May 22 2018

Ethical Considerations Must Take Precedence in Precision Medicine

Precision medicine offers the potential for patients to receive medical care tailored to their needs. But ethical considerations must be top of mind for providers on the giving end of such treatments, says Paul Ford, director of the Center for Bioethics at Cleveland Clinic.

At the Precision Medicine Summit in Washington, D.C., last week, Ford talked about issues providers must weigh regarding the delivery of such care: who will receive it, affordability issues, concerns about technology as it relates to device design. To the latter point, he says, innovation oftentimes takes place well in advance of regulation.

“There is an increased responsibility for designers, developers and specialists to design the technologies in a good and reflective way,” Ford says. “It’s our responsibility to try to predict what the challenges are going to be in the future if policy isn’t there to guide us.”

Sacrificing Resources for One Versus Many

Where precision medicine ethics become interesting is when one important aspect of care must be sacrificed for another, he says. Both providers and patients must ask themselves what’s important in their choices and who is bearing what cost moving forward.

The classic case in cancer is a patient weighing a longer life versus a higher quality of life, Ford says. “Which one are you going to give up to some degree? … Sensitivity, specificity, this looks like a scientific choice — it is based on good information — but it’s an ethical choice.”

Additionally, only so many resources can be committed to one patient without taking away resources from another patient, he says. For every patient receiving an innovative treatment, another who is out of frame goes without.

“What’s at stake, and who might pay the cost of that?” Ford says. “Sometimes it is all the kids in the local community who aren’t going to get free care for them because you want this one high-tech intervention.”

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Clinicians Must Weigh ‘Value Choices’

The inclination for many patients is to go toward high-tech interventions, Ford says. Clinicians, however, often want to be sure about a diagnosis or to verify that something is responsive.

For their part, clinicians must always be forthright about their intent, he says.

“When we order testing, we should always be clear that this is really to help substantiate with a clinical diagnosis, and it’s not just to make a clinician feel better about what they already have a good sense is going on,” Ford says. “You have to ask yourself, ‘When is a new intervention an investment ... and when is it simply a gamble with resources?’ These are value choices.”

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