[情境精准医学:围绕精准医学辩论的伦理评论]。

Innere Medizin (Heidelberg, Germany) Pub Date : 2024-10-01 Epub Date: 2024-08-28 DOI:10.1007/s00108-024-01772-6
Andreas Lob-Hüdepohl
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引用次数: 0

摘要

"精准医学 "这一标签似乎具有 "道德高价值词 "的地位。道德高价值词具有明暗矛盾的辩证关系。一方面,"精准医疗 "承诺以病人为中心,对严重疾病进行个体化诊断和治疗,尽可能减少不良副作用。另一方面,"精准医学 "这一标签迅速导致一切看起来 "不精准"、"含糊不清 "或只是 "一般不具体 "的东西逐渐贬值。因此,"精准医学 "几乎自动地促进了稀缺资源分配中的优先级和优先权,而这同时又与稀缺资源分配中 "不那么有价值 "的优先级降低或劣势相关联。作为另一个传播弱点,对 "精准 "的有限理解引人注目:精准医疗通常与技术上的高效医疗联系在一起,它往往对明确(严重)的疾病情况做出反应;然而,许多疾病的病程仍处于不明确阶段,或处于明显没有(更长)康复前景的情况下,治疗措施在医学上已不再适用。本文从三个伦理方面展开论述,这三个方面应在有关精准医学的讨论中发挥重要作用:稀缺资源分配的首要标准、医疗的首要目标与患者的相关性以及患者对生活质量或福祉的内在理解。
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[Situation-precise medicine : Ethical comments on the debate around precision medicine].

The label "precision medicine" appears to have the status of a "moral high-value word". Moral high-value words possess an ambivalent dialectic of light and dark. On the one hand, precision medicine promises an individual diagnosis and treatment of severe diseases focussed on the ill person with reduction of undesired side effects as far as possible. On the other hand, the label "precision medicine" rapidly leads to a gradual devaluation of everything that only seems "not precise", "vague" or simply "generally just unspecific". Precision medicine therefore nearly automatically promotes their prioritization and preference in the distribution of scarce resources, which is simultaneously associated with a deprioritization or inferiority in the distribution of scarce resources for the "not so valuable". As a further communicative weak point the limited understanding of "precision" catches the eye: precision medicine is often associated with technological high-performance medicine, which often reacts to a clear (severe) disease picture; however, many courses of diseases are still in an unclear stage or in a situation where there are clearly no (longer) perspectives for recovery and curative measures are no longer medically indicated. This article takes up on three ethical aspects, which should play an essential role in the debate on precision medicine: the uppermost criterion in the distribution of scarce resources, the relevance for patients as the uppermost aim of medical treatment and that of the patient-relevant inner understanding of the quality of life or well-being of patients.

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