Result card

  • ETH2: Can Abdominal Aorta Aneurysm Screening challenge cultural or moral convictions or beliefs of some groups or change current social arrangements - especially gender related definition of the screening group?
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Can Abdominal Aorta Aneurysm Screening challenge cultural or moral convictions or beliefs of some groups or change current social arrangements - especially gender related definition of the screening group?

Authors: Gottfried Endel

Internal reviewers: Wilhelm Donner, Scott Goulden, Grace Jennings, Paolo Giorgi Rossi, Ingrid Wilbacher, Claudia Wild

The main challenge in this question is finding a “threshold” of incidence or prevalence for screening in general and for gender-specific screening in particular.

  • Respect for autonomy: organised population screening does not threaten autonomy.
  • Non-maleficence: organised population screening meets this criterion. The organised programme with a definition of those eligible for screening reduces “waste of resources” for those at low risk. It could harm people outside the target group by reducing access to this preventive care intervention. This problem is particularly relevant if eligibility is linked to gender. Is the difference in incidence high enough to exclude women from this type of screening?
  • Beneficence: balancing risks and cost with potential benefits can only be done at the local level (information on cost is local). To balance of risks and potential benefits without regard to costs, the first step is to decide whether to look at the risks of ultrasound alone or – in the case of a positive finding – to consider the risks and decision problems of the following chain of diagnostics and potential interventions. Gender differences in the overall pattern of diseases and differences in life expectancy are important.
  • Justice: Excluding women from screening needs a strong argumentation.

The main problem is whether gender is a suitable criterion for determining eligibility for screening. This judgment should be based on results from the effectiveness and safety domain.

Judgement has to be used with regard to national/local epidemiology.

Critical
Partially
Endel G Result Card ETH2 In: Endel G Ethical analysis In: Jefferson T, Vicari N, Frønsdal K [eds.]. Abdominal Aorta Aneurysm Screening [Core HTA], Agenzia nationale per i servizi sanitari regionali (age.na.s), Italy; 2013. [cited 30 June 2022]. Available from: http://corehta.info/ViewCover.aspx?id=106