期刊
JOURNAL OF BIOETHICAL INQUIRY
卷 19, 期 2, 页码 287-297出版社
SPRINGER
DOI: 10.1007/s11673-022-10167-x
关键词
Bioethics; Alzheimer's disease; Risk testing; Clinical ethics; Biomarkers
资金
- Netherlands Organization for Health Research and Development [731010012]
- European Union-European Federation of Pharmaceutical Industries and Associations (EU-EFPIA) Innovative Medicines Initiatives 2 Joint Undertaking [115952]
An increasing number of older people seek medical attention for mild cognitive symptoms due to concerns about developing Alzheimer's disease. Some guidelines suggest biomarker testing to improve diagnostic certainty and enable early diagnosis, while critics argue that biomarker tests lack clinical validity. This paper explores the use of reflective equilibrium to weigh the arguments on both sides of the debate, considering factors such as clinical validity, ethical principles, and societal ideals.
An increasing number of people seek medical attention for mild cognitive symptoms at older age, worried that they might develop Alzheimer's disease. Some clinical practice guidelines suggest offering biomarker testing in such cases, using a brain scan or a lumbar puncture, to improve diagnostic certainty about Alzheimer's disease and enable an earlier diagnosis. Critics, on the other hand, point out that there is no effective Alzheimer treatment available and argue that biomarker tests lack clinical validity. The debate on the ethical desirability of biomarker testing is currently polarized; advocates and opponents tend to focus on their own line of arguments. In this paper, we show how the method of reflective equilibrium (RE) can be used to systematically weigh the relevant arguments on both sides of the debate to decide whether to offer Alzheimer biomarker testing. In the tradition of RE, we reflect upon these arguments in light of their coherence with other argumentative elements, including relevant facts (e.g. on the clinical validity of the test), ethical principles, and theories on societal ideals or relevant concepts, such as autonomy. Our stance in the debate therefore rests upon previously set out in-depth arguments and reflects a wide societal perspective.
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