Diagnosis of schizophrenia: future ethics

The healthcare burden, to the affected individual, their family and to society, caused by the schizophrenias provides a strong moral appeal for non-discriminatory allocation of resources for both research and service provision. Nevertheless, the anticipated advances in clinical research findings are likely to lead to a new healthcare situation where a number of values and moral appeals are likely to be in conflict. The sources of these conflicts are explored with respect to the nature and origin of the schizophrenias, the challenges of pre-clinical and possible prenatal diagnosis. It is argued that the ethical problems associated with discovery of early markers for the development of schizophrenia should be anticipated and appropriate guidelines developed in advance of their realisation. Experience of other screening programmes strongly cautions against the introduction of such markers before the benefits and safety aspects have been clearly defined.