Inherent Risks of the Construction of High-Risk Individuals in Diabetes Treatment and Prevention: An Ethical Challenge

Abstract

Type 2 diabetes is presented as a current global health challenge of epidemic proportions. In an effort to meet this challenge, identification of high-risk individuals has become an essential part of a strategy blurring the traditional divide between treatment and prevention. This strategy is framed within a risk discourse, where many health risks are defined as the outcome of individual lifestyle choices. As a consequence, individuals are offered new subject positions, attributed with personal responsibility for maintaining their own health. In this chapter, some ethical challenges implicit in this discourse are addressed. Among them are the arbitrary construction of diagnoses like type 2 diabetes and prediabetes, the potential burden of getting a lifelong diagnosis without ever experiencing a symptomatic disease and being diagnosed through ethnic stereotypes built into diabetes risk calculators. Once diagnosed, those identified as carrying a high risk of diabetes carries a further risk of shaming and blaming due to their failure to fulfil the obligations attributed to the subject position of healthy citizens. Finally, the chapter addresses how overlooking structural injustice and poverty may be a major failure of the high-risk approach to diabetes.