Human integrity has to be considered in any “public” intervention. In a healthcare system based on “solidarity” it is expressed in the root documents cited to define the principles of these ethical considerations that some responsibilities are allocated at the system level. Typically they address questions that individuals are not able to answer. This can derive from a different view on discounting the future, the broad public health perspective necessary or the access to data and methods for informing decision making. Just as in medicine where guidelines summarise the clinical evidence because individual medical doctors cannot read one billion publications a year (the expected number of entries in PubMed in 2012), public health policy, with democratic legitimacy, summarises the evidence and the preferences of their population.
So questions of democratic legitimacy and citizen or patient involvement in policy decisions have to be considered. The nine principles of the common quality framework for SSGIs should be followed.
Nevertheless the integrity or freedom of the healthcare professionals is reduced by standardisation of an organised screening programme. The definition of a screening programme, the data acquisition, the quality assurance, monitoring and evaluation challenge professional values and opinions.
Respect for autonomy: organised population screening is an intervention recommended by “the public” and therefore reduces the autonomy of the individual healthcare professional. The performance of the service provision is standardised and monitored. The autonomy of the individual citizen in cases where a recommendation is made is not at stake.
- Non-maleficence: standardisation is sometimes seen as destruction of the professional “art”. In a pluralistic society a total consensus cannot be achieved. Decisions supported by majorities have to consider the right to abstain for minorities.
- Beneficence: balancing risks and cost with potential benefits can only be done at the local level (information on cost and organisational issues is local). On a societal level organised programmes secure access.
- Justice: In this question the domain of justice addresses the political interests of the healthcare providers. The impact on different groups of providers depends on the type of organisational decision. Organised programmes have the potential to reduce the gaps in access to care caused by lack of education and information.