Who should be tested in a pandemic? Ethical considerations

Abstract

Background In the initial phase of the Covid-19 pandemic, difficult decisions had to be made on the allocation of testing resources. Similar situations can arise in future pandemics. Therefore, careful consideration of who should be tested is an important part of pandemic preparedness. We focus on four ethical aspects of that problem: how to prioritize scarce testing resources, the regulation of commercial direct-to-consumer test services, testing of unauthorized immigrants, and obligatory testing. Main text The distribution of scarce resources for testing: We emphasize the use of needs-based criteria, but also acknowledge the importance of choosing a testing strategy that contributes efficiently to stopping the overall spread of the disease. Commercial direct-to-consumer test services: Except in cases of acute scarcity, such services will in practice have to be allowed. We propose that they should be subject to regulation that ensures test quality and adequate information to users. Testing of unauthorized immigrants, their children and other people with unclear legal status: Like everyone else, these individuals may be in need of testing, and it is in society’s interest to reach them with testing in order to stop the spread of the disease. A society that offers comprehensive medical services to unauthorized immigrants is in a much better position to reach them in a pandemic than a society that previously excluded them from healthcare. Obligatory testing: While there are often strong reasons for universal testing in residential areas or on workplaces, there are in most cases better ways to achieve testing coverage than to make testing mandatory. Conclusion In summary, we propose (1) decision-making primarily based on needs-based criteria, (2) strict regulation but not prohibition of direct-to-consumer test services, (3) test services offered to unauthorized immigrants, preferably as part of comprehensive medical services, and (4) broad outreach of testing services whenever possible, but in general not obligatory testing.

Ethical issues in direct-to-consumer healthcare: A scoping review

“…These included worries about individuals misinterpreting test results [ 1 , 31 , 94 ] or having difficulty understanding results without medical guidance [ 30 , 35 ]. Relatedly, there were concerns about “overinterpretation” and false reassurance from false negative results [ 30 , 74 , 95 ], as well as the possibility of an incorrect diagnosis and increased healthcare costs [ 7 ]. Moreover, some articles raised questions about whether DTC testing provides actionable information [ 31 ] or if unclear or incomprehensive results could lead to unnecessary follow-up [ 30 ].…”

“…Several publications discussed how DTC products and services will impact the healthcare market (15%; n = 13). For example, labs may need to adapt to meet the new demand [ 95 ] and offer lab testing consultation services [ 94 ]. Regarding DTC telemedicine, concerns were raised that the rapid growth of companies might outpace the ability of healthcare stakeholders, such as payers and providers, to effectively respond and adapt [ 38 ].…”

COVID testing hesitancy among pregnant patients: Lessons learned from the COVID-19 pandemic about the unique needs and challenges of medically complex populations

“…While there was signi cant pressure to implement testing during the pandemic in a time-sensitive fashion, these ndings highlight the need for strategies that address the needs of different patient populations, particularly given the support for a universal testing approach for this population [41,42].…”

Universal Coronavirus Testing to Control the Pandemic: Ethical Issues and Dilemmas

“…Mandatory testing needs to be implemented in a way that the public does not lose faith and trust in the government and its public health measures. 3,[17][18][19][20][21][22][23][24][25][26]…”

“…The voice of the general public should be heard while drafting health policies to foster health democracy and ensure the success of such programs. [1][2][3] The ethical dilemmas involved in COVID testing and the challenges and solutions to implement universal COVID testing to prevent the spread of this fatal pandemic (Figure) are discussed below.…”