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- Ethical considerations in presymptomatic testing for variant CJD

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Table 1 Four protocols for presymptomatic testing for vCJD

	Universal testing	Selective testing

Voluntary testing	Protocol 1: all persons who want to be tested can be tested	Protocol 2: all persons undergoing a medical procedure posing a potentially higher risk of transmission can be tested
Compulsory testing	Protocol 3: all persons must be tested	Protocol 4: all persons undergoing a medical procedure posing a potentially higher risk of transmission must be tested

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Table 2 An analysis of the four protocols with respect to personal autonomy

Protocol	Ability to promote personal autonomy

Protocol 1: All persons who want to be testedcan be tested	Maximises personal autonomy by allowing all persons to decide for themselves
Protocol 2: All persons undergoing a medical procedure involving a high risk of transmissioncan be tested	Maintains personal autonomy but limits it to a subset of the population
Protocol 3: All persons must be tested	Fails to respect personal autonomy by removing choice for all persons
Protocol 4: All persons undergoing a medical procedure involving a high risk of transmissionmust be tested	Fails to respect personal autonomy by removing choice for a subset of the population

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Table 3 An analysis of the four protocols with respect to the promotion of public health

Protocol	Ability to promote public health

Protocol 1: All persons who want to be testedcan be tested	May help to promote public health but only if people who are undergoing higher risk procedures choose to be tested; many may not
Protocol 2: All persons undergoing a medical procedure involving a higher risk of transmissioncan be tested	May help to promote public health but only if people choose to be tested; many may not
Protocol 3: All persons must be tested	Maximum effect on public health by reducing the possibility of transmission but at a large economic cost
Protocol 4: All persons undergoing a medical procedure involving a higher risk of transmissionmust be tested	Maximum effect on public health by reducing the possibility of transmission and is more cost effective than protocol 3

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