Schaper Manuel, Schicktanz Silke
Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073, Göttingen, Germany.
BMC Med Ethics. 2018 Jun 5;19(1):56. doi: 10.1186/s12910-018-0292-3.
Commercial genetic testing offered over the internet, known as direct-to-consumer genetic testing (DTC GT), currently is under ethical attack. A common critique aims at the limited validation of the tests as well as the risk of psycho-social stress or adaption of incorrect behavior by users triggered by misleading health information. Here, we examine in detail the specific role of advertising communication of DTC GT companies from a medical ethical perspective. Our argumentative analysis departs from the starting point that DTC GT operates at the intersection of two different contexts: medicine on the one hand and the market on the other. Both fields differ strongly with regard to their standards of communication practices and the underlying normative assumptions regarding autonomy and responsibility.
Following a short review of the ethical contexts of medical and commercial communication, we provide case examples for persuasive messages of DTC GT websites and briefly analyze their design with a multi-modal approach to illustrate some of their problematic implications.
We observe three main aspects in DTC GT advertising communication: (1) the use of material suggesting medical professional legitimacy as a trust-establishing tool, (2) the suggestion of empowerment as a benefit of using DTC GT services and (3) the narrative of responsibility as a persuasive appeal to a moral self-conception.
While strengthening and respecting the autonomy of a patient is the focus in medical communication, specifically genetic counselling, persuasive communication is the normal mode in marketing of consumer goods, presuming an autonomous, rational, independent consumer. This creates tension in the context of DTC GT regarding the expectation and normative assessment of communication strategies. Our analysis can even the ground for a better understanding of ethical problems associated with intersections of medical and commercial communication and point to perspectives of analysis of DTC GT advertising.
通过互联网提供的商业基因检测，即直接面向消费者的基因检测（DTC GT），目前正受到伦理抨击。一种常见的批评针对的是检测验证有限，以及用户因误导性健康信息而产生心理社会压力或行为改变的风险。在此，我们从医学伦理角度详细审视DTC GT公司广告传播的具体作用。我们的论证分析始于这样一个出发点：DTC GT在两种不同背景的交叉点运作，一方面是医学，另一方面是市场。这两个领域在沟通实践标准以及关于自主性和责任的潜在规范性假设方面有很大差异。
在简要回顾医学和商业沟通的伦理背景后，我们提供DTC GT网站说服性信息的案例，并采用多模态方法简要分析其设计，以说明其中一些问题影响。
我们在DTC GT广告传播中观察到三个主要方面：（1）使用暗示医学专业合法性的材料作为建立信任的工具；（2）暗示使用DTC GT服务的好处是增强权能；（3）将责任叙述作为对道德自我概念的有说服力的诉求。
虽然加强和尊重患者自主性是医学沟通特别是基因咨询的重点，但说服性沟通是消费品营销的常态模式，假定消费者自主、理性、独立。这在DTC GT背景下就沟通策略的期望和规范性评估产生了紧张关系。我们的分析可为更好理解医学与商业沟通交叉点相关的伦理问题奠定基础，并指出DTC GT广告分析的视角。
