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Precision medicine and the fragmentation of solidarity (and justice)

Solidarity is a fundamental social value in many European countries, though its precise practical and theoretical meaning is disputed. In a health care context, I agree with European writers who take solidarity normatively to mean roughly equal access to effective health care for all. That is, solid...

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Autor principal: Fleck, Leonard M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Netherlands 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8744576/
https://www.ncbi.nlm.nih.gov/pubmed/35006450
http://dx.doi.org/10.1007/s11019-022-10067-2
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author Fleck, Leonard M.
author_facet Fleck, Leonard M.
author_sort Fleck, Leonard M.
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description Solidarity is a fundamental social value in many European countries, though its precise practical and theoretical meaning is disputed. In a health care context, I agree with European writers who take solidarity normatively to mean roughly equal access to effective health care for all. That is, solidarity includes a sense of justice. Given that, I will argue that precision medicine represents a potential weakening of solidarity, albeit not a unique weakening. Precision medicine includes 150 targeted cancer therapies (mostly for metastatic cancer), all of which are extraordinarily expensive. Our critical question: Must a commitment to solidarity as defined mean that all these targeted cancer therapies should be guaranteed to all within each country in the European Union, no matter the cost, no matter the degree of effectiveness? Such a commitment would imply that cancer was ethically special, rightfully commandeering unlimited resources. That in itself would undermine solidarity. I offer multiple examples of how current and future dissemination of these targeted cancer drugs threaten a commitment to solidarity. An alternative is to fund more cancer prevention efforts. However, that too proves a threat to solidarity. Solidarity, with or without a sense of justice, is too abstract a notion to address these challenges. Further, we need to accept that we can only hope to achieve “rough justice” and “supple solidarity.” The precise practical meaning of these notions needs to be worked out through a fair and inclusive process of rational democratic deliberation, which is the real and practical foundation of just solidarity.
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spelling pubmed-87445762022-01-10 Precision medicine and the fragmentation of solidarity (and justice) Fleck, Leonard M. Med Health Care Philos Scientific Contribution Solidarity is a fundamental social value in many European countries, though its precise practical and theoretical meaning is disputed. In a health care context, I agree with European writers who take solidarity normatively to mean roughly equal access to effective health care for all. That is, solidarity includes a sense of justice. Given that, I will argue that precision medicine represents a potential weakening of solidarity, albeit not a unique weakening. Precision medicine includes 150 targeted cancer therapies (mostly for metastatic cancer), all of which are extraordinarily expensive. Our critical question: Must a commitment to solidarity as defined mean that all these targeted cancer therapies should be guaranteed to all within each country in the European Union, no matter the cost, no matter the degree of effectiveness? Such a commitment would imply that cancer was ethically special, rightfully commandeering unlimited resources. That in itself would undermine solidarity. I offer multiple examples of how current and future dissemination of these targeted cancer drugs threaten a commitment to solidarity. An alternative is to fund more cancer prevention efforts. However, that too proves a threat to solidarity. Solidarity, with or without a sense of justice, is too abstract a notion to address these challenges. Further, we need to accept that we can only hope to achieve “rough justice” and “supple solidarity.” The precise practical meaning of these notions needs to be worked out through a fair and inclusive process of rational democratic deliberation, which is the real and practical foundation of just solidarity. Springer Netherlands 2022-01-10 2022 /pmc/articles/PMC8744576/ /pubmed/35006450 http://dx.doi.org/10.1007/s11019-022-10067-2 Text en © The Author(s), under exclusive licence to Springer Nature B.V. 2022 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Scientific Contribution
Fleck, Leonard M.
Precision medicine and the fragmentation of solidarity (and justice)
title Precision medicine and the fragmentation of solidarity (and justice)
title_full Precision medicine and the fragmentation of solidarity (and justice)
title_fullStr Precision medicine and the fragmentation of solidarity (and justice)
title_full_unstemmed Precision medicine and the fragmentation of solidarity (and justice)
title_short Precision medicine and the fragmentation of solidarity (and justice)
title_sort precision medicine and the fragmentation of solidarity (and justice)
topic Scientific Contribution
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8744576/
https://www.ncbi.nlm.nih.gov/pubmed/35006450
http://dx.doi.org/10.1007/s11019-022-10067-2
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