Personalising disease and health

This project will analyse how personalised medicine (PM) will impact on our concepts of disease and health, and use this analysis to identify future ethical challenges of PM. PM is a set of strategies used to tailor medical interventions to individuals, utilising various new technologies and fields of study such as systems biology, molecular medicine, and bioinformatics. PM is envisioned to improve medical treatment while reducing provision of ineffective treatments. Like other new medical developments, PM is likely to raise new ethical challenges.

To identify and illuminate these challenges, the project will draw on a method derived from work in the philosophy of technology. This method suggests that ethical challenges of new technologies and approaches in medicine can be anticipated by examining their impacts on our concepts of disease and health. This is because new technologies often change how diseases are identified, measured, and defined. The technology can thus alter what it means to preserve or protect health, and to eliminate or prevent disease, in ways that pose ethical challenges.

Some of the conceptual changes likely to arise from PM are continuous with, but may exacerbate, existing pressures on our concepts of disease and health. For instance, PM presents disease as diagnosable on the basis of data, long before the onset of clinical symptoms. This may influence us to think of disease as quantitative rather than qualitative, divorced from patient experience. Such changes have been linked to several ethical challenges such as overdiagnosis, increased health anxiety and treatment- seeking, and patient dehumanisation.

There are also further potential conceptual changes associated with PM that may be distinctive to it. PM raises the possibility that not only treatment but diagnosis could become personalised: that the same biological features or measurements may indicate disease in some people, but be consistent with health in others. This possibility has as yet not been analysed, and may also be a source of ethical issues.

This project will approach how disease and health might be conceptualised as ‘personalised’ via two routes. It will examine potential alternative conceptual structures drawing on recent scholarship in the philosophy of medicine, and conceptual resources from traditional Chinese medicine, which already tailors treatments on the basis of individuals’ biological features. In pursuing and then integrating these two routes the project will describe probable alterations to our concepts arising from PM, and use these to identify and illuminate future ethical challenges.