Why is preventive medicine exempted from ethical constraints?

Abstract

It is a paradox that medical experimentation on individuals, whether patients or healthy volunteers, is now controlled by strict ethical guidelines, while no such protection exists for whole populations which are subjected to medical interventions in the name of preventive medicine or health promotion. As many such interventions are either of dubious benefit or of uncertain harm-benefit balance, such as mass screening for cancers or for risk factors associated with coronary heart disease, there is no justification for maintaining the ethical vacuum in which preventive medicine finds itself at present.

Potential Uses and Inherent Challenges of Using Genome-Scale Sequencing to Augment Current Newborn Screening

“…The public health benefits and importance of NBS must be weighed against the rights of parents to make decisions about their child. Some have argued that preventive programs conducted under public health auspices should be held to the same ethical standards as medical innovations introduced into the private sector (Skrabanek 1990). Some have proposed screening for all but a selected group of conditions, whereas others point out the potential for a "treatment odyssey" undertaken by families whose child is identified with a serious condition through screening for which no effective treatment exists (Baily and Murray 2008;Bailey et al 2008).…”

Salud pública, genética y ética

“…La intención es más bien de fundamentar la idea que la bioética, como actualmente cultivada, es un instrumento inadecuado para esta reflexión, y que debe ser complementada por una bioética social preocupada de categorías comunitarias sensibles a conceptos como esferas de justicia, 21 reconocimiento, 20 cuidados protectivos. 19 A fin de evitar importantes transgresiones a la ética social, es recomendable que la genética sea una actividad financiada o a lo muy menos cuidadosamente fiscalizada por el interés público. Se está produciendo la erosión de aquella ideología que entendió la democracia como generando un Estado de bienestar con fuertes compromisos sociales.…”

The potential social impact of predictive genetic testing for susceptibility to common chronic diseases: a review and proposed research agenda

“…Probabilities derived from group risk become the basis for intervention focused on individuals. The treatment of risk factors for disease, as opposed to diseases themselves, and the problems inherent in the application of group risk to individuals, have been important subjects for recent scientific, ethical and policy debate in the field of public health (Skrabanek 1988;Davison et al 1991;Skrabanek 1990;HuUey et al 1992;Brett 1984;Rose, G. 1985Rose, G. , 1981.…”