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Prevention in the age of personal responsibility: epigenetic risk-predictive screening for female cancers as a case study

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. Epi...

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Autores principales: Bolt, Ineke, Bunnik, Eline M., Tromp, Krista, Pashayan, Nora, Widschwendter, Martin, de Beaufort, Inez
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8639925/
https://www.ncbi.nlm.nih.gov/pubmed/33208479
http://dx.doi.org/10.1136/medethics-2020-106146
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author Bolt, Ineke
Bunnik, Eline M.
Tromp, Krista
Pashayan, Nora
Widschwendter, Martin
de Beaufort, Inez
author_facet Bolt, Ineke
Bunnik, Eline M.
Tromp, Krista
Pashayan, Nora
Widschwendter, Martin
de Beaufort, Inez
author_sort Bolt, Ineke
collection PubMed
description 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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spelling pubmed-86399252021-12-15 Prevention in the age of personal responsibility: epigenetic risk-predictive screening for female cancers as a case study Bolt, Ineke Bunnik, Eline M. Tromp, Krista Pashayan, Nora Widschwendter, Martin de Beaufort, Inez J Med Ethics Original Research 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. BMJ Publishing Group 2021-12 2020-11-18 /pmc/articles/PMC8639925/ /pubmed/33208479 http://dx.doi.org/10.1136/medethics-2020-106146 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Bolt, Ineke
Bunnik, Eline M.
Tromp, Krista
Pashayan, Nora
Widschwendter, Martin
de Beaufort, Inez
Prevention in the age of personal responsibility: epigenetic risk-predictive screening for female cancers as a case study
title Prevention in the age of personal responsibility: epigenetic risk-predictive screening for female cancers as a case study
title_full Prevention in the age of personal responsibility: epigenetic risk-predictive screening for female cancers as a case study
title_fullStr Prevention in the age of personal responsibility: epigenetic risk-predictive screening for female cancers as a case study
title_full_unstemmed Prevention in the age of personal responsibility: epigenetic risk-predictive screening for female cancers as a case study
title_short Prevention in the age of personal responsibility: epigenetic risk-predictive screening for female cancers as a case study
title_sort prevention in the age of personal responsibility: epigenetic risk-predictive screening for female cancers as a case study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8639925/
https://www.ncbi.nlm.nih.gov/pubmed/33208479
http://dx.doi.org/10.1136/medethics-2020-106146
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