Respect women, promote health and reduce stigma: ethical arguments for universal hepatitis C screening in pregnancy

What is it about?

Hepatitis C virus (HCV) is increasing due to the opioid crisis and is now curable with recently developed direct-acting antiviral medications. Current U.S. recommendations are for risk-stratified screening in pregnancy on the basis of the greatest risk factors: IV drug use history and sexually transmitted infection risks. Though recent evidence suggests that it may be cost-effective in the long-term to apply universal screening in pregnancy, the great near-term costs of screening and treatment coupled with the prolonged latent disease course complicates the picture. This article discusses three key ethical arguments in favor of a national policy of universal screening for HCV in pregnancy. First, unlike the other infectious diseases pregnant women are universally screened for (HIV, HBV, Syphilis), HCV screening primarily benefits women but cannot prevent transmission to infants, and respect for persons demands that our policies reflect the view that pregnant women are ";ends in themselves."; Second, we appeal to beneficence, since universal screening will maximize health outcomes for women and infants, particularly if it promotes treatment in pregnancy. Finally, we raise justice concerns regarding the harmful effects of applying risk-stratified screening on the basis of substance use and sexual behaviors that are highly stigmatized, especially for pregnant women.

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