Ethics Related to Liver Biopsies and Antiviral Therapies in Chronic Viral Hepatitis

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Abstract
Ethics related to liver biopsies in patients with chronic viral hepatitis mainly include issues on the indications, potential risks and benefits and validity of available alternative options. Liver biopsy is the gold standard for the overall evaluation of liver lesions, but its indications are decreasing. It is not usually required for the correct etiological diagnosis but mostly for the appropriate classification in specific settings. It certainly estimates the severity of liver injury, which influences the prognosis and perhaps therapeutic decisions. It is generally a simple and safe but invasive procedure, which carries a small risk for complications, requires the patient’s admission for 12–24 h and may have sampling errors. New, rather accurate, noninvasive tests have been developed and their use may increase in the future, perhaps not for the initial evaluation but mostly for the long-term follow-up of such patients. Therapeutic options for chronic viral hepatitis have substantially improved over the last decade, but there are still several unsettled issues creating ethical dilemmas. Treating physicians should ideally have knowledge and personal experience on several aspects of the management of patients with chronic viral hepatitis, who should be adequately informed and participate in the decisions for liver biopsy and/or therapeutic intervention.

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