Diagnostic self-testing: Autonomous choices and relational responsibilities

Bioethics

Volumn 24, Issue 4, 2010, Pages 199-207

  Kearns, Alan J ^a   O'Mathúna, Dónal P ^a   Scott, P Anne ^a  

^a DUBLIN CITY UNIVERSITY   (Ireland)

Author keywords

Accuracy; Autonomy; Diagnosis; Person; Personal significance; Relational responsibility; Self testing

Indexed keywords

ANALYTICAL EQUIPMENT; ARTICLE; EQUIPMENT; ETHICAL THEORY; ETHICS; HUMAN; PERSONAL AUTONOMY; PERSONHOOD; REPRODUCIBILITY; SELF CARE; SOCIAL BEHAVIOR;

DIAGNOSTIC EQUIPMENT; ETHICAL THEORY; HUMANS; PERSONAL AUTONOMY; PERSONHOOD; REAGENT KITS, DIAGNOSTIC; REPRODUCIBILITY OF RESULTS; SELF CARE; SOCIAL RESPONSIBILITY;

EID: 77954743194     PISSN: 02699702     EISSN: 14678519     Source Type: Journal    
DOI: 10.1111/j.1467-8519.2008.00711.x     Document Type: Article

References (39)

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3. Editorial. Home HIV Testing: Why Not in Canada? Can Med Assoc J 2000; 162(11): 1545.
4. A 'biomarker' is a physiological or biochemical indicator that can be objectively measured and that has been correlated with an indicator of health or illness. See Biomarkers Definitions Working Group. Biomarkers and Surrogate Endpoints: Preferred Definitions and Conceptual Framework. Clin Pharmacol There 2001; 69(3): 89-95.
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6. Biomedical Diagnostics Institute. 2006. Background. Available at, [Accessed 23 June 2008] http://www.bdi.ie/about_bdi/background.html.
7. For example, ethical issues often arise regarding the status of the embryo in embryonic stem cell research and in the area of reproductive medicine in general.
8. See K. Doran. 1989. What is a Person: The Concept and the Implications for Ethics. Lewiston: Edwin Mellen Press; J. Fletcher. 1979. Humanhood: Essays in Biomedical Ethics. New York: Prometheus Books; P. Singer. 1994. Rethinking Life and Death: The Collapse of our Traditional Ethics. Oxford: Oxford University Press; T.L. Beauchamp. The Failure of Theories of Personhood. Kennedy Inst Ethics J 1999; 9(4): 309-324.
9. H.T. Engelhardt. 1996. The Foundations of Bioethics. 2nd Edition. Oxford: Oxford University Press: 123. We also accept that something might be deemed to be harmful but not necessarily ethically wrong or considered ethically wrong but not necessarily harmful.
10. This is not to reduce any ethical investigation to a simple for-and-against inquiry.
11. Biomedical Diagnostics Institute, op. cit. note 7.
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16. See A.W. Cappelen & O.F. Norheim. Responsibility in Health Care: A Liberal Egalitarian Approach. J Med Ethics 2005; 31(8): 467-480.
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23. S. Holm. 1997. Ethical Problems in Clinical Practice: The Ethical Reasoning of Health Care Professionals. Manchester: Manchester University Press.
24. On another front, in the future, companies might take advantage of portable self-testing devices to examine the health status of its potential new employees. Such devices might provide medical information regarding these would-be employees in a fast and relatively inexpensive way. As already indicated, however, new devices might also generate fresh problems regarding the way that the medical information is used, shared and protected. Once again, it could be argued that the 'good' that is achieved by self-testing devices needs to be constantly measured against the potential 'harm' they may pose to the individual.
25. Federal Trade Commission (FTC). 2004. FTC Halts US Sales of Defective 'Discreet' HIV Home Test Kits. Available at, [Accessed 23 June 2008] http://www.ftc.gov/opa/2004/06/seville.shtm.
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27. M.J. Fritzler et al. The Use and Abuse of Commercial Kits Used to Detect Autoantibodies. Arthritis Res Ther, 193 2003; 5(4): 192-201
28. L.A. Bastian et al. Diagnostic Efficiency of Home Pregnancy Test Kits. Arch Fam Med 1998; 7(5): 465-469.
29. C. Lewis. 2001. Home Diagnostic Tests: The Ultimate House Call? FDA Consumer Magazine. Available at, [Accessed 23 June 2008]: http://www.fda.gov/fdac/features/2001/601_home.html.
30. C. Taylor. 1985. The Person. In The Category of the Person: Anthropology, Philosophy, History. M. Carrithers, S. Collins & S. Lukes, eds. Cambridge: Cambridge University Press: 257-281.
31. C. Taylor. 1985. Human Agency and Language: Philosophical Papers I. Cambridge: Cambridge University Press.
32. For that reason, Taylor describes the human person as a self-interpreting being. See Taylor, op. cit. note 31.
33. Taylor, op. cit. note 32.
34. The argument could be made that it is also significant to a dog, for example, whether it has cancer or not. However, what distinguishes human agents from animals, for instance, is the possibility for reflective thinking on the meaning of cancer for themselves, for their families and friends. A terminal sickness can bring human agents face-to-face with the stark reality of their mortal nature.
35. Aside from the significant issues surrounding diagnosis itself, there are ethical issues regarding the attempt to make diagnosis more amiable by labelling a person not as a 'cancer patient' but a 'cancer survivor'. The term 'cancer survivor' has been defined as someone from the time of diagnosis for the rest of her life. This may be problematic since in everyday language a survivor is someone who has lived through the bad event and 'survived'. Calling someone a 'cancer survivor' when a diagnosis has just been made and treatment remains on the horizon could thus be questioned. In any case, the person may not 'survive' the cancer at all. On the other hand, calling the person a 'survivor' may provide a psychological boost - a linguistic placebo effect. Regardless, words should be defined and used carefully. See C. Doyle et al. Nutrition and Physical Activity During and After Cancer Treatment: An American Cancer Society Guide for Informed Choices. CA Cancer J Clin 2006; 56(6): 323-353
36. R.S. Downie. Definition. J Med Ethics 1994; 20(3): 181-184.
37. Unsurprisingly, the same argument can be made with regard to any disclosure of a diagnosis between a physician and a patient. However, in those contexts there is, at least, the opportunity for the knowledge to be communicated according to the intellectual abilities and emotional needs of the patient.
38. Editorial, op. cit. note 4.
39. Lewis, op. cit. note 30.