Legislation is being planned in Germany to coerce people, through financial
penalties, to take part in screening procedures. You can read the news story
at:
http://bmj.bmjjournals.com/cgi/data/333/7574/877-c/DC1/1
In brief, the following groups of people will have to make higher
co-payments if they do not take up screening and then develop the
associated cancer:
1 Women who have not had annual cervical smears from the age of 20
2. Women who have not had annual breast examinations from the age of 30 and
mammography every 2 years between the ages 50-69
3. Men who do not have annual digital rectal examination of the prostate
from the age of 45
4. All adults who do not participate in annual faecal occult blood testing
from the age of 55 and have two colonoscopies, ten years apart.
Does it matter to us who makes decisions about health care? I believe that
it does. The role of evidence in evidence-based health care is to INFORM
decisions. What "appears" to be true is not an immediate prescription for
what should be done. Practitioners and health service organisations should
guide but should not coerce. Coercion runs counter to the ethics of
evidence-based health care. As the Sicily Statement says:
"These decisions [about health care] should be made by those receiving care,
informed by the tacit and explicit knowledge of those providing care, within
the context of available resources."
The planned legislation also breaks with another ethical principle: the duty
to give information based on the best available evidence and a qualification
of the strength of that evidence. Many of the screening programmes above are
not backed up by sound evidence. Where evidence does exist, for example
mammography, interpretation of the evidence is controversial.
--
B/W, Kev Hopayian
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