Predictive medicine

In the last part of the twentieth century, predictive medicine has gained currency as an important ideal in biomedical research and health care. Research in the genetic and molecular basis of disease suggested that the insights gained might be used to develop tests that predict the future health state of asymptomatic individuals. The desirability of this ideal and the technologies developed to realize it have been the subject of much ethical debate and analysis. This contribution discusses the most important ethical concerns about predictive medicine and points out how these have coevolved with scientific and technological developments in the field. The focus is on genetics- and genomics-based predictive testing of individuals for health purposes, but many issues are pertinent for nongenetic predictive testing as well. Early on, many ethical analyses asked how knowledge of one’s future health state might impact an individual’s quality of life, family relations, and social relations. Later discussions shifted toward the interpretation of test results, to what should be considered as a benefit of predictive testing and who should define this. In addition, there have been recurring worries about potential shifts in attributing responsibility for one’s health and about the impact of predictive testing on society.