Why Screening?
Abstract
In order to determine whether a certain screening programme should be implemented or not, one has to ponder the basic issue of why such an effort may be worthwhile at all. That is, in order to provide a rationale or justification for any screening programme one has to have some idea about the values that the programme should promote. Of course, whatever values a certain screening programme may promote, this promotion has to be balanced against the potential drawbacks of the programme. Thus, as already mentioned, much ethical debate about screening is cast in terms of some kind of cost benefit-analysis. It must be noted, though, that in the context of an ethical analysis, terms such as “cost” and “benefit” must be understood very broadly. They can only partly be translated into straightforward monetary figures, since the values and drawbacks often regard qualities mentioned in basic ethical theories, like autonomy, justice, or well-being. Moreover, unlike monetary costs, it cannot be taken for granted that these values can or should be traded off against each other in any way imaginable. To substantiate more particular ideas on what values may motivate what costs or sacrifices in terms of other values and in what way, explicit (and thereby controversial) moral premises need to be a part of the argument.
Keywords
Down Syndrome Screening Programme Prenatal Diagnosis Screen Programme Public Health PerspectiveReferences
- Battin, M.P., L.P. Francis, J.A. Jacobson, and C.B. Smith. 2008. The patient as victim and vector: Ethics and infectious disease. Oxford: Oxford University Press.Google Scholar
- Beauchamp, T.L., and J.F. Childress. 2001. Principles of biomedical ethics, 5th edition. New York, NY and Oxford: Oxford University Press.Google Scholar
- Dawson, A., and M. Verweij. 2007a. The meaning of ‘public’ in ‘public health’. In Ethics, prevention, and public health, eds. A. Dawson and M. Verweij. Oxford: Oxford University Press.Google Scholar
- Eddy, D.M. 1990. Anatomy of a decision. Journal of the American Medical Association 263:441.PubMedCrossRefGoogle Scholar
- Glover, J. 1977. Causing death and saving lives. London: Penguin Books.Google Scholar
- Hampton, M.L., J. Anderson, B.S. Lavizzo, and A.B. Bergman. 1974. Sickle-cell “nondisease”. American Journal of Diseases of Children 128:58–61.Google Scholar
- Hoedemaekers, R. 1999. Genetic screening and testing. A moral map. In The ethics of genetic screening, eds. R. Chadwick et al. Dordrecht: Kluwer Academic Publishers.Google Scholar
- Juth, N. 2005. Genetic information – values and rights: The morality of presymptomatic genetic testing. Göteborg: Acta Universitatis Gothoburgensis.Google Scholar
- Meade, N., and P. Bower. 2000. Patient-centeredness: A conceptual framework and review of the empirical literature. Social Science & Medicine 51:1087–1110.CrossRefGoogle Scholar
- Mill, J.S. 1859. On liberty. Suffolk: Penguin Books, 1974.Google Scholar
- Munthe, C. 1996. The moral roots of prenatal diagnosis. Ethical aspects of the early introduction and presentation of prenatal diagnosis in Sweden. Göteborg: Centrum för forskningsetik.Google Scholar
- Munthe, C. 2008. The goals of public health: An integrated, multidimensional model. Public Health Ethics 1(1):39–53.CrossRefGoogle Scholar
- Murray, C.J.L., J.A. Salomon, C.D. Mathers, and A.D. Lopez. 2002. Summary measures of population health: Concepts, ethics, measurement and applications. Geneva: WHO.Google Scholar
- Nozick, R. 1974. Anarchy, state and Utopia. New York, NY: Basic Books.Google Scholar
- Parens, E., and A. Asch. 2000. Prenatal testing and disability rights. Washington, DC: Georgetown University Press.Google Scholar
- Rawls, J. 1972. A theory of justice. London: Oxford University Press.Google Scholar
- Rhodes, R. 1998. Genetic links, family ties and social bonds: Rights and responsibilities in the face of genetic knowledge. Journal of Medicine and Philosophy 23:10–30.PubMedCrossRefGoogle Scholar
- Rose, G. 1992. The strategy of preventive medicine. Oxford: Oxford University Press.Google Scholar
- Sandman, L., and C. Munthe. 2009. Shared decision making and patient autonomy. Theoretical Medicine and Bioethics 30(4):289–310.PubMedCrossRefGoogle Scholar
- Sandman, L., and C. Munthe. 2010. Shared decision making, paternalism and patient choice. Health Care Analysis 18(1):60–84.PubMedCrossRefGoogle Scholar
- Shickle, D. 1999. The Wilson and Jungner principles of screening and genetic testing. In The ethics of genetic screening, eds. R. Chadwick et al. Dordrecht: Kluwer Academics Publishers.Google Scholar
- Verweij, M. 2000. Preventive medicine between obligation and aspiration. Dordrecht, Boston, MA and London: Kluwer Academic Publishers.Google Scholar
- Wilson, J.M.G., and G. Jungner. 1968. Principles and practice of screening for disease. Public Health Papers, WHO No. 34, Geneva.Google Scholar
- Clarke, A. 1998. Genetic counselling. Encyclopaedia of applied ethics, Volume 2. San Diego, CA: Academic Press.Google Scholar
- Locke, J. 1689. Two treaties of government, ed. P. Laslett. New York: Cambridge University Press, 1988.Google Scholar
- Munthe, C., L. Sandman, and D. Cutas. 2011. Person centred care and shared decision making: Implications for ethics, public health and research. Health Care Analysis 19, online first. doi: 10.1007/s10728-011-0183-y.Google Scholar
- Dawson, A., and M. Verweij. (eds.) 2007b. Ethics, prevention, and public health. Oxford: Oxford University Press.Google Scholar