Respect women, promote health and reduce stigma: ethical arguments for universal hepatitis C screening in pregnancy

被引:6
|
作者
Gross, Marielle S. [1 ]
Ruth, Alexandra R. [2 ]
Rasmussen, Sonja A. [3 ,4 ]
机构
[1] Johns Hopkins Bloomberg Sch Publ Hlth, Berman Inst Bioeth, Baltimore, MD USA
[2] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, Baltimore, MD USA
[3] Univ Florida, Coll Med, Dept Pediat, Gainesville, FL USA
[4] Univ Florida, Coll Publ Hlth & Hlth Profess, Dept Epidemiol, Gainesville, FL USA
关键词
health care economics; interests of woman; fetus; father; ostetrics and gynecology; public health ethics; drugs and drug industry; UNITED-STATES; DRUG-USE; VIRUS; TRANSMISSION; INFECTION; RISK;
D O I
10.1136/medethics-2019-105692
中图分类号
B82 [伦理学(道德学)];
学科分类号
摘要
In the USA, there are missed opportunities to diagnose hepatitis C virus (HCV) in pregnancy because screening is currently risk-stratified and thus primarily limited to individuals who disclose history of injection drug use or sexually transmitted infection risks. Over the past decade, the opioid epidemic has dramatically increased incidence of HCV and a feasible, well-tolerated cure was introduced. Considering these developments, recent evidence suggests universal HCV screening in pregnancy would be cost-effective and several professional organisations have called for updated national policy. Historically, universal screening has been financially disincentivised on the healthcare system level, particularly since new diagnoses may generate an obligation to provide expensive treatments to a population largely reliant on public health resources. Here, we provide ethical arguments supporting universal HCV screening in pregnancy grounded in obligations to respect for persons, beneficence and justice. First, universal prenatal HCV screening respects pregnant women as persons by promoting their long-term health outside of pregnancy. Additionally, universal screening would optimise health outcomes within current treatment guidelines and may support research on treatment during pregnancy. Finally, universal screening would avoid potential harms of risk-stratifying pregnant women by highly stigmatised substance use and sexual behaviours.
引用
收藏
页码:674 / 677
页数:4
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