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

• Published in: Journal of medical ethics Vol. 47; no. 12; p. e46
• Main Authors: Bolt, Ineke, Bunnik, Eline M., Tromp, Krista, Pashayan, Nora, Widschwendter, Martin, de Beaufort, Inez
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and Institute of Medical Ethics 01.12.2021; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Case reports; DNA methylation; Epigenetics; genetic screening/testing; Health care; Health literacy; Medical ethics; Original Research; technology/risk assessment; genetic screening/testing; technology/risk assessment
• ISSN: 0306-6800; 1473-4257; 1473-4257
• DOI: 10.1136/medethics-2020-106146

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.