The Challenging Ethical Landscape of Non-alcoholic Fatty Liver Disease

Abstract

Non-alcoholic fatty liver disease presents a number of ethical dilemmas. These relate to the potential harms of diagnosing the disease in health, diagnosing a condition for which there is no effective treatment, and variability in specialists’ attitudes to discussing and managing obesity. Erroneous homogenisation of a patient group that is extremely varied in terms of risk factors such as ethnic background, socioeconomic status, and genetic predisposition may result in inappropriate uniformity of approach when counselling patients as to underlying causes. This article will explore these challenges from the perspective of the gastroenterologist or hepatologist who must navigate them. Each section starts with questions posed by patients or comments made by doctors. Caution is suggested before widespread population-based screening is established, and the need for good adherence to referral algorithms is emphasised. Physicians are urged to engage with the condition’s hidden complexities and reflect on their own communication strategies.

Support Needs and Coping Strategies in Non-Alcoholic Fatty Liver Disease (NAFLD): A Multidisciplinary Approach to Potential Unmet Challenges beyond Pharmacological Treatment

“…Although the importance of patients with NAFLD understanding their condition in order to aid their self-management is widely recognized, there seems to be a certain lack of awareness among such patients, and indeed among the general public, regarding NAFLD and its related health issues [12,16]. As such, these patients are often confused when faced with the NAFLD diagnosis, and may believe that liver failure is the main health risk, whereas CVD is in fact the leading cause of mortality in this patient population [13].…”

“…Further issues arise regarding diagnosis of a disorder whereby there is currently no established specific pharmacological treatment, and where clinicians' attitudes to discussing the management of obesity may vary considerably [13]. As suggested by Berry & Kotha [13], failure to communicate effectively when applying the label of NAFLD during diagnosis, may lead to patients leaving the consultation with the opinion that they are likely to encounter liver failure.…”

“…Further issues arise regarding diagnosis of a disorder whereby there is currently no established specific pharmacological treatment, and where clinicians' attitudes to discussing the management of obesity may vary considerably [13]. As suggested by Berry & Kotha [13], failure to communicate effectively when applying the label of NAFLD during diagnosis, may lead to patients leaving the consultation with the opinion that they are likely to encounter liver failure. Thus, it is suggested that NAFLD represents an ethical dilemma, not only because of its association with obesity, but also due to confusion regarding its diagnosis, lack of specific treatment, and difficulties surrounding physicians' attitudes when discussing obesity [13].…”

“…As suggested by Berry & Kotha [13], failure to communicate effectively when applying the label of NAFLD during diagnosis, may lead to patients leaving the consultation with the opinion that they are likely to encounter liver failure. Thus, it is suggested that NAFLD represents an ethical dilemma, not only because of its association with obesity, but also due to confusion regarding its diagnosis, lack of specific treatment, and difficulties surrounding physicians' attitudes when discussing obesity [13]. In addition, there is also marked diversity among the patients with NAFLD due to risk elements, including socioeconomic status, ethnicity and genetic factors.…”

“…In this context and as NAFLD prevalence keeps increasing, the support needs of individuals with NAFLD may often remain unnoticed, which could lead to additional problems, such as loneliness and social isolation. Furthermore, there appears to be a lack of information and limited understanding regarding NAFLD as a chronic health condition [12,13], which could result in the emergence of feelings of isolation.…”