Beeres Dorien T, Cornish Darren, Vonk Machiel, Ravensbergen Sofanne J, Maeckelberghe Els L M, Boele Van Hensbroek Pieter, Stienstra Ymkje
Infectious Disease Unit, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Babylon Primary Health Care Services, Elst, Groningen, The Netherlands.
BMC Med Ethics. 2018 Mar 2;19(1):16. doi: 10.1186/s12910-018-0256-7.
With a large number of forcibly displaced people seeking safety, the EU is facing a challenge in maintaining solidarity. Europe has seen millions of asylum seekers crossing European borders, the largest number of asylum seekers since the second world war. Endemic diseases and often failing health systems in their countries of origin, and arduous conditions during transit, raise questions around how to meet the health needs of this vulnerable population on arrival in terms of screening, vaccination, and access to timely and appropriate statutory health services. This paper explores the potential role of the principle of reciprocity, defined as the disposition 'to return good in proportion to the good we receive, and to make reparations for the harm we have done', as a mid-level principle in infectious disease screening policies.
More than half of the European countries implemented screening programmes for newly arrived asylum seekers. Screening may serve to avoid potential infectious disease risks in the receiving countries as well as help identify health needs of asylum seekers. But screening may infringe upon basic rights of those screened, thus creating an ethical dilemma. The use of the principle of reciprocity can contribute to the identification of potential improvements for current screening programmes and emphasizes the importance of certain rights into guidelines for screening. It may create a two way moral obligation, upon asylum seekers to actively participate in the programme, and upon authorities to reciprocate the asylum seekers' participation and the benefits for the control of public health.
The authors argue that the reciprocity principle leads to a stronger ethical justification of screening programmes and help achieve a balance between justifiable rights claims of the host population and the asylum seekers. The principle deserves a further and more thorough exploration of its potential use in the field of screening, migration and infectious diseases.
随着大量被迫流离失所者寻求安全庇护，欧盟在维持团结方面面临挑战。欧洲见证了数百万寻求庇护者跨越欧洲边境，这是自第二次世界大战以来寻求庇护者数量最多的情况。他们原籍国的地方病以及往往运转不良的卫生系统，加上途中的艰苦条件，引发了关于如何在筛查、疫苗接种以及获得及时和适当的法定卫生服务方面满足这一弱势群体抵达时的健康需求的问题。本文探讨了互惠原则作为传染病筛查政策中的一项中级原则的潜在作用，互惠原则被定义为“以与我们所受之善成比例的方式回报善，并对我们所造成的伤害进行赔偿”的倾向。
超过一半的欧洲国家对新抵达的寻求庇护者实施了筛查计划。筛查有助于避免接收国出现潜在的传染病风险，也有助于识别寻求庇护者的健康需求。但筛查可能侵犯被筛查者的基本权利，从而造成伦理困境。互惠原则的运用有助于确定当前筛查计划的潜在改进之处，并强调某些权利在筛查指南中的重要性。它可能会产生一种双向道德义务，即寻求庇护者有义务积极参与该计划，而当局有义务回报寻求庇护者的参与以及在公共卫生控制方面的益处。
作者认为，互惠原则为筛查计划提供了更强有力的伦理依据，并有助于在东道国人口和寻求庇护者的合理权利主张之间实现平衡。该原则值得在筛查、移民和传染病领域对其潜在用途进行进一步和更深入的探索。
