Personalised, predictive and preventive medicine: a decision-theoretic perspective

Background. The last decade has witnessed remarkable developments in medical treatment that is personalised, predictive and preventive. The advances made here have the potential to bring about radical change, not only in diagnostic tests and prescriptions, but also in more fundamental patterns in the provision of health care. Methods. The conceptual framework and principles of modern decision theory are applied to some of the ethical issues raised by recent advances in personalised, predictive and preventive medicine, including questions about limits of autonomy and the implications of justice and fairness in the distribution of health care services. Results. A new way of conceptualising and understanding the ethical issues raised by personalised, predictive and preventive medicine is sketched. Such medicine involves decisions under risk and decisions under uncertainty, depending on the extent to which current knowledge gaps can be filled. Conclusions. The various ways of conceptualising and understanding these problems need to be discussed before personalised, predictive and preventive medicine is implemented in practical health care.