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The Ethics of Information: Absolute Risk Reduction and Patient Understanding of Screening

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Abstract

Some experts have argued that patients should routinely be told the specific magnitude and absolute probability of potential risks and benefits of screening tests. This position is motivated by the idea that framing risk information in ways that are less precise violates the ethical principle of respect for autonomy and its application in informed consent or shared decision-making. In this Perspective, we consider a number of problems with this view that have not been adequately addressed. The most important challenges stem from the danger that patients will misunderstand the information or have irrational responses to it. Any initiative in this area should take such factors into account and should consider carefully how to apply the ethical principles of respect for autonomy and beneficence.

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Acknowledgements

The authors would like to thank Thomas Imperiale, MD, and Greg Sachs, MD, for helpful comments on earlier drafts of this paper. We would also like to thank audiences who participated in discussion of earlier versions of this work at the Seminars in Medical Humanities and Bioethics, Medical Humanities Program, Indiana University School of Medicine, Indianapolis, IN, USA and at the Poynter Health Care Ethics Seminar, Indiana University, Bloomington, IN, USA.

The authors were supported in part by grants from the Indiana Genomics Initiative, which is funded by the Lilly Endowment (PHS, EMM), and from the Richard M. Fairbanks Foundation to the Indiana University Center for Bioethics (PHS, EMM).

Conflict of Interest

Dr. Meslin serves as a consultant to Eli Lilly and Company, Indianapolis.

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Correspondence to Peter H. Schwartz MD, PhD.

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Schwartz, P.H., Meslin, E.M. The Ethics of Information: Absolute Risk Reduction and Patient Understanding of Screening. J GEN INTERN MED 23, 867–870 (2008). https://doi.org/10.1007/s11606-008-0616-y

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  • DOI: https://doi.org/10.1007/s11606-008-0616-y

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