粪菌移植技术的医学伦理问题思考

Ethical Consideration of Fecal Microbiota Transplantation

粪菌移植(fecal microbiota transplantation,FMT)在当前临床中主要应用于复发性艰难梭菌感染、溃疡性结肠炎等疾病的治疗。其在应用中所存在的伦理学问题主要包括“知情同意的困境”“较难实现患者利益最大化”“安全隐患”和“粪菌资源分配稀缺”。从医学伦理基本原则角度出发,新技术应用中必须兼顾人们的内心情感,尊重患者的自主选择、必须以为患者谋福益为根本目的、必须具有安全性,在“不伤害”的前提下发展,同时,严守科学规范,根据患者实际病情需要合理做出分配决策,以期更好地实现新技术在临床中的应用,使之更好地为人类生命健康服务。

Fecal microbiota transplantation(FMT)is mainly used in current clinical practice for the treatment of recurrent clostridium difficile infections and ulcerative colitis.The main ethical issues in its application include"dilemma of informed consent","difficulties in maximizing patient benefits","safety concerns"and"scarcity of fecal microbiota resource allocation".From the perspective of the basic principles of medical ethics,emotions and independent choice of patients have to be taken into account in the application of new technologies.The practice must also stand for the benefits of patients as the fundamental purpose and secure safety under the premise of"do no harm".At the same time,doctors should also bear in mind the strict adherence to scientific norms and the actual needs of patients when making reasonable decisions of allocation,so as to better realize the application of new technologies in the clinical setting and to better serve human life and health.