Disrupting medical necessity: Setting an old medical ethics theme in new light

Abstract

Recent medical innovations like ‘omics’ technologies, mobile health (mHealth) applications or telemedicine are perceived as part of a shift towards a more preventive, participatory and affordable healthcare model. These innovations are often regarded as ‘disruptive technologies’. It is a topic of debate to what extent these technologies may transform the medical enterprise, and relatedly, what this means for medical ethics. The question of whether these developments disrupt established ethical principles like respect for autonomy has indeed received increasing normative attention during the past years. Yet, more fundamental ethical considerations of a possible disruption of the concept of ‘medical necessity’ (and the potential ensuing clinical ramifications) have been limited if not absent. It is our modest – though morally and practically relevant – aim to address this objective in this article, by exploring how the current wave of allegedly disruptive innovation is invoking a resurgence of this concept and related debates on ‘the’ goal(s) of medicine.

The paradox of medical necessity

“…In addition to the papers by Davies, Ioannidis, and Prendergast, this issue features Rebecca Brown and Andrea Mulligan on ‘maternal request’ caesarean sections; 18 Zsuzsanna Chappell and Sofia Jeppsson on ‘normalisation’ in psychiatry; 19 Evie Kendal on the necessity of abortion; 20 Richard Gibson on surgical amputation as a potential treatment for bodily integrity dysphoria; 3 and Seppe Segers and Michiel De Proost on the concept of medical necessity in relation to new and disruptive technologies. 21 Together, these essays explore the what is , what does , and what ought dimensions of medical necessity, using live examples from ongoing debates, to shed much needed light on a notoriously murky yet increasingly influential concept.…”