Risk, Overdiagnosis and Ethical Justifications

Many healthcare practices expose people to risks of harmful outcomes. However,
the major theories of moral philosophy struggle to assess whether, when and why it is ethically justifable to expose individuals to risks, as opposed to actually harming them. Sven Ove Hansson has proposed an approach to the ethical assessment of risk imposition that encourages attention to factors including questions of justice in the distribution of advantage and risk, people’s acceptance or otherwise of risks, and the scope individuals have to infuence the practices that generate risk. This paper investigates the ethical justifability of preventive healthcare practices that expose people to risks including overdiagnosis. We applied Hansson’s framework to three such practices: an ‘ideal’ breast screening service, a commercial personal genome testing service, and a guideline that lowers the diagnostic threshold for hypertension.
The framework was challenging to apply, not least because healthcare has unclear boundaries and involves highly complex practices. Nonetheless, the framework encouraged attention to issues that would be widely recognised as morally pertinent. Our assessment supports the view that at least some preventive healthcare practices that impose risks including that of overdiagnosis are not ethically justifable. Further work is however needed to develop and/or test refned assessment criteria and guidance for applying them.