The best possible and most objective information to permit informed decision making or informed consent is needed, not only with regard to the ultrasound test but also, in cases where there is a positive test, about the subsequent pathway of care. Information on the subsequent steps should provide both an overview and in depth information on demand.

• Respect for autonomy: organised population screening is a recommendation and provides information to support decision making on the individual level. Endpoints relevant for participants – their preferences and their fears – should be taken from qualitative surveys.
• Non-maleficence: comprehensive information is needed to ameliorate the reduction in quality of life in cases of positive test results.
• Beneficence: balancing risks and cost with potential benefits can only be done at the local level (information on cost and organisational issues is local). A societal perspective – looking beyond the healthcare system perspective – is recommended. The fears and preferences of citizens guide this balancing.
• Justice: In this question the domain of justice addresses mainly the question of citizen involvement in the decision-making process. Expert opinion is also needed, but the leading role stays with patients and citizens.

The general approach on the EU level has to be put into operation at the local level. This could be done using an interactive participatory approach to HTA.

• Respect for autonomy: organised population screening is a recommendation and provides information to support decision making on the individual level. Endpoints relevant for participants – their preferences and their fears – should be taken from qualitative surveys.
• Non-maleficence: comprehensive information is needed to ameliorate the reduction in quality of life in cases of positive test results.
• Beneficence: balancing risks and cost with potential benefits can only be done at the local level (information on cost and organisational issues is local). A societal perspective – looking beyond the healthcare system perspective – is recommended. The fears and preferences of citizens are the guidance for this balancing.
• Justice: In this question the domain of justice addresses mainly the question of citizen involvement in the decision process. Expert opinion is also needed, but the leading role stays with patients and citizens.