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Screening – How?

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The Ethics of Screening in Health Care and Medicine

Part of the book series: International Library of Ethics, Law, and the New Medicine ((LIME,volume 51))

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Abstract

Besides the actual testing and analysis of samples, application of follow-up procedures, et cetera, screening programmes also involve the processes of contacting people for recruitment to the programme, informing them about the procedures prior to testing, as well as about the result of the test afterwards, counselling about possible follow up-procedures, and help with coping with the reactions to the test result. These features of screening programmes give rise to a host of questions of how screening programmes should be designed and conducted in these respects. Plausibly, all programmes should involve all of the tasks mentioned to some extent. But how much? And in what way? If ill-designed, the programme may end up not promoting the values it could have promoted and producing negative side-effects it could have avoided. So, even if defensible in terms of the condition targeted, the testing method utilised and the treatments available, a programme may still be open to serious criticism if organised in an inferior way. This has been underscored, e.g., in research on the new risk assessment methods in prenatal screening discussed in Section 3.2.1.

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Notes

  1. 1.

    Saltvedt (2005).

  2. 2.

    See e.g. ESHG (2003), p. 56, point (12) and (23).

  3. 3.

    Hoedemaekers (1999), p. 216.

  4. 4.

    Munthe (1996).

  5. 5.

    See Wilkinson (2003), chapter 6, for a general discussion of this question.

  6. 6.

    Parens and Asch (2000).

  7. 7.

    Munthe et al. (1998).

  8. 8.

    This is increasingly recognized in the literature on genetic counselling (see e.g. Platt Walker (1998); Munthe (1999), p. 83; and Juth (2005), pp. 84–85).

  9. 9.

    See e.g. Beauchamp and Childress (2001), pp. 83–88; Hoedemaekers (1999), p. 219; and Juth (2005), pp. 92–98.

  10. 10.

    Häyry and Takala (2000); and Juth (2005), chapter 5.

  11. 11.

    ESHG (2003), p. 56, point (27).

  12. 12.

    Juth (2005), pp. 92–98.

  13. 13.

    See Tännsjö (1999), where a radical ideal of anti-paternalism in health care is defended on the basis of this kind of considerations.

  14. 14.

    Nijsingh (2007).

  15. 15.

    Sandman and Munthe (2009).

  16. 16.

    See Beauchamp and Childress (2001), chapters 3–5. The position that respect for autonomy should only be prima facie and not absolute, regardless of basis, is argued in Juth (2005), pp. 205–206.

  17. 17.

    Fraser (1974), p. 637. Adopted by the American Society of Human Genetics in 1975, this conception of genetic counselling has since then become standard.

  18. 18.

    Holm (1999).

  19. 19.

    For passages on the history of genetic counselling, see Juth (2005); and Platt Walker (1998).

  20. 20.

    That ethically defensible testing, whether done in screening programs or not, should include counselling is almost unanimously accepted. See e.g. ESHG (2003), p. 56; and WHO (1998), p. 9.

  21. 21.

    Platt Walker (1998), p. 5.

  22. 22.

    Fraser (1974), p. 637.

  23. 23.

    There are genetic analyses made without molecular or other biochemical testing, most notably by making a pedigree of a family history of disease. For those cases, it is more appropriate to talk about pre- and post-analysis.

  24. 24.

    Platt Walker (1998), p. 9.

  25. 25.

    Platt Walker (1998), p. 10.

  26. 26.

    Sobel and Cowan (2000).

  27. 27.

    For instance, the increased risk of suicide due to a cancer diagnosis (see Section 5.4).

  28. 28.

    Juth (2005), pp. 79–97.

  29. 29.

    Juth (2005), pp. 85–87.

  30. 30.

    Kessler (1997), p. 166. See also Munthe (1999), p. 82.

  31. 31.

    ten Have (2000).

  32. 32.

    See Juth (2005), p. 87 for a discussion and further references regarding this.

  33. 33.

    Juth (2005), p. 89.

  34. 34.

    Munthe (1999), p. 85.

  35. 35.

    This is also increasingly recognized in the discussion about genetic counselling . See Shiloh (1996).

  36. 36.

    Kessler (1997), pp. 169–170.

  37. 37.

    Sandman and Munthe (2009, 2010).

  38. 38.

    Sandman and Munthe (2010).

  39. 39.

    Sandman and Munthe (2009).

  40. 40.

    Cf. Danish Council of Ethics (1999), chapter 5.3.

  41. 41.

    E.g. Justman (2010) claims that harms should be weighed considerably higher in preventive medicine (see Section 5.3).

  42. 42.

    For instance mammography programs (see Section 5.3).

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Authors and Affiliations

  1. Karolinska Institutet Dept. Learning, Informatics, Management & Ethics (LIME), Berzelius väg 3, 171 77, Stockholm, Sweden

    Niklas Juth

  2. Dept. Philosophy, Linguistics & Theory of Science, University of Göteborg, PO Box 200, 405 30, Göteborg, Sweden

    Christian Munthe

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Juth, N., Munthe, C. (2012). Screening – How?. In: The Ethics of Screening in Health Care and Medicine. International Library of Ethics, Law, and the New Medicine, vol 51. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-2045-9_4

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  • DOI: https://doi.org/10.1007/978-94-007-2045-9_4

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