Ethical, Legal, and Social Implications of Precision Cancer Medicine

Abstract

Like many other emerging biomedical technologies, precision cancer medicine (or precision oncology) poses a broad range of ethical, legal, and social implications (ELSI). These ELSI issues are present across multiple levels of health care, research, and social policy. For example, at the individual (patient) level, use of next-generation sequencing (NGS) presents challenges for securing truly informed consent and honoring patient preferences for the many different types of genetic information potentially yielded by NGS. At the institutional level, various stakeholders (e.g., professional organizations in genetics and oncology, test laboratories, clinical trials networks) have vested interests in deciding which types of sequencing results will be analyzed and returned to patients or research participants, and how the clinical implications of results will be managed. Finally, at a broader societal level, we must wrestle with questions of resource allocation and priority setting. Precision oncology represents a promising avenue for breakthroughs in cancer therapies, but what proportion of public funds should be earmarked for this approach versus other domains of cancer treatment, where significant disparities in health care access and outcomes still persist? In this chapter, we will address such ELSI issues, drawing upon both empirical research and ethical and policy commentary in the field.