Is risk stratification ever the same as ‘profiling’?

Abstract

Physicians engage in risk stratification as a normative part of their professional duties. Risk stratification has the potential to be beneficial in many ways, and implicit recognition of this potential benefit underlies its acceptance as a cornerstone of the medical profession. However, risk stratification also has the potential to be harmful. We argue that 'profiling' is a term that corresponds to risk stratification strategies in which there is concern that ethical harms exceed likely or proven benefits. In the case of risk stratification for health goals, this would occur most frequently if benefits were obtained by threats to justice, autonomy or privacy. We discuss implications of the potential overlap between risk stratification and profiling for researchers and for clinicians, and we consider whether there are salient characteristics that make a particular risk stratification algorithm more or less likely to overlap with profiling, such as whether the risk stratification algorithm is based on voluntary versus non-voluntary characteristics, based on causal versus non-causal characteristics, or based on signifiers of historical disadvantage. We also discuss the ethical challenges created when a risk stratification scheme helps all subgroups but some more than others, or when risk stratification harms some subgroups but benefits the aggregate group.

Challenges and Legal Gaps of Genetic Profiling in the Era of Big Data

“…In health care, physicians use profiling as a part of their professional duties. Another term that can be used is "risk stratification, " i.e., using certain patient characteristics for classifying different types of disease forming (Braithwaite et al, 2016). Naturally, group-related characteristics often lead to the risk of discrimination as soon as decisions with a direct impact on the respective individuals are taken.…”

“I need to know what makes somebody tick …”: Challenges and Strategies of Implementing Shared Decision-Making in Individualized Oncology

“…“Individualized oncology” promises to deploy patients’ biological characteristics for an optimal treatment approach . Nevertheless, because of its inherently probability‐based nature, individualized decisions of patients and physicians are often decisions under uncertainty .…”

Is health profiling morally permissible?

“…Scott Braithwaite, Elizabeth R. Stevens and Arthur Caplan argue that some risk stratifications—that is, “employing patient characteristics to reduce the uncertainty that a future event will occur”—amount to profiling and, thus, invidious discrimination 1. These are forms of risk stratification “in which there is concern that ethical harms exceed likely or proven benefits for a group, and in the case of health care, involves any differential treatment in response to a personal characteristic that may cause an unwanted consequence for that person or for other persons with that characteristic”.…”