Lev-Ran Shaul, Nitzan Uri, Fennig Shmuel
Shalvata Mental Health Center, Hod Hasharon, Israel Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
Shalvata Mental Health Center, Hod Hasharon, Israel.
Isr J Psychiatry Relat Sci. 2014;51(3):175-80.
Harm reduction is a general term for pragmatic interventions aimed at reducing problematic behaviors. Emerging from addiction treatments, it is based on the understanding that people will continue to behave in ways that pose a risk to them and their communities, and that an important goal of any treatment program is to minimize the harm associated with these behaviors. Despite its evidence based background, harm reduction is not readily applied in general psychiatry. This is mainly due to the complex ethical dilemmas arising within harm reduction practices, as well as a lack of scientific knowledge and theoretical frameworks essential for dealing with such ethical dilemmas. In this paper we introduce the fundamental theoretical and scientific base of harm reduction strategies, and present three clinical examples of the complex ethical dilemmas arising when working within a harm reduction practice. We finally present a theoretical framework for dealing with the ethical dilemmas and argue this may make harm reduction strategies more accessible in general psychiatry.
减少伤害是针对减少问题行为的务实干预措施的统称。它起源于成瘾治疗，基于这样一种认识，即人们会继续以对自身及社区构成风险的方式行事，且任何治疗项目的一个重要目标是将与这些行为相关的伤害降至最低。尽管减少伤害有循证背景，但在普通精神病学中却未得到广泛应用。这主要是由于减少伤害实践中产生的复杂伦理困境，以及缺乏处理此类伦理困境所必需的科学知识和理论框架。在本文中，我们介绍了减少伤害策略的基本理论和科学基础，并给出了在减少伤害实践中出现的复杂伦理困境的三个临床实例。我们最后提出了一个处理伦理困境的理论框架，并认为这可能会使减少伤害策略在普通精神病学中更容易被采用。
