Farnia Benjamin, Majumder Mary A, Paulino Arnold C
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas.
J Am Coll Radiol. 2015 May;12(5):484-90. doi: 10.1016/j.jacr.2014.10.010. Epub 2014 Dec 18.
The treatment of orbital rhabdomyosarcoma is a topic of debate between North American and European clinicians, with the utility of radiation therapy as part of initial management in question. Despite differences in philosophy, the dominant North American approach of upfront radiation and the dominant European approach of radiation only in the event of recurrence yield a similar rate of overall survival. We sought to identify the ethical arguments for each approach.
Established moral principles and appeals in contemporary medical ethics were utilized to identify the ethical arguments supporting each treatment approach. The potential for technologic advances to alter the analysis was considered.
Emphasizing the principle of beneficence, the North American approach seeks to reduce recurrence rates. In contrast, the European approach seeks to avoid radiation-induced sequelae, emphasizing the principle of nonmaleficence. Both approaches are based on well-established ethical principles, evidence, and clinical experience. Thus, both approaches currently appear to have legitimacy and should be included in the informed consent process. However, if treatment-related toxicity is reduced through improvements in radiation delivery, the North American approach could emerge as ethically superior.
Ethical analysis can aid in addressing challenges that arise when professional practices and perspectives differ in the management of cancer patients.
眼眶横纹肌肉瘤的治疗是北美和欧洲临床医生之间争论的一个话题，放射治疗作为初始治疗的一部分其效用存在疑问。尽管理念存在差异，但北美主要的 upfront 放疗方法和欧洲主要的仅在复发时才进行放疗的方法产生了相似的总生存率。我们试图确定每种方法的伦理依据。
利用当代医学伦理学中既定的道德原则和诉求来确定支持每种治疗方法的伦理依据。考虑了技术进步改变分析的可能性。
北美方法强调行善原则，力求降低复发率。相比之下，欧洲方法力求避免放疗引起的后遗症，强调不伤害原则。两种方法都基于既定的伦理原则、证据和临床经验。因此，目前两种方法似乎都具有合理性，应纳入知情同意过程。然而，如果通过改进放疗技术降低与治疗相关的毒性，北美方法在伦理上可能会更具优势。
伦理分析有助于应对在癌症患者管理中专业实践和观点存在差异时出现的挑战。
