Sandman Lars, Hansson Emma
National Centre for Priorities in Health, Department of Health, Medicine and Caring Sciences, Linköping University, S-581 83, Linköping, Sweden.
, Västra Götaland Region, Sweden.
BMC Med Ethics. 2020 Oct 2;21(1):94. doi: 10.1186/s12910-020-00539-6.
Healthcare systems are increasingly struggling with resource constraints, given demographic changes, technological development, and citizen expectations. The aim of this article is to normatively analyze different suggestions regarding how publicly financed plastic surgery should be delineated in order to identify a well-considered, normative rationale. The scope of the article is to discuss general principles and not define specific conditions or domains of plastic surgery that should be treated within the publicly financed system.
This analysis uses a reflective equilibrium approach, according to which considered normative judgements in one area should be logically and argumentatively coherent with considered normative judgements and background theories at large within a system.
In exploring functional versus non-function conditions, we argue that it is difficult to find a principled reason for an absolute priority of functional conditions over non-functional conditions. Nevertheless, functional conditions are relatively easier to establish objectively, and surgical intervention has a clear causal effect on treating a functional condition. Considering non-functional conditions that require plastic surgery [i.e., those related to appearance or symptomatic conditions (not affecting function)], we argue that the patient needs to experience some degree of suffering (and not only a preference for plastic surgery), which must be 'validated' in some form by the healthcare system. This validation is required for both functional and non-functional conditions. Functional conditions are validated by distinguishing between statistically normal and abnormal functioning. Similarly, for non-functional conditions, statistical normality represents a potential method for distinguishing between what should and should not be publicly funded. However, we acknowledge that such a concept requires further development.
鉴于人口结构变化、技术发展和公民期望，医疗保健系统在资源限制方面面临着越来越大的压力。本文的目的是对有关如何界定公共资助的整形手术的不同建议进行规范性分析，以确定一个经过充分考虑的规范性理由。本文的范围是讨论一般原则，而不是界定公共资助系统内应治疗的整形手术的具体条件或领域。
本分析采用反思平衡法，根据该方法，一个领域中经过深思熟虑的规范性判断应在逻辑和论证上与一个系统内的其他经过深思熟虑的规范性判断及总体背景理论保持一致。
在探讨功能性与非功能性病症时，我们认为很难找到一个原则性理由来支持功能性病症绝对优先于非功能性病症。然而，功能性病症相对更容易客观确定，并且手术干预对治疗功能性病症有明确的因果效应。考虑到需要整形手术的非功能性病症（即那些与外观或症状性病症相关的病症（不影响功能）），我们认为患者需要经历一定程度的痛苦（而不仅仅是对整形手术的偏好），并且这种痛苦必须以某种形式得到医疗保健系统的“确认”。功能性和非功能性病症都需要这种确认。功能性病症通过区分统计学上的正常和异常功能来确认。同样，对于非功能性病症，统计学上的正常是区分哪些应得到公共资助和哪些不应得到公共资助的一种潜在方法。然而，我们承认这样一个概念需要进一步发展。
