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Should Doctors Offer Biomarker Testing to Those Afraid to Develop Alzheimer’s Dementia?

Applying the Method of Reflective Equilibrium for a Clinical Dilemma

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A Correction to this article was published on 04 April 2022

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An increasing number of people seek medical attention for mild cognitive symptoms at older age, worried that they might develop Alzheimer’s disease. Some clinical practice guidelines suggest offering biomarker testing in such cases, using a brain scan or a lumbar puncture, to improve diagnostic certainty about Alzheimer’s disease and enable an earlier diagnosis. Critics, on the other hand, point out that there is no effective Alzheimer treatment available and argue that biomarker tests lack clinical validity. The debate on the ethical desirability of biomarker testing is currently polarized; advocates and opponents tend to focus on their own line of arguments. In this paper, we show how the method of reflective equilibrium (RE) can be used to systematically weigh the relevant arguments on both sides of the debate to decide whether to offer Alzheimer biomarker testing. In the tradition of RE, we reflect upon these arguments in light of their coherence with other argumentative elements, including relevant facts (e.g. on the clinical validity of the test), ethical principles, and theories on societal ideals or relevant concepts, such as autonomy. Our stance in the debate therefore rests upon previously set out in-depth arguments and reflects a wide societal perspective.

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  1. Notably, there is a small difference in pre- and post-test probability because dementia is a relatively common disease

  2. One could argue that feelings of relief or a confirmation of worries would be simply misplaced in response to receiving a (uncertain) risk status. In the context of clinical practice, however, making a prognosis and assumptions about future health based on risk information would be the exact purpose of testing these biomarkers and is therefore hard to avoid.


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This work has received support from the Netherlands Organization for Health Research and Development [grant number 731010012] and the European Union—European Federation of Pharmaceutical Industries and Associations (EU-EFPIA) Innovative Medicines Initiatives 2 Joint Undertaking [grant number 115952]. This publication represents the views of the authors and not necessarily those of the entire latter research consortium.

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Correspondence to Marthe Smedinga.

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The original version of this article has been revised: The second author's name has been corrected.

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Smedinga, M., Bunnik, E.M., Richard, E. et al. Should Doctors Offer Biomarker Testing to Those Afraid to Develop Alzheimer’s Dementia?. Bioethical Inquiry 19, 287–297 (2022).

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