Holman C D, English D R
Department of Public Health, University of Western Australia, Nedlands.
J R Soc Med. 1996 Mar;89(3):123-9. doi: 10.1177/014107689608900303.
There is increasingly widespread acceptance that alcohol taken in moderation by the population aged 35 years or older reduces the risks of ischaemic heart disease and all-cause mortality. Ten causal criteria are used to evaluate the scientific evidence for a protective effect of low alcohol intake on ischaemic heart disease. Inferences for public policy are then assessed using the principles of beneficence, non-maleficence, justice and autonomy to support a framework of nine ethical considerations: intervention versus causation; effect modification by gender, smoking, biogenetic and other factors; inappropriate adoption of recommendations; competing hazards between atherosclerotic disease and cancer; opportunity cost; equity of access; the value system used to judge outcomes; the degree of social influence warranted; and consent and responsibility. We conclude that in the absence of more adequate scientific knowledge and informed community debate it is unethical to promote low alcohol intake as a preventive health measure.
越来越多的人普遍接受这样一种观点，即35岁及以上人群适度饮酒可降低缺血性心脏病风险和全因死亡率。有十条因果标准用于评估低酒精摄入量对缺血性心脏病具有保护作用的科学证据。然后，运用有益、无害、公正和自主原则评估公共政策推论，以支持一个包含九条伦理考量的框架：干预与因果关系；性别、吸烟、生物遗传及其他因素的效应修正；建议的不当采纳；动脉粥样硬化疾病与癌症之间的竞争风险；机会成本；获取公平性；用于判断结果的价值体系；合理的社会影响程度；以及同意与责任。我们得出结论，在缺乏更充分科学知识和社区充分知情辩论的情况下，将低酒精摄入量作为预防性健康措施加以推广是不道德的。
