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Authors: Gottfried Endel
Internal reviewers: Wilhelm Donner, Scott Goulden, Grace Jennings, Paolo Giorgi Rossi, Ingrid Wilbacher, Claudia Wild
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.
The integrity of screening subjects is respected as there is no obligation to participate. But by standardisation of healthcare provision the integrity of healthcare providers can be reduced. In a healthcare system based on solidarity a restriction, for the healthcare providers, in their ability to live according their moral convictions, preferences or commitments is to some extent justified. The rules of SSGI should be followed and an inclusive discussion to gain broad acceptance and democratic legitimacy is necessary.