Journal Article

Fair allocation of telemedical counseling services in early detection of Alzheimer's disease: Empirically informed ethical considerations

Perry, Julia, Schicktanz, Silke, Roth, Felix

2025

Overview

INTRODUCTION Counseling for early Alzheimer's disease (AD) detection is essential, especially regarding emerging blood‐based biomarkers. The increasing need for counseling requires innovative approaches and simultaneously consideration of ethical issues. ETHICAL CONSIDERATIONS Telemedicine is discussed as a means of providing more accessible and fairer health care. Nevertheless, barriers to accessing telemedicine are important to consider, such as required technical hardware and ethical criteria regarding interpersonal counseling, including individual adaptation of information to ensure self‐determined decision‐making. Regarding resource allocation, issues must be considered before telemedicine is implemented. THEORETICAL REFLECTION Fair counseling structures require the discussion of resource allocation. To avoid justifying telemedical counseling based solely on cost‐effectiveness and overlooking further ethical demands, we propose a ranked approach. To strengthening self‐determined decisions, we argue that equal care structures can be built on these prerequisite aspects and enable realization of fair resource allocation as a last step. Highlights Blood‐based biomarkers in Alzheimer's disease (AD) facilitate easier access to risk assessment and early detection. Currently, insufficient pre‐diagnostic counseling structures exist which support informed decision‐making. Telemedicine may be a meaningful approach for innovative counseling services. However, unresolved ethical and legal issues regarding telemedical counseling services for the early detection of AD must first be addressed. Telemedical counseling in the early detection of AD is yet rarely discussed in the literature. Therefore, we combine insights from ethical analysis of telemedical counseling with the ethical issues of fair and empowering counseling in the early detection of AD separately. In a second step, we discuss the use of telemedical counseling for the early detection of AD inductively to highlight ethically relevant aspects and present our considerations in light of the principles of autonomy, non‐maleficence, beneficence, and justice. To provide ethical guidance for possible future implementation without overprioritizing one approach to counseling for the early detection of AD, considerations regarding fair resource allocation are required. We argue that three major ethical topics should be considered in the future: Strengthening individuals’ autonomy, equal care structures, and fair resource allocation.

• Publisher: Wiley
• Subject: Alzheimer's disease / early detection / ethics / fair resource allocation / telemedicine