Table 2.

Ethical Aspects of MHE Screening Adapted from Beauchamp and Childress

Principle	Potential harm
Beneficence	• Finding and treating HE at an early stage could prevent episodes of OHE • Even without treatment, identifying patients at risk will raise awareness, and caregivers will know what to expect • Accidents can be prevented by advising selected MHE patients against driving and working heavy machinery
Non‐malfeasance	• Screening tests pose no harm to patients • First‐line treatment (nonabsorbable disaccharides) have only a few and well‐known side effects • Screening tests are nonspecific but sensitive, so a number of false positives must be expected
Justice	• Screening is still not uniformly performed, and it is an ethical concern that some patients are screened and counseled whereas others are left unaware
Autonomy	• Patients participating in screening could end up being deemed unfit to drive or work machinery, and by restricting driving the patient may be asked to forgo his/her ability to decide their own best course of action