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Abstract Details
You Can't Have One Without the Other: Innovation and Ethical Dilemmas in Gastroenterology and Hepatology
Clin Gastroenterol Hepatol. 2021 Oct;19(10):2015-2019.doi: 10.1016/j.cgh.2020.05.024. Epub 2020 May 20.
Thomas Couri1, Andrew Aronsohn2
Author information
Department of Medicine, Section of Gastroenterology, Hepatology, & Nutrition, The University of Chicago Medicine, Chicago, Illinois. Electronic address: thomas.couri@uchospitals.edu.
Department of Medicine, Section of Gastroenterology, Hepatology, & Nutrition, The University of Chicago Medicine, Chicago, Illinois; Center for Liver Diseases, The University of Chicago Medicine, Chicago, Illinois.
Abstract
Medical innovation and ethical dilemmas are intertwined in gastroenterology and hepatology. This narrative review explores direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) as a touchstone example of how medical innovation breeds ethical dilemmas. A few quandaries-informed consent as well as informed deferral during the first wave of DAA approvals, sobriety restrictions from payors, and high DAA costs for patients-are addressed through the lens of the foundational principles of clinical medical ethics: autonomy, beneficence, non-maleficence, justice, and utility. By placing these issues within a medical ethics framework, we hope not only to focus on the solutions that the gastroenterology and hepatology community developed in the advent of DAA therapy, but to highlight an ethical paradigm that can be applied to similar dilemmas that will be faced as new therapies for other gastrointestinal diseases are approved.