Linköping University Medical Ethics Conference (LIMEC)

Speaker: Prof. Dr. Silke Schicktanz, Institute of Medical Ethics and History of Medicine, University Medical Center Göttingen

Abstract: In the domain of personalized medicine, prediction has emerged as a pivotal element. Optimists contend that prediction enables preemptive actions. It utilizes physiological or digital biomarkers to furnish statistical data regarding the onset or progression of a disease.

The field of Alzheimer's disease (AD) represents a particularly challenging area for such prediction. New blood biomarkers have been shown to predict higher risks for AD with a lead time of 10 to 15 years.

In this presentation, I will engage in a dialogue on the ethical considerations of predictive testing, being accompanied by empirical insights into public attitudes. I explore the implications of predictive testing on the liberal right to information, juxtaposing it with communitarian concerns of promoting hope and (self-)responsibilisation.

Speaker: Prof. Leonard Fleck, Center for Bioethics and Social Justice, Department of Philosophy, Michigan State University

Abstract: What is most distinctive of the ethical challenges raised by precision medicine is that they are “wicked” ethical problems. A “wicked” ethical problem is defined as one where every attempted resolution results in an equally ethically problematic outcome, or an even more problematic outcome. For example, hematologic cancers can be treated with CAR- T-cell therapies with a front-end cost of $475,000.

Roughly 30% of those patients will survive less than a year.  Would it be ethically acceptable, as a matter of health care justice, to do research aimed at finding biomarkers that would identify such patients before the fact with 90% confidence so that we could deny them that therapy (presumably to re-allocate to higher priority health care needs)?  There are dozens of problems like this generated by our current deployment of precision medicine.

I argue that none of our theories of justice have the resources to yield satisfactory responses to these ethical challenges.

We need to rely instead on fair and inclusive processes of rational democratic deliberation constrained by the relevant medical facts, a range of considered judgments of health care justice, a public or political conception of health care justice (building on Rawls), what I describe as constitutional principles of health care justice, and a certain understanding of wide reflective equilibrium.

The result will be deliberative judgments, autonomously generated, that are “roughly just” (given the wickedness of the problems). The ultimate goal is to prevent cancer and precision medicine from capturing an unfair share of health care resources.