Overdiagnosis and risk: When is it justifiable to impose risk of harm in health care?

Prof. Wendy Rogers1, Professor Stacy Carter2, Professor Vikki  Entwistle3

1Macquarie University, Sydney, Australia, 2University of Wollongong, Wollongong, Australia, 3National University of Singapore, , Singapore

As several philosophers have noted, moral theories generally focus on when and why it is justifiable to cause actual harm, and struggle to explain when and why it is justifiable to impose risks of harm. Questions about the justifiability of risk imposition in healthcare have become more acute with increasing recognition that screening and other health interventions run the risk of harming people via overdiagnosis.

To date, attempts to resolve ethical concerns about overdiagnosis focus on asking people to make informed decisions and provide explicit consent before undergoing relevant interventions. However, this approach fails to tackle the prior question of whether, and if so under what circumstances, it is ethically justifiable for healthcare interventions to impose risks on people.

This paper draws on the work of Sven Ove Hansson to investigate the justifiability of risk imposition associated with several exemplar health care interventions associated with overdiagnosis. Hansson proposes a set of exemption conditions under which it may be acceptable to expose people to risk. Hansson’s conditions include that the exposure “is part of a persistently justice-seeking social practice of risk taking” and that everyone exposed has as much influence over their exposure as it is possible for all to have equally without losing the social benefits that justify the risk.

Hansson’s promising procedural approach generates interpretive challenges and some counterintuitive assessments when used to analyse the risk imposed by interventions associated with overdiagnosis across different healthcare systems.

We conclude with suggestions regarding how Hansson’s approach may need to be reformulated to make it more serviceable in assessing the ethics of imposing risk in healthcare.


Biography:

Wendy Rogers has spent four years engaged in research on overdiagnosis, funded by an ARC Future Fellowship. This work has focused on the relationship between overdiagnosis and the definition of disease, and ethical issues arising from overdiagnosis. Her other areas of research include the ethics of surgical innovation, conceptualising vulnerability in research and clinical ethics, and bioethics activism against forced organ harvesting in China.