Ethico-Political Aspects of Conceptualizing Screening: The Case of Dementia

Abstract

While the value of early detection of dementia is largely agreed upon, population-based screening as a means of early detection is controversial. This controversial status means that such screening is not recommended in most national dementia plans. Some current practices, however, resemble screening but are labelled “case-finding” or “detection of cognitive impairment”. Labelled as such, they may avoid the ethical scrutiny that population-based screening may be subject to. This article examines conceptualizations of screening and case-finding. It shows how the definitions and delimitations of the concepts (the what of screening) are drawn into the ethical, political, and practical dimensions that screening assessment criteria or principles are intended to clarify and control (the how of screening, how it is and how it should be performed). As a result, different conceptualizations of screening provide the opportunity to rethink what ethical assessments should take place: the conceptualizations have different ethico-political implications. The article argues that population-based systematic screening, population-based opportunistic screening, and case-finding should be clearly distinguished.

Ethical issues when using digital biomarkers and artificial intelligence for the early detection of dementia

“…As such, they are highly relevant to early detection programs—whether established by health systems, health insurers or in other settings, for example by technology developers. To date, this wider relevance has rarely been recognized in discussions of digital health, including in the case of dementia (Gunnarson et al, 2021 ). Below, we consider how these principles apply for the paradigm of dementia early detection using digital biomarkers and automated detection methods, and emphasize the ethical issues brought to light by each principle.…”

Towards feminist health empowerment for self-testing apps : testing for dementia

“…In the landscape of testing practices for dementia, some mixed forms of screening and case-fining are conducted under names like 'opportunistic case-finding', or simply 'detection of cognitive impairment' (Gunnarson et al, 2021). It has been criticised that these practices, labelled as such, may avoid the ethical scrutiny that population-based screening is usually subjected to (McCartney, 2014;Wald & Morris, 1996).…”

“…I examine the conditions for empowerment in the literature and am concerned with logical coherence, but I do not subscribe to the idea of an a priori essence of these concepts as a "classic" philosophical conceptual analysis would. On the contrary, based on the theory described in the last chapter, I assume that concepts are constructed and performative (Gunnarson et al, 2021;Hacking, 1985Hacking, , 1999Hacking, , 2007. Therefore, I study the concept of empowerment as it is used in public health documents and mHealth advertisements.…”

Ethico-Political aspects of clinical judgment in opportunistic screening for cognitive impairment: Arendtian and aristotelian perspectives

“…The ambition to improve early detection and diagnosis of dementia is, however, strong, and in the absence of any national population-based systematic screening programs -in which every member of a predefined population is offered testing -variations on this type of screening have emerged. One such example is "population-based opportunistic screening" (Gunnarson et al 2021). Unlike systematic screening, opportunistic screening offers testing to a predefined population when the opportunity arises, most commonly when members of the population are admitted to hospital for other reasons than those that the screening concerns.…”

“…"Opportunistic screening" refers to a type of screening offered to a predefined population when the opportunity arises, for example when members of the population are admitted to hospital for other reasons than that which the screening concerns. As such, it can be contrasted to population-based systematic screening, in which everyone in a predefined population is offered testing (Gunnarson et al 2021). This article examines a population-based opportunistic screening practice for cognitive impairment that takes place at a hospital in Sweden.…”