Rubeis Giovanni, Steger Florian
Institut für Geschichte, Theorie und Ethik der Medizin, Universität Ulm, Parkstraße 11, 89073, Ulm, Deutschland.
Nervenarzt. 2019 May;90(5):497-502. doi: 10.1007/s00115-018-0663-5.
Internet and mobile-based interventions (IMIs) for mental disorders are seen by some authors as a step forward to narrow the treatment gap in mental health; however, especially in Germany professionals voice ethical concerns against the implementation of IMIs. The fact that there is broad evidence in favor of IMIs and that IMIs have already been implemented in several countries requires an ethical analysis to answer these concerns.
The objective is to tackle ethical issues connected to a possible implementation of IMIs for mental disorders in Germany and to point out possible solutions.
We conducted an ethical analysis using the criteria of well-being of patients, non-maleficence, justice, and patient autonomy, based on the empirical evidence.
The ethical analysis showed that IMIs for mental disorders principally have a positive effect on the well-being of patients and have a low risk of impairment. Additionally, IMIs can minimize risk, improve justice, and strengthen autonomy of mentally ill patients. Despite the broad evidence, there are still research desiderates with respect to ethical aspects, e. g. patient information for mentally ill patients.
一些作者认为，针对精神障碍的基于互联网和移动设备的干预措施（IMIs）是缩小心理健康治疗差距的一大进步；然而，特别是在德国，专业人士对实施IMIs表达了伦理方面的担忧。鉴于有大量证据支持IMIs，且IMIs已在多个国家实施，因此需要进行伦理分析以回应这些担忧。
目的是解决与在德国可能实施针对精神障碍的IMIs相关的伦理问题，并指出可能的解决方案。
我们基于实证证据，使用患者福祉、不伤害、公正和患者自主性的标准进行了伦理分析。
伦理分析表明，针对精神障碍的IMIs原则上对患者福祉有积极影响，且损害风险较低。此外，IMIs可以将风险降至最低，提高公正性，并增强精神病患者的自主性。尽管有大量证据，但在伦理方面仍有研究需求，例如为精神病患者提供信息。
