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Medical Decision Making and the Previvor.

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  • 1Assistant Professor of Law and Co-Director of the Health Law and Policy Institute at the University of Houston Law Center in Houston, Texas USA; and Director of Law and Ethics at the University of Chicago MacLean Center for Clinical Medical Ethics in Chicago, Illinois USA. vgkoch@central.uh.edu.

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Genetic testing identifies "previvors" with disease predisposition. This necessitates a shift from informed consent to shared decision-making in medicine and law.

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Area of Science:

  • Medical Ethics
  • Genetics
  • Health Law

Background:

  • Genetic testing identifies individuals with a predisposition to disease, termed "previvors."
  • The concept of previvorship highlights the evolving nature of medical practice and decision-making.
  • Current legal frameworks and policies struggle to accommodate advancements in genetic medicine.

Purpose of the Study:

  • To examine the impact of previvorship on the physician-patient relationship and informed consent.
  • To advocate for a transition towards shared decision-making models in healthcare.
  • To explore the need for updated legal doctrines that support contemporary medical practices.

Main Methods:

  • Conceptual analysis of medical ethics and legal doctrine.
  • Review of the implications of genetic predisposition on patient autonomy.
  • Examination of the challenges posed by risk/benefit assessment and uncertainty.

Main Results:

  • The previvor experience challenges traditional informed consent, revealing its declining utility.
  • Existing legal doctrines are increasingly inapplicable to modern medical scenarios.
  • There is a clear need for a new legal framework supporting shared decision-making.

Conclusions:

  • A shared decision-making model is essential to address patient values, complex risk assessments, and medical uncertainty.
  • This model promotes a more inclusive and expansive understanding of illness.
  • Legal doctrines must evolve to support patient-centered, collaborative healthcare decisions.