Serving Society or Serving the Patient?
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The subject of the ethics of screening is vast and complex. It gives rise to several layers of issues, from the concrete level of actually conducting a screening programme, via complicated scientific and technical details connected to issues regarding the ethical assessment of risks and the goals of screening, to overarching policy issues regarding the basic criteria for when and which screening programmes should actually be conducted and what room for informed consent they should provide. Nevertheless, some general thematic threads can be discerned through the analyses undertaken in the preceding chapters. First, many of the potential ethical conflicts or underlying value issues brought to the fore by screening programmes connect to the tension between applying a standard health care ethical or a public health ethical perspective on screening. In particular, prenatal screening programmes seem very difficult to justify unless their goals are formulated solely in terms of reducing the incidence of inborn disease in the population, while standard health care ethical requirements of respecting autonomy are discounted. A related example is the question of how to trade off severity and prevalence of the targeted disease when these factors pull in opposite directions. At the same time, the intricate problems surrounding the issue of what should be required by tests and follow-up procedures/treatments give rise to a need for value judgements that seem impossible to import from either of the perspectives in isolation, but rather create a need for mixing the two.
KeywordsScreening Programme Screen Programme Neonatal Screening Prenatal Screening Institutional Approach
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