Table 1. Potential ethical... | American Society of Hematology

Table 1.

Potential ethical considerations relevant to testing for and treating blood cancer precursor conditions

	Benefits: testing and surveillance	Risks: testing and surveillance	Added benefits: preventive treatment	Added risks: preventive treatment
Beneficence	Early diagnosis through surveillance could improve outcomes, but prospective data are needed to support this Surveillance may identify and manage other conditions Psychological benefit of expert evaluation and guidance	The patient may benefit more from focusing on other health-promoting activities	Potential psychological benefit of taking action to reduce risk	Prevention does not directly improve health
Nonmaleficence	Negative test results may obviate the need for further intervention	Anxiety of diagnosis with a precursor condition Time toxicity of surveillance	Potentially preventing cancer avoids significant harms	Exposure to risks of cancer therapy for a condition that may never become cancer Time toxicity of treatment
Justice	Testing can include diverse outreach if well-implemented	Specialized hematology is often not accessible for all Insurance coverage uncertain for precursor workup Precursor could be classified as a preexisting condition	If widely available, could potentially prevent burdensome, costly malignancies	Insurance coverage uncertain for preventive treatment
Respect for autonomy	Individuals can decide whether testing is appropriate for them Knowledge of risk yields options such as surveillance, research participation, and health promotion	Often an incidental finding, which may violate a “right not to know” Communicating uncertain risk is challenging	Adds a treatment option to reduce risk beyond surveillance	Anxious patients may feel pressured to choose treatment over surveillance Informed consent for treatment of an uncertain future condition is challenging
Cancer stigma	Having a “diagnosis” can facilitate connection to others experiencing similar challenges	Blurring the lines between sick and well Failure to act on risk information may lead to blame for malignancy	If treatment is successful, a patient may no longer have the precursor “diagnosis”	Stigma of receiving cancer treatment and taking on the sick role of a cancer patient Impossible to know if treatment was the correct decision on an individual level
Stewardship of medical resources	Precursor diagnosis may spur risk-reducing activities that reduce future health care costs Incidental discovery of comorbid conditions could allow for proactive management and conserve resources down the line	Testing and subsequent visits increase costs for the health care system yet no risk-modifying interventions currently exist Widespread testing may not be cost-effective if surveillance does not reduce downstream costs	Preventing myeloid malignancies may reduce overall cancer treatment costs	Scarce medical resources to treat a risk factor could be better utilized for patients with cancer

	Benefits: testing and surveillance	Risks: testing and surveillance	Added benefits: preventive treatment	Added risks: preventive treatment
Beneficence	Early diagnosis through surveillance could improve outcomes, but prospective data are needed to support this Surveillance may identify and manage other conditions Psychological benefit of expert evaluation and guidance	The patient may benefit more from focusing on other health-promoting activities	Potential psychological benefit of taking action to reduce risk	Prevention does not directly improve health
Nonmaleficence	Negative test results may obviate the need for further intervention	Anxiety of diagnosis with a precursor condition Time toxicity of surveillance	Potentially preventing cancer avoids significant harms	Exposure to risks of cancer therapy for a condition that may never become cancer Time toxicity of treatment
Justice	Testing can include diverse outreach if well-implemented	Specialized hematology is often not accessible for all Insurance coverage uncertain for precursor workup Precursor could be classified as a preexisting condition	If widely available, could potentially prevent burdensome, costly malignancies	Insurance coverage uncertain for preventive treatment
Respect for autonomy	Individuals can decide whether testing is appropriate for them Knowledge of risk yields options such as surveillance, research participation, and health promotion	Often an incidental finding, which may violate a “right not to know” Communicating uncertain risk is challenging	Adds a treatment option to reduce risk beyond surveillance	Anxious patients may feel pressured to choose treatment over surveillance Informed consent for treatment of an uncertain future condition is challenging
Cancer stigma	Having a “diagnosis” can facilitate connection to others experiencing similar challenges	Blurring the lines between sick and well Failure to act on risk information may lead to blame for malignancy	If treatment is successful, a patient may no longer have the precursor “diagnosis”	Stigma of receiving cancer treatment and taking on the sick role of a cancer patient Impossible to know if treatment was the correct decision on an individual level
Stewardship of medical resources	Precursor diagnosis may spur risk-reducing activities that reduce future health care costs Incidental discovery of comorbid conditions could allow for proactive management and conserve resources down the line	Testing and subsequent visits increase costs for the health care system yet no risk-modifying interventions currently exist Widespread testing may not be cost-effective if surveillance does not reduce downstream costs	Preventing myeloid malignancies may reduce overall cancer treatment costs	Scarce medical resources to treat a risk factor could be better utilized for patients with cancer

This table is intended to identify ethically salient considerations to guide future research. Risks and benefits are currently hypothetical.

View Large

This Feature Is Available To Subscribers Only