The Value of Information and the Ethics of Personal-Genomic Screening

摘要

Burger and Kass (2009) argue that physicians should avoid ordering screening tests in most cases where there are no professional guidelines or where guidelines discourage the use of the test (class D recommendation). Examples of unproven screening tests include whole-body computed tomography (CT) scanning in healthy individuals, and brain magnetic resonance angiography (MRA) scans in patients with a family history of aneurysms. Burger and Kass claim that it is unethical to order such tests partly because patients requesting them may be unaware of the risks and the uncertainties about them (3). Ordering such a test also diverts healthcare resources from more effective uses, increases the chance that the test will become “standard of care,” and undermines the ability of researchers to recruit subjects for randomized studies of it (3). Even if the risk of the test is small, false positives or incidental findings can lead tomore risky and expensive tests and treatments, which again may cause no benefit and even net harm. For all these reasons, the authors take a firm position against the use of unproven screening tests (as described in the case examples).