Ethical issues in the treatment of hepatitis C.
Ethical issues in the treatment of hepatitis C.
复制标题
丙型肝炎治疗中的伦理问题。
DOI：
10.1016/s1542-3565(05)00183-7
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发表时间：
2005
期刊：
影响因子：
--
通讯作者：
Arora,Sanjeev
中科院分区：
文献类型：
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作者：
Geppert,CynthiaMA;Arora,Sanjeev
背景与目标 四百万美国人感染丙型肝炎病毒 (HCV)，使其成为美国最常见的血液传播感染。囚犯和精神疾病患者等弱势群体的丙肝病毒感染率高于一般人群。伦理、临床、经济和社会障碍常常阻止这些患者接受现有的有效抗病毒治疗。这些护理障碍在文献中很少受到关注，然而，HCV 治疗的伦理和社会正义方面的知识可以提高胃肠病学家的患者护理质量。方法本文分析了 5 种经常提出的限制患者接受 HCV 治疗的临床伦理论点：风险/效益平衡、正义、依从性、成本效益和歧视。结果适当的精神科和物质使用干预 可以为弱势群体成员的治疗带来良好的成本效益和风险/收益平衡。尽管弱势群体的成员可能表现出较高的精神副作用发生率和抗病毒治疗的依从性较差，但协作护理可以提高依从性并减少不良反应。如果这些人群的遵守率和风险/收益平衡与其他人群没有显着差异，则正义原则可能需要对这些人群进行治疗。对丙型肝炎患者的歧视往往会减少囚犯和其他受污名群体获得护理的机会。结论这项分析表明，如果胃肠病学家和心理健康和药物滥用专业人士积极合作，在许多情况下，丙型肝炎抗病毒治疗的机会可以安全有效地扩大到弱势群体。
Background & AimsFour million Americans are infected with hepatitis C virus (HCV), making it the most common blood-borne infection in the United States. Members of disadvantaged groups such as prisoners and those with psychiatric disorders have a higher prevalence of HCV infection than the general population. Ethical, clinical, economic, and social barriers often prevent these patients from receiving the effective antiviral treatments now available. These barriers to care have received little attention in the literature, and yet, knowledge of the ethical and social justice aspects of HCV treatment can enhance the quality of gastroenterologists’ patient care.MethodsThis article analyzes 5 clinical-ethical arguments frequently presented for limiting patient access to HCV treatment: risk/benefit balance, justice, compliance, cost-effectiveness, and discrimination.ResultsAppropriate psychiatric and substance use intervention can result in a favorable cost-effectiveness and risk/benefit balance for treating members of disadvantaged groups. Although members of disadvantaged populations might exhibit higher rates of psychiatric side effects and poorer compliance with antiviral regimens, collaborative care can improve adherence and reduce adverse effects. The principle of justice might warrant treatment of these populations if the rate of adherence and risk/benefit balance is not significantly different than in other populations. Discrimination against persons with hepatitis C often reduces access to care among prisoners and other stigmatized groups.ConclusionsThis analysis suggests that if gastroenterologists and mental health and substance abuse professionals actively collaborate, access to antiviral therapy for HCV can, in many cases, be safely and effectively expanded to disadvantaged populations.