Berman Institute of Bioethics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
J Med Ethics. 2020 Oct;46(10):674-677. doi: 10.1136/medethics-2019-105692. Epub 2020 Feb 13.
In the USA, there are missed opportunities to diagnose hepatitis C virus (HCV) in pregnancy because screening is currently risk-stratified and thus primarily limited to individuals who disclose history of injection drug use or sexually transmitted infection risks. Over the past decade, the opioid epidemic has dramatically increased incidence of HCV and a feasible, well-tolerated cure was introduced. Considering these developments, recent evidence suggests universal HCV screening in pregnancy would be cost-effective and several professional organisations have called for updated national policy. Historically, universal screening has been financially disincentivised on the healthcare system level, particularly since new diagnoses may generate an obligation to provide expensive treatments to a population largely reliant on public health resources. Here, we provide ethical arguments supporting universal HCV screening in pregnancy grounded in obligations to respect for persons, beneficence and justice. First, universal prenatal HCV screening respects pregnant women as persons by promoting their long-term health outside of pregnancy. Additionally, universal screening would optimise health outcomes within current treatment guidelines and may support research on treatment during pregnancy. Finally, universal screening would avoid potential harms of risk-stratifying pregnant women by highly stigmatised substance use and sexual behaviours.
在美国，存在许多未能诊断丙型肝炎病毒（HCV）感染的机会，因为目前的筛查是基于风险分层的，因此主要限于那些披露过注射毒品使用史或性传播感染风险的个体。在过去十年中，阿片类药物泛滥极大地增加了 HCV 的发病率，并且已经引入了一种可行且耐受性良好的治疗方法。考虑到这些发展，最近的证据表明，在妊娠期间进行普遍的 HCV 筛查将具有成本效益，并且有几个专业组织呼吁更新国家政策。从历史上看，由于新的诊断可能会产生向主要依赖公共卫生资源的人群提供昂贵治疗的义务，因此在医疗保健系统层面上普遍筛查在经济上没有得到激励。在这里，我们提供了支持在妊娠期间进行普遍 HCV 筛查的伦理论据，这些论据基于对尊重个人、善行和正义的义务。首先，普遍的产前 HCV 筛查通过促进孕妇在妊娠以外的长期健康来尊重她们作为个人的地位。此外，普遍筛查将根据当前治疗指南优化健康结果，并可能支持妊娠期间的治疗研究。最后，普遍筛查将避免通过高度污名化的药物使用和性行为对孕妇进行风险分层所带来的潜在危害。
