Balancing Innovation and Responsibility: Training Medical Students in Ethical Issues in Precision Medicine

Abstract

The emergence of precision medicine has transformed the manner in which healthcare is delivered to the general population. Regardless of these merits, we must acknowledge that a number of ethical issues are linked to precision medicine, and they must be carefully dealt with to avoid harm to patients. As there are many ethical concerns, we must prepare our medical students during their undergraduate training period to respond to them effectively and efficiently. In conclusion, there is an immense need to train medical students using a combination of teaching-learning methods, and that too throughout the duration of training so that future generations of healthcare professionals can maintain dignity and be respectful to all patients.

Introduction

The emergence of precision medicine has transformed the manner in which healthcare is delivered to the general population. ¹ As medical students of today’s generation will be the future members of the health team, it is extremely essential that they should be trained in precision medicine, as such initiatives will expose them to the field of genomics and biomarkers, and also empower them to deliver patient-centered care.^{2, 3} The adoption of precision medicine has been linked with a wide range of benefits to medical students, healthcare professionals, patients, the community, the healthcare delivery system, and the nation as a whole.^{1, 4} Regardless of these merits, we must acknowledge that a number of ethical issues are linked with precision medicine, and they must be carefully dealt with to avoid harm to patients. ⁵ In other words, we must maintain a balance between advancement in scientific knowledge and the safety and welfare of patients. ⁵

Ethical Issues in Precision Medicine Education

As precision medicine essentially involves genetic testing of patients to enable customized delivery of treatment, there is an indispensable need to obtain written informed consent from the patients prior to testing. ⁶ As healthcare professionals are obtaining informed consent, they must ascertain the validity and reliability of genetic tests that will be performed on the patient and must educate patients about the potential limitations of these tests as well.^{6, 7} The issues become even more prominent when we are performing genetic testing among minor and other vulnerable groups of patients. ⁸ There is an indispensable need that obtained genetic reports to be kept confidential, as we cannot rule out the possibility of discriminating against patients based on their genetic information with regard to their medical insurance, job opportunities, and other social contexts.^{9, 10} Further, we must also explicitly state who will be the accountable person when genomic data will be shared to other stakeholders or institutions for research purposes, and how patient confidentiality will be maintained.^{6, 7} In addition, we must maintain transparency while doing research or sharing data and strictly adhere to standard ethical norms.^{11, 12}

We also should consider ethical issues about the allocation of resources in different aspects of precision medicine, and make efforts to distribute them equitably. ¹³ As precision medicine is gradually increasing in popularity, we must ensure that access to precision medicine-related technologies or treatment is accessible to everyone, and should not augment the prevailing disparities in the health sector. ¹⁴ Though the healthcare professional is the one who is running these genetic and biomarker-related tests, we must educate and empower patients regarding their condition, including the genetic information, so that they can make autonomous decisions regarding their clinical treatment (patient-centered care).^1–3 Further, there is a definite need to recognize and be respectful toward the varied cultural perspectives on genetics so that we can understand and accordingly communicate to patients keeping in mind the potential cultural biases. ¹⁵ We must also be wary of the long-term follow-up and monitoring of patients who underwent genetic testing and thus might develop psychological and social consequences. ¹⁶

Potential Solutions

As there are many ethical concerns, we must prepare our medical students during their undergraduate training period to respond to them effectively and efficiently. ⁷ Medical students should be trained in ethics across different professional phases in relation to precision medicine, starting right from the first professional phase, and this will ensure that they are pretty much aware of ethical principles. ¹⁷ Teachers can conduct different case-based learning sessions with different ethical challenges in relation to precision medicine, and this exposure will provide them with an opportunity to discuss real-world situations. ¹⁸ Further, an institutional ethics committee can be involved in all complex ethical issues related to precision medicine, and give students hands-on exposure to navigate through these scenarios. ¹⁹ During clinical rotations, teachers can encourage patient-centered discussions, with emphasis on basic ethics principles, informed consent, maintaining privacy, and being respectful of patients’ autonomy in the context of genetic details.^{3, 20}

In order to ensure holistic understanding among medical students, experts from other professions (viz. legal experts, social scientists, etc.) can be invited to share their perspectives and this will benefit students to correlate any issue from different angles. ²¹ Another approach could be via exposing medical students to simulation exercises, wherein students can once again learn about ethical decision-making in controlled settings. ²² As a part of the mentorship programs, whenever students are stuck in any ethical issue surrounding precision medicine, they can approach their mentors for appropriate guidance. Students can also be trained in patient advocacy, wherein medical students learn to advocate for the rights and privacy of patients. In addition, students can also be trained in cultural competence, which will empower them to be more aware and respectful of the ethical perspectives of patients belonging to different regions. ¹⁵

Further, medical students can be encouraged to attend other training programs or sensitization sessions conducted in the field of precision medicine, and not only improve their understanding but even realize the presence of various ethical concerns that can emerge. ²³ Another strategy to respond to the ethical challenges is encouraging students to perform reflection on ethical grounds and then discuss the same openly to get better insights. ³ It is also a welcome move to train students in the domain of research ethics, as this will enable responsible conduct in genomic research and ensure that students are aware of all ethical issues in research areas. ¹²

Conclusion

In conclusion, there is an immense need to expose medical students to the ethical dimensions of precision medicine as it will significantly improve their approach to healthcare delivery in the future. This calls for the need to train medical students using a combination of teaching-learning methods, and that too throughout the duration of training so that future generations of healthcare professionals can maintain dignity and be respectful to all patients.