In their article on handling incidental findings, Ells and Thombs1 compare the extensive official guidance available in the United States with the rather more concise comments for Canadian researchers in the Tri-Council Policy Statement.2 Although the report, “Anticipate and communicate: ethical management of incidental and secondary findings in clinical, research, and direct-to-consumer contexts,”3 provides helpful details for US-based research, the Tri-Council Policy Statement is essential in the Canadian context.
A core principle of the statement is respect for persons, which incorporates the dual moral obligations to “respect autonomy and protect those with developing, impaired or diminished autonomy.”2 In the case of the competent patient, the moral obligation, according to article 1.1, is to respect autonomy. The statement further clarifies that “[r]especting autonomy means giving due deference to a person’s judgment and ensuring that the person is free to choose without interference.” Dictating what incidental information is withheld, in the absence of patient input, interferes with a patient’s freedom to choose without interference.
Ells and Thombs’1 recommendation that the plans for incidental findings simply be described to patients could be revised to ensure patient awareness of their own autonomy. Article 1.1 could be preserved by seeking the patient’s decision after describing the potential benefits and harms of disclosure of the incidental findings. This approach could elicit an informed decision while respecting patient autonomy and values and could be applied even when patient preferences differ from current research on the benefits and harms of disclosure.4