食管癌姑息性手术的伦理学
Ethics of palliative surgery in esophageal cancer.
作者信息
Mousavi Seyed Mahdi, Mousavi Seyed Reza, Akbari Mohammad Esmaeil
机构信息
Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
出版信息
Iran J Cancer Prev. 2013 Winter;6(1):8-11.
BACKGROUND
Surgery is one of the important palliative methods for patients withesophageal cancer. In addition to concerns related to clinical decision making, various moral challenges are encountered in palliative surgery. Some of them are related to patients and their illness, others to surgeons, their attitudes, skills and knowledge base.
METHODS
Pertinent moral challenges are addressed and analyzed with respect to prevailing perspectives in normative ethics (Ross style pluralism). Demandsregarding sensibility and precaution in this clinical setting represent substantial challenges with regard to the beneficence, non-maleficence, justice, autonomy and proper patient information.
RESULTS
Moreover, variations in definition of palliative surgery as well as limited scientific evidence in efficacy, effectiveness and efficiency pose methodological and moral problems. We have shown that ethical principles (beneficence, non-maleficence, and justice) in all procedures and treatments in esophageal cancer, including psychological problems of the patients are effective in improving their quality of life.
CONCLUSION
Both surgical skills and moral sensibility are required to improve surgical palliative care in esophageal cancer, and should be taken into account not only in clinical practice but also in education and research.
背景
手术是食管癌患者重要的姑息治疗方法之一。除了与临床决策相关的问题外，姑息手术还面临各种道德挑战。其中一些与患者及其病情有关，另一些则与外科医生、他们的态度、技能和知识基础有关。
方法
根据规范伦理学（罗斯式多元主义）的主流观点，对相关道德挑战进行探讨和分析。在这种临床环境中，对敏感性和预防措施的要求在行善、不伤害、公正、自主和适当告知患者信息方面构成了重大挑战。
结果
此外，姑息手术定义的差异以及疗效、有效性和效率方面科学证据的有限性带来了方法学和道德问题。我们已经表明，食管癌所有手术程序和治疗中的伦理原则（行善、不伤害和公正），包括患者的心理问题在内，都有助于提高他们的生活质量。
结论
提高食管癌手术姑息治疗水平既需要手术技能，也需要道德敏感性，这不仅应在临床实践中加以考虑，还应在教育和研究中予以重视。
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