Journal of Medical Ethics:medethics-2020-106146 (forthcoming)

Authors
Ineke Bolt
Utrecht University
Abstract
Epigenetic markers could potentially be used for risk assessment in risk-stratified population-based cancer screening programmes. Whereas current screening programmes generally aim to detect existing cancer, epigenetic markers could be used to provide risk estimates for not-yet-existing cancers. Epigenetic risk-predictive tests may thus allow for new opportunities for risk assessment for developing cancer in the future. Since epigenetic changes are presumed to be modifiable, preventive measures, such as lifestyle modification, could be used to reduce the risk of cancer. Moreover, epigenetic markers might be used to monitor the response to risk-reducing interventions. In this article, we address ethical concerns related to personal responsibility raised by epigenetic risk-predictive tests in cancer population screening. Will individuals increasingly be held responsible for their health, that is, will they be held accountable for bad health outcomes? Will they be blamed or subject to moral sanctions? We will illustrate these ethical concerns by means of a Europe-wide research programme that develops an epigenetic risk-predictive test for female cancers. Subsequently, we investigate when we can hold someone responsible for her actions. We argue that the standard conception of personal responsibility does not provide an appropriate framework to address these concerns. A different, prospective account of responsibility meets part of our concerns, that is, concerns about inequality of opportunities, but does not meet all our concerns about personal responsibility. We argue that even if someone is responsible on grounds of a negative and/or prospective account of responsibility, there may be moral and practical reasons to abstain from moral sanctions.
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DOI 10.1136/medethics-2020-106146
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References found in this work BETA

Personal Responsibility Within Health Policy: Unethical and Ineffective.P. Friesen - 2017 - Journal of Medical Ethics Recent Issues 44 (1):53-58.
Medicalization and Overdiagnosis: Different but Alike.Bjørn Hofmann - 2016 - Medicine, Health Care and Philosophy 19 (2):253-264.
Epigenetic Responsibility.Maria Hedlund - 2012 - Medicine Studies 3 (3):171-183.

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