Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO;
Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO.
Clin Chem. 2019 Dec;65(12):1497-1507. doi: 10.1373/clinchem.2019.306670. Epub 2019 Aug 21.
Laboratory medicine, like other areas of medicine, is obliged to adhere to high ethical standards. There are particular ethical issues that are unique to laboratory medicine and other areas in which ethical issues uniquely impact laboratory practice. Despite this, there is variability in ethics education within the profession. This review provides a foundation for the study of ethics within laboratory medicine.
The Belmont Report identifies 3 core principles in biomedical ethics: respect for persons (including autonomy), beneficence (and its corollary nonmalfeasance), and justice. These core principles must be adhered to in laboratory medicine. Informed consent is vital to maintain patient autonomy. However, balancing patient autonomy with the desire for beneficence can sometimes be difficult when patients refuse testing or treatment. The use of leftover or banked samples is fundamental to the ability to do research, create reference intervals, and develop new tests, but it creates problems with consent. Advances in genetic testing have created unique ethical issues regarding privacy, incidental findings, and informed consent. As in other professions, the emergence of highly contagious and deadly infectious diseases poses a difficult ethical dilemma of helping patients while protecting healthcare workers.
Although many clinical laboratorians do not see or treat patients, they must be held accountable to the highest ethical and professional behavior. Recognition and understanding of ethical issues are essential to ethical practice of laboratory medicine.
实验室医学与医学的其他领域一样,有义务遵守高标准的伦理规范。实验室医学有其独特的伦理问题,其他领域的伦理问题也会对实验室实践产生独特的影响。尽管如此,该专业内的伦理教育仍存在差异。本文为实验室医学领域的伦理学研究奠定了基础。
《贝尔蒙报告》确定了生物医学伦理学的 3 个核心原则:尊重人(包括自主性)、行善(及其推论不伤害)和公正。这些核心原则必须在实验室医学中得到遵守。知情同意对于维护患者自主性至关重要。然而,当患者拒绝检测或治疗时,平衡患者自主性与行善愿望有时会很困难。利用剩余或储存的样本对于进行研究、创建参考区间和开发新检测至关重要,但这会引发同意方面的问题。基因检测的进步带来了有关隐私、偶然发现和知情同意的独特伦理问题。与其他专业一样,高传染性和致命传染病的出现带来了帮助患者同时保护医护人员的艰难伦理困境。
尽管许多临床检验师不直接接触或治疗患者,但他们必须遵守最高的伦理和专业行为标准。认识和理解伦理问题对于实验室医学的伦理实践至关重要。