Scanning the body, sequencing the genome: Dealing with unsolicited findings

Abstract

The introduction of novel diagnostic techniques in clinical domains such as genomics and radiology has led to a rich ethical debate on how to handle unsolicited findings that result from these innovations. Yet while unsolicited findings arise in both genomics and radiology, most of the relevant literature to date has tended to focus on only one of these domains. In this article, we synthesize and critically assess similarities and differences between "scanning the body" and "sequencing the genome" from an ethical perspective. After briefly describing the novel diagnostic contexts leading to unsolicited findings, we synthesize and reflect on six core ethical issues that relate to both specialties: terminology; benefits and risks; autonomy; disclosure of unsolicited findings to children; uncertainty; and filters and routine screening. We identify ethical rationales that pertain to both fields and may contribute to more ethically sound policies. Considerations of preserving public trust and ensuring that people perceive healthcare policies as fair also support the need for a combined debate.

Unconsented genetic testing in psychiatry: an (almost) no go?

“…We hope that case-specific decisions, such as the one described opting for the most targeted genetic test or applying extensive genetic filtering, thus minimising the chances of incidental findings. [2][3][4] In similar cases to that described here, we also endorse moral case deliberation by a team of medical doctors, nurses, and ethical counsellors, 5 including careful consideration of the patient's possible personal preferences should their mental competence not have been severely impaired.…”

“…I declare no competing interests. 3 In 2015, there were close to 8 million Bahá'ís worldwide and the countries with the largest Bahá'í populations were India, Kenya, Vietnam, Congo (Brazzaville), Philippines, Zambia, South Africa, Iran, and Bolivia, ranging from 232 000 in Bolivia to just over 2 million in India. 4 Although psychiatrists in Asia are more likely to encounter Bahá'í patients, several hundred thousand Bahá'ís live in the USA and Canada.…”

Managing unsolicited findings in genomics: A qualitative interview study with cancer patients

“…However, these findings are not necessarily contradictory. Many previous contributions to the debate on genomics have pointed out that autonomy should not be taken to imply that individuals are isolated moral beings that are blind to social circumstances and the needs of others . In addition, autonomy is not singular concept in ethics .…”

The Duty to Look for Incidental Findings in Imaging Research

“…In the future, it might become possible to use artificial intelligence and deep learning to further increase the identification of incidental findings. Strategies to decrease the yield of incidental findings include reducing the image field of view, 10 digitally “filtering out” aspects of the image unrelated to the specific abnormalities being looked for, 11 or simply discouraging researchers and radiographers from looking for abnormalities while taking scans 12 . The strategies adopted by researchers or institutions can have a significant impact on how many incidental findings are discovered and reported to participants.…”