Zarzeczny Amy, Clark Marianne
Johnson-Shoyama Graduate School of Public Policy, University of Regina, Regina, Canada.
BMC Med Ethics. 2014 Oct 14;15:75. doi: 10.1186/1472-6939-15-75.
The pursuit of unproven stem cell-based interventions ("stem cell tourism") is an emerging issue that raises various concerns. Physicians play different roles in this market, many of which engage their legal, ethical and professional obligations. In Canada, physicians are members of a self-regulated profession and their professional regulatory bodies are responsible for regulating the practice of medicine and protecting the public interest. They also provide policy guidance to their members and discipline members for unprofessional conduct.
We conducted semi-structured telephone interviews with representatives from six different provincial Colleges of Physicians and Surgeons in Canada to discuss their experiences and perspectives regarding stem cell tourism. Our focus was on exploring how different types of physician involvement in this market would be viewed by physicians' professional regulatory bodies in Canada.
When considering physicians' professional obligations, participants drew analogies between stem cell tourism and other areas of medical tourism as well as with some aspects of complementary alternative medicine where existing policies, codes of ethics and regulations provide some guidance. Canadian physicians are required to act in the best interests of their patients, respect patient autonomy, avoid conflicts of interest and pursue evidence-based practice in accordance with accepted standards of care. Physicians who provide unproven treatments falling outside the standard of care, not in the context of an approved research protocol, could be subject to professional discipline. Other types of problematic conduct include referrals involving financial conflict of interest and failure to provide urgent medically necessary care. Areas of ambiguity include physicians' obligations when asked for information and advice about seeking unproven medical treatments, in terms of providing non-urgent follow-up care, and when asked to support efforts to go abroad by providing tests or procedures in advance that would not otherwise be medically indicated.
Specific policy guidance regarding the identified areas of tension or ambiguity may prove helpful for physicians struggling with these issues. Further consideration of the complex interplay of factors at issue in how physicians may (should) respond to patient demands related to unproven medical interventions while meeting their professional, legal and ethical obligations, is warranted.
追求未经证实的基于干细胞的干预措施（“干细胞旅游”）是一个新出现的问题，引发了各种担忧。医生在这个市场中扮演着不同角色，其中许多角色涉及他们的法律、伦理和职业义务。在加拿大，医生是一个自我监管职业的成员，其专业监管机构负责规范医疗实践并保护公众利益。它们还为其成员提供政策指导，并对行为不专业的成员进行纪律处分。
我们对加拿大六个不同省级医师和外科医师学院的代表进行了半结构化电话访谈，以讨论他们对干细胞旅游的经历和看法。我们的重点是探讨加拿大医生的专业监管机构如何看待医生在这个市场中的不同参与类型。
在考虑医生的职业义务时，参与者将干细胞旅游与其他医疗旅游领域以及补充替代医学的某些方面进行了类比，现有政策、道德规范和法规在这些方面提供了一些指导。加拿大医生被要求以患者的最佳利益行事，尊重患者自主权，避免利益冲突，并按照公认的护理标准遵循循证医学实践。提供不符合护理标准且不在批准的研究方案范围内的未经证实治疗的医生可能会受到专业纪律处分。其他有问题的行为包括涉及财务利益冲突的转诊以及未能提供紧急医疗必需护理。存在模糊不清的领域包括医生在被问及有关寻求未经证实的医疗治疗的信息和建议时的义务、提供非紧急后续护理时的义务，以及在被要求通过提前提供否则在医学上无必要的检查或程序来支持出国就医的努力时的义务。
针对已确定的紧张或模糊领域的具体政策指导可能对在这些问题上苦苦挣扎的医生有所帮助。有必要进一步考虑在医生如何（应该）回应与未经证实的医疗干预相关的患者需求同时履行其职业、法律和伦理义务方面所涉及的复杂因素相互作用。
