Ethics and infectious disease
Ethics and infectious disease
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DOI：
10.1111/j.1467-8519.2005.00441.x
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发表时间：
2005-06-01
期刊：
影响因子：
2.2
通讯作者：
Selgelid, MJ
中科院分区：
文献类型：
--
作者：
Selgelid, MJ
生物伦理学显然受到研究资源分配不当的影响，类似于医学研究中的“10/90”鸿沟。虽然传染病应该被认为是生命伦理学的首要主题，但与堕胎、安乐死、遗传学、克隆、干细胞研究、传染病的历史和潜在的未来后果几乎是无与伦比的，这一事实是传染病的主题传染病值得生物伦理学家更多关注。在14世纪，“黑死病”消灭了欧洲三分之一的人口; 1918年的流感杀死了2000万到1亿人;而在20世纪，天花杀死的人可能是那个时期所有战争的三倍。在当今世界，流行病（艾滋病、耐多药结核病和新出现的传染病，如SARS）继续造成严重后果。传染病这个话题值得进一步关注的第二个原因是，它本身就提出了棘手的伦理问题。例如，虽然受感染的个人可能威胁其他个人和整个社会的健康，但监视、隔离和检疫等公共卫生保健措施可能需要侵犯广泛接受的基本人权和自由。一个重要而困难的伦理问题是，在涉及传染性、致命性或其他危险性疾病（程度不同）的情况下，如何在促进公共健康的功利主义目标与保护隐私和行动自由的自由主义目标之间取得平衡。第三，由于（发展中国家的）穷人承担了最沉重的负担，传染病深深地涉及到正义问题--这应该是伦理学的核心关注点。最后，我提供了社会学和历史学的解释，为什么传染病的话题还没有得到更多的关注，从生物伦理学。
Bioethics apparently suffers from a misdistribution of research resources analogous to the '10/90' divide in medical research. Though infectious disease should be recognized as a topic of primary importance for bioethics, the general topic of infectious disease has received relatively little attention from the discipline of bioethics in comparison with things like abortion, euthanasia, genetics, cloning, stem cell research, and so on. The fact that the historical and potential future consequences of infectious diseases are almost unrivalled is one reason that the topic of infectious disease warrants more attention from bioethicists. The 'Black Death' eliminated one third of the European population during the 14(th) Century; the 1918 flu killed between 20 and 100 million people; and, in the 20(th) Century smallpox killed perhaps three times more people than all the wars of that period. In the contemporary world, epidemics (of AIDS, multi-drug resistant tuberculosis, and newly emerging infectious diseases such as SARS) continue to have dramatic consequences. A second reason why the topic of infectious disease deserves further attention is that it raises difficult ethical questions of its own. While infected individuals can threaten the health of other individuals and society as a whole, for example, public health care measures such as surveillance, isolation, and quarantine can require the infringement of widely accepted basic human rights and liberties. An important and difficult ethical question asks how to strike a balance between the utilitarian aim of promoting public health, on the one hand, and libertarian aims of protecting privacy and freedom of movement, on the other, in contexts involving diseases that are - to varying degrees - contagious, deadly, or otherwise dangerous. Third, since their burden is most heavily shouldered by the poor (in developing countries), infectious diseases deeply involve issues of justice - which should be a central concern of ethics. I conclude by providing sociological and historical explanations of why the topic of infectious disease has not already received more attention from bioethicists.