Lipworth Wendy, Stewart Cameron, Kerridge Ian
Perspect Biol Med. 2018;61(1):90-105. doi: 10.1353/pbm.2018.0029.
The term innovation is frequently used as a justification for allowing clinicians to offer unproven autologous stem cell-based interventions (SCBIs) to their patients. Proponents of this kind of innovation (which we refer to as "clinical innovation") argue that physicians should be free to administer whatever interventions they choose, and informed consumers should be free to receive them. This article refutes the notion that clinician autonomy and consumer demand are a sufficient justification for offering patients unproven autologous SCBIs. We argue that, while clinician and consumer preferences need to be taken seriously, access to unproven SCBIs can only be fully justified when it is based on a commitment to beneficence and prudence. We also argue that there is a need for a clearer distinction between the definition of clinical innovation with autologous stem cells, which is morally neutral, and its justification, which entails a commitment to beneficence and prudence. Finally, we argue that regulation of clinical innovation with autologous stem cells needs to be based on a bioethics of innovation that attends to beneficence and prudence alongside other ethical principles.
“创新”一词经常被用作允许临床医生向患者提供未经证实的自体干细胞干预措施(SCBIs)的理由。这种创新(我们称之为“临床创新”)的支持者认为,医生应可自由实施他们选择的任何干预措施,而有知情权的消费者也应可自由接受这些措施。本文驳斥了临床医生的自主权和消费者需求足以成为向患者提供未经证实的自体SCBIs的理由这一观点。我们认为,虽然临床医生和消费者的偏好需要得到认真对待,但只有在基于对行善和审慎的承诺时,提供未经证实的SCBIs才能完全站得住脚。我们还认为,有必要更明确地区分自体干细胞临床创新的定义(这在道德上是中立的)与其理由(这需要对行善和审慎的承诺)。最后,我们认为对自体干细胞临床创新的监管需要基于一种创新生物伦理学,该伦理学在关注其他伦理原则的同时,也要兼顾行善和审慎。