Fleck Leonard M
Center for Ethics and Humanities in the Life Sciences, College of Human Medicine, Michigan State University, East Lansing, MI.
Urol Oncol. 2014 Feb;32(2):202-6. doi: 10.1016/j.urolonc.2013.09.013.
Personalized medicine has been touted as a revolutionary form of cancer care. It has been portrayed as precision medicine, targeting with deadly accuracy cancer cells and sparing patients the debilitating broad-spectrum side effects of more traditional forms of cancer therapy. But personalized medicine still has its costs to patients and society, both moral and economic costs. How to recognize and address those issues will be the focus of this essay. We start with these questions: Does everyone faced with cancer have a moral right to the most effective cancer care available, no matter what the cost, no matter whether a particular individual has the personal ability to pay for that care or not? Or are there limits to the cancer care that anyone has a right to at social expense? If so, what are those limits and how are those limits to be determined? Are those limits a matter of both morality and economics? I will answer this last question in the affirmative. This is what I refer to as the "Just Caring" problem in health care.
个性化医疗被誉为癌症治疗的一种革命性形式。它被描绘成精准医疗，能极其准确地靶向癌细胞，使患者免受更传统癌症治疗方式带来的使人虚弱的广谱副作用。但个性化医疗对患者和社会仍有成本，包括道德和经济成本。如何认识和解决这些问题将是本文的重点。我们从这些问题开始：每个面临癌症的人是否都有道德权利获得最有效的癌症治疗，无论成本如何，无论某个特定个体是否有个人支付能力？或者，以社会为代价，任何人有权获得的癌症治疗是否存在限制？如果是这样，这些限制是什么，以及如何确定这些限制？这些限制是道德和经济两方面的问题吗？我将肯定地回答最后一个问题。这就是我所说的医疗保健中的“公正关怀”问题。
