Individually based preventive medical recommendations - are they sustainable and responsible? A call for ethical reflection

Abstract

Ultimately, medicine is a moral enterprise. In mainstream medical ethics courses, doctors learn to consider clinical practice in light of the four principles respect for autonomy, nonmaleficence, beneficence, and justice. This "principlistic" approach [1] was developed to ensure the welfare and will of vulnerable patients in the context of curative medical care. It is first and foremost a tool for analysing ethical questions in the clinical encounter. The principlistic paradigm is not meant as a tool for remote planning, goal setting, prioritizing, and overall coordination of medical care. Things have changed since the four principles were launched around 1979. A "risk epidemic" has occurred in biomedical research and publishing [2]. Clinical practice has become characterized by a strong emphasis on prevention of future disease among currently asymptomatic people. As opposed to well-established, comprehensive community-oriented preventive programmes involving, for example, sanitation and immunizations, individually oriented preventive medicine is characterized by fragmentation, biological monitoring, and technological interventions for which there is often limited evidence of effectiveness [3,4]. There has been little debate about "downstream" effects of this development, in terms of consequences for the individual, the healthcare system, and society at large.