Serving Society or Serving the Patient?

Juth, Niklas; Munthe, Christian

doi:10.1007/978-94-007-2045-9_6

Cited by 19 publications

(47 citation statements)

References 20 publications

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“…As a consequence, couples may receive few practical courses of action other than to decide whether or not to terminate the pregnancy. This has prompted considerable debate over why prenatal screening for conditions that are generally not preventable might be offered in the first place (Clarke 1997; de Jong and de Wert 2015; Juth and Munthe 2012; Munthe 2015; van El et al 2012; Wilkinson 2015). In relation to this question, several justifications are readily discussed within ethical debate.…”

Section: Prenatal Screening For Fetal Anomaliesmentioning

confidence: 99%

“…The third justification for offering screening for reproductive choice is that this may lessen the overall burden of disease on society (Clarke 1997; Juth and Munthe 2012; Stein 1975; Stein and Susser 1971; Wilkinson 2015). Unlike the personal appeals to avoid suffering, justifications based on the social utility of women’s reproductive choices are highly impersonal and only indirectly concerned with the wellbeing of each couple and their future child.…”

Section: Prenatal Screening For Fetal Anomaliesmentioning

confidence: 99%

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Qualifying choice: ethical reflection on the scope of prenatal screening

Stapleton

2016

Med Health Care and Philos

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In the near future developments in non-invasive prenatal testing (NIPT) may soon provide couples with the opportunity to test for and diagnose a much broader range of heritable and congenital conditions than has previously been possible. Inevitably, this has prompted much ethical debate on the possible implications of NIPT for providing couples with opportunities for reproductive choice by way of routine prenatal screening. In view of the possibility to test for a significantly broader range of genetic conditions with NIPT, the European Society of Human Genetics (ESHG) and American Society of Human Genetics (ASHG) recommend that, pending further debate, prenatal screening for reproductive choice should only be offered where concerning serious congenital conditions and childhood disorders. In support of this recommendation, the ESHG and ASHG discuss a number of ethical issues on which they prompt further debate: the informational privacy of the future child, the trivialization of abortion, the risk of information overload, and issues of distributive justice. This paper responds to this call with further reflection on each ethical issue and how it relates to the moral justification of providing couples with opportunities for meaningful reproductive choice. The paper concludes that whilst there may be good reasons for qualifying the scope of any unsolicited prenatal screening offer to serious congenital conditions and childhood disorders, if prenatal screening is justified for providing couples with opportunities for meaningful reproductive choice, then health services may have obligations to empower couples with the same opportunity where concerning other conditions.

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Section: Prenatal Screening For Fetal Anomaliesmentioning

confidence: 99%

Section: Prenatal Screening For Fetal Anomaliesmentioning

confidence: 99%

Qualifying choice: ethical reflection on the scope of prenatal screening

Stapleton

2016

Med Health Care and Philos

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“…that prenatal screening targeting some alleged criminality gene is out of the question, may change just as quickly as past eugenic stances once transformed into the more liberal views that currently prevail in this area of medicine. There is also a particular structural and institutional pull of screening solutions, due to the economic and status benefits for organizations of heading such programmes, that has been highlighted in the health context ( Juth and Munthe, 2012 : 2) and which seems no less likely in the new Lombrosian case. To the extent that a society is thus lured into setting up programmes of this sort despite wanting evidence, this will, of course, add to the ethical complications to be presented in the following sections.…”

Section: Components Challenges and Envisioned Approachesmentioning

confidence: 99%

“…The lack of research on ethical implications of the new Lombrosian vision may be due to the intricacies of applying standard bioethics perspectives to areas where health care and medicine is put to serve the legal system, such as forensic psychiatry ( Appelbaum, 2008 ; Munthe et al , 2010 ). However, the general notion of broad screening programmes for the purpose of advancing general societal values actualize particular ethical complexities ( Juth and Munthe, 2012 ), and the very idea of basing both penal and preventive criminal policy on forensic psychiatric risk assessment brings both scientific and ethical hazards of its own ( Nilsson et al , 2009 ). At the same time, just as it did in the 19th century, the idea of switching said policy to a mode of prevention rather than one that is met within the range of criminal sanctions, may seem the logical step given that crimes can be explained by factors outside the offenders’ control and thus be used to challenge the very idea of retribution ( Gray, 1858 ; Raine, 2013 ; Glenn and Raine, 2014 ).…”

Section: Introductionmentioning

confidence: 99%

The Return of Lombroso? Ethical Aspects of (Visions of) Preventive Forensic Screening

Munthe

Radovic

2015

Public Health Ethics

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The vision of legendary criminologist Cesare Lombroso to use scientific theories of individual causes of crime as a basis for screening and prevention programmes targeting individuals at risk for future criminal behaviour has resurfaced, following advances in genetics, neuroscience and psychiatric epidemiology. This article analyses this idea and maps its ethical implications from a public health ethical standpoint. Twenty-seven variants of the new Lombrosian vision of forensic screening and prevention are distinguished, and some scientific and technical limitations are noted. Some lures, biases and structural factors, making the application of the Lombrosian idea likely in spite of weak evidence are pointed out and noted as a specific type of ethical aspect. Many classic and complex ethical challenges for health screening programmes are shown to apply to the identified variants and the choice between them, albeit with peculiar and often provoking variations. These variations are shown to actualize an underlying theoretical conundrum in need of further study, pertaining to the relationship between public health ethics and the ethics and values of criminal law policy.

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“…According to this view, a respectful approach should accommodate citizens who wish to rely on others to guide or choose for them. Finally, some argue that providing citizens with enough information to make fully informed screening choices may be prohibitively time consuming [ 46 ].…”

Section: Introductionmentioning

confidence: 99%

The role of communication in breast cancer screening: a qualitative study with Australian experts

2015

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BackgroundOne well-accepted strategy for optimising outcomes in mammographic breast cancer screening is to improve communication with women about screening. It is not always clear, however, what it is that communication should be expected to achieve, and why or how this is so. We investigated Australian experts’ opinions on breast screening communication. Our research questions were: 1 What are the views of Australian experts about communicating with consumers on breast screening? 2 How do experts reason about this topic?MethodsWe used a qualitative methodology, interviewing 33 breast screening experts across Australia with recognisable influence in the Australian mammographic breast cancer screening setting. We used purposive and theoretical sampling to identify experts from different professional roles (including clinicians, program managers, policy makers, advocates and researchers) with a range of opinions about communication in breast screening.ResultsExperts discussed the topic of communication with consumers by focusing on two main questions: how strongly to guide consumers’ breast cancer screening choices, and what to communicate about overdiagnosis. Each expert adopted one of three approaches to consumer communication depending on their views about these topics. We labelled these approaches: Be screened; Be screened and here’s why; Screening is available please consider whether it’s right for you. There was a similar level of support for all three approaches. Experts’ reasoning was grounded in how they conceived of and prioritised their underlying values including: delivering benefits, avoiding harms, delivering more benefits than harms, respecting autonomy and transparency.ConclusionsThere is disagreement between experts regarding communication with breast screening consumers. Our study provides some insights into this persisting lack of consensus, highlighting the different meanings that experts give to values, and different ways that values are prioritised. We suggest that explicit discussion about ethical values might help to focus thinking, clarify concepts and promote consensus in policy around communication with consumers. More specifically, we suggest that decision-makers who are considering policy on screening communication should begin with identifying and agreeing on the specific values to be prioritised and use this to guide them in establishing what the communication aims will be and which communication strategy will achieve those aims.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1749-0) contains supplementary material, which is available to authorized users.

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Serving Society or Serving the Patient?

Cited by 19 publications

References 20 publications

Qualifying choice: ethical reflection on the scope of prenatal screening

Qualifying choice: ethical reflection on the scope of prenatal screening

The Return of Lombroso? Ethical Aspects of (Visions of) Preventive Forensic Screening

The role of communication in breast cancer screening: a qualitative study with Australian experts

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