL AND CULTURAL: The findings of epidemiologic studies must be adapted to precise socio-cultural environments. In our culture, for example, caregivers should be the first to practise what they preach. It must also be remembered that at the present time the basic preventive measures are still not accessible to everyone.
对于预防医学的伦理问题，人们看法不一。需要在虚无主义（什么都不做）和狂热主义（做得太多）之间找到平衡。作者从执业医生的角度考虑预防医学的伦理问题。可以确定各个方面：科学与方法学：与任何医疗行为一样，预防实践依赖于良好的科学数据。流行病学研究应具有临床相关性，其建议在纳入临床实践之前必须经过批判性解读。不应忘记，我们面对的是患者及其行为。巧妙的对话和个性化干预至关重要。道义学：现代医学以健康维护和促进为导向，因此包括预防。尽管社区已从预防措施（如使用疫苗）中明显受益，但绝不能让预防成为医疗专制。对个人的尊重应始终是其核心关注点。伦理学：“生活的意义”绝不能被遗忘。在衡量预防的益处时，应始终牢记生活质量等因素。通过提供客观信息和量身定制的咨询，预防的目的是鼓励个人对自己的健康表达自身责任。财务：预防医学不在健康保险计划范围内。成本效益分析不仅应考虑预防的经济方面，还应考虑其对整个社会领域的积极影响。社会与文化：流行病学研究的结果必须适应精确的社会文化环境。例如，在我们的文化中，护理人员应率先以身作则。还必须记住，目前并非每个人都能获得基本的预防措施。
