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Abstract：
BACKGROUND: Scientific and technological advancements in mapping and understanding the interrelated pathways through which biological and environmental exposures affect disease development create new possibilities for detecting disease risk factors. Early detection of such risk factors may help prevent disease onset or moderate the disease course, thereby decreasing associated disease burden, morbidity, and mortality. However, the ethical implications of screening for disease risk factors are unclear and the current literature provides a fragmented and case-by-case picture.
METHODS: To identify key ethical considerations arising from the early detection of disease risk factors, we performed a systematic scoping review. The Scopus, Embase, and Philosopher\'s Index databases were searched for peer-reviewed, academic records, which were included if they were written in English or Dutch and concerned the ethics of (1) early detection of (2) disease risk factors for (3) disease caused by environmental factors or gene-environment interactions. All records were reviewed independently by at least two researchers.
RESULTS: After screening 2034 titles and abstracts, and 112 full papers, 55 articles were included in the thematic synthesis of the results. We identified eight common ethical themes: (1) Reliability and uncertainty in early detection, (2) autonomy, (3) privacy, (4) beneficence and non-maleficence, (5) downstream burdens on others, (6) responsibility, (7) justice, and (8) medicalization and conceptual disruption. We identified several gaps in the literature, including a relative scarcity of research on ethical considerations associated with environmental preventive health interventions, a dearth of practical suggestions on how to address expressed concerns about overestimating health capacities, and a lack of insights into preventing undue attribution of health responsibility to individuals.
CONCLUSIONS: The ethical concerns arising with the early detection of risk factors are often interrelated and complex. Comprehensive ethical analyses are needed that are better embedded in normative frameworks and also assess and weigh the expected benefits of early risk factor detection. Such research is necessary for developing and implementing responsible and fair preventive health policies.
METHODS: To identify key ethical considerations arising from the early detection of disease risk factors, we performed a systematic scoping review. The Scopus, Embase, and Philosopher\'s Index databases were searched for peer-reviewed, academic records, which were included if they were written in English or Dutch and concerned the ethics of (1) early detection of (2) disease risk factors for (3) disease caused by environmental factors or gene-environment interactions. All records were reviewed independently by at least two researchers.
RESULTS: After screening 2034 titles and abstracts, and 112 full papers, 55 articles were included in the thematic synthesis of the results. We identified eight common ethical themes: (1) Reliability and uncertainty in early detection, (2) autonomy, (3) privacy, (4) beneficence and non-maleficence, (5) downstream burdens on others, (6) responsibility, (7) justice, and (8) medicalization and conceptual disruption. We identified several gaps in the literature, including a relative scarcity of research on ethical considerations associated with environmental preventive health interventions, a dearth of practical suggestions on how to address expressed concerns about overestimating health capacities, and a lack of insights into preventing undue attribution of health responsibility to individuals.
CONCLUSIONS: The ethical concerns arising with the early detection of risk factors are often interrelated and complex. Comprehensive ethical analyses are needed that are better embedded in normative frameworks and also assess and weigh the expected benefits of early risk factor detection. Such research is necessary for developing and implementing responsible and fair preventive health policies.
摘要：
背景：在绘制和理解生物和环境暴露影响疾病发展的相关途径方面的科学技术进步为检测疾病风险因素创造了新的可能性。早期发现这些危险因素可能有助于预防疾病发作或缓和病程。从而减少相关的疾病负担，发病率，和死亡率。然而,筛查疾病危险因素的伦理含义尚不清楚,目前的文献提供了零散的个案情况.
方法：为了确定早期发现疾病风险因素引起的关键伦理考虑因素，我们进行了系统的范围审查.Scopus,Embase,和哲学家索引数据库进行了同行评审，学术记录,如果它们是用英语或荷兰语编写的，并且涉及（1）早期发现（2）疾病危险因素（3）由环境因素或基因-环境相互作用引起的疾病的伦理学。所有记录由至少两名研究人员独立审查。
结果：在筛选2034个标题和摘要后，和112篇完整的论文，55篇文章被纳入结果的主题综合。我们确定了八个共同的道德主题：(1)早期检测的可靠性和不确定性，(2)自主性,(3)隐私,(4)慈善和非恶意，(5)下游对他人的负担，（6）责任，（7）正义，（8）医疗化和概念中断。我们发现了文献中的几个空白，包括与环境预防性健康干预措施相关的伦理考虑研究相对缺乏，缺乏关于如何解决对高估健康能力的担忧的实际建议，以及缺乏对防止个人健康责任的不当归因的见解。
结论：早期发现危险因素引起的伦理问题通常是相互关联和复杂的。需要进行全面的道德分析，以更好地嵌入规范框架中，并评估和权衡早期风险因素检测的预期收益。这种研究对于制定和实施负责任和公平的预防性卫生政策是必要的。
方法：为了确定早期发现疾病风险因素引起的关键伦理考虑因素，我们进行了系统的范围审查.Scopus,Embase,和哲学家索引数据库进行了同行评审，学术记录,如果它们是用英语或荷兰语编写的，并且涉及（1）早期发现（2）疾病危险因素（3）由环境因素或基因-环境相互作用引起的疾病的伦理学。所有记录由至少两名研究人员独立审查。
结果：在筛选2034个标题和摘要后，和112篇完整的论文，55篇文章被纳入结果的主题综合。我们确定了八个共同的道德主题：(1)早期检测的可靠性和不确定性，(2)自主性,(3)隐私,(4)慈善和非恶意，(5)下游对他人的负担，（6）责任，（7）正义，（8）医疗化和概念中断。我们发现了文献中的几个空白，包括与环境预防性健康干预措施相关的伦理考虑研究相对缺乏，缺乏关于如何解决对高估健康能力的担忧的实际建议，以及缺乏对防止个人健康责任的不当归因的见解。
结论：早期发现危险因素引起的伦理问题通常是相互关联和复杂的。需要进行全面的道德分析，以更好地嵌入规范框架中，并评估和权衡早期风险因素检测的预期收益。这种研究对于制定和实施负责任和公平的预防性卫生政策是必要的。
