Ethical Principles, Constraints and Opportunities in Clinical Proteomics

Abstract

Recent advances in mass spectrometry (MS)-based proteomics have vastly increased the quality and scope of biological information that can be derived from human samples. These advances have rendered current workflows increasingly applicable in biomedical and clinical contexts. As proteomics is poised to take an important role in the clinic, associated ethical responsibilities increase in tandem with impacts on the health, privacy, and wellbeing of individuals. We conducted and here report a systematic literature review of ethical issues in clinical proteomics. We add our perspectives from a background of bioethics, the results of our accompanying paper extracting individual-sensitive results from patient samples, and the literature addressing similar issues in genomics. The spectrum of potential issues ranges from patient re-identification to incidental findings of clinical significance. The latter can be divided into actionable and unactionable findings. Some of these have the potential to be employed in discriminatory or privacy-infringing ways. However, incidental findings may also have great positive potential. A plasma proteome profile, for instance, could inform on the general health or disease status of an individual regardless of the narrow diagnostic question that prompted it. We suggest that early discussion of ethical issues in clinical proteomics can ensure that eventual healthcare practices and regulations reflect the considered judgment of the community and anticipate opportunities and problems that may arise as the technology matures.

Graphical abstract

Fig. 1

Examples of specifications and concrete proteomic examples for the bioethical principles. APOE, apolipoprotein E.

Fig. 2

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 flow diagram. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart visualizes the flow of information through sequential phases of our systematic review (16).

Fig. 3

Ten themes identified in our systematic review. The graph visualizes the ethical themes identified by the reviewing authors (S. P. M. and P. V. T.) and the frequency with which they were identified in the 16 included articles (x-axis), following the methodology described in the Experimental Procedures section. Note that frequency of thematic identification is not a measure of the ethical importance of a theme. Rather, it is a descriptive visualization of the number of times these themes have been mentioned in the 16 selected articles. QC, quality control.