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脑疾病的前驱症状和临床前检测:预测脑健康的伦理景观调查。

Prodromes and Preclinical Detection of Brain Diseases: Surveying the Ethical Landscape of Predicting Brain Health.

机构信息

Graduate Program in Neuroscience, Emory University, Atlanta 30322, GA.

Department of Neurology, Emory University, Atlanta 30322, GA

出版信息

eNeuro. 2019 Jul 25;6(4). doi: 10.1523/ENEURO.0439-18.2019. Print 2019 Jul/Aug.

Abstract

The future of medicine lies not primarily in cures but in disease modification and prevention. While the science of preclinical detection is young, it is moving rapidly. Preclinical interventions offer hope to decrease the severity of a disease or delay the development of a disorder. With such promise, the research and practice of detecting brain disorders at a preclinical stage present unique ethical challenges that must be addressed to ensure the benefit of these technologies. Direct brain interventions have the potential to impact not just what a patient has but who they are and who they could become. Further, receiving an assessment for a preclinical or prodromal state has potential to impact perceptions about capacity, autonomy and personhood and could become entangled with stigma and discrimination. Exploring ethical issues alongside and integrated into the experimental design and research of these technologies is critical. This review will highlight ethical issues attendant to the current and near future states of preclinical detection across the life span, specifically as it relates to autism spectrum disorder (ASD), schizophrenia, and Alzheimer's disease.

摘要

医学的未来不在于治疗,而在于疾病的修饰和预防。虽然临床前检测的科学还很年轻,但它发展迅速。临床前干预为减轻疾病的严重程度或延缓疾病的发展带来了希望。有了这样的前景,在临床前阶段检测脑部疾病的研究和实践带来了独特的伦理挑战,必须加以解决,以确保这些技术的益处。直接的大脑干预不仅有可能影响患者的现状,还可能影响他们的身份和未来的可能性。此外,接受临床前或前驱状态的评估有可能影响对能力、自主性和人格的看法,并可能与污名和歧视纠缠在一起。在这些技术的实验设计和研究中,探讨伦理问题并将其纳入其中至关重要。这篇综述将重点介绍与整个生命周期中临床前检测的当前和近期状态相关的伦理问题,特别是与自闭症谱系障碍(ASD)、精神分裂症和阿尔茨海默病相关的问题。

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