Ethical considerations

There is a key difference between clinical consultation and health screening. In the clinical consultation, the patient approaches the doctor for advice or treatment for a health complaint and has to give consent to certain diagnostic procedures and therapy having been advised of some limitations or even possible adverse effects. In health screening, however, the doctor reviews an apparently healthy person for the possible presence of asymptomatic disease. In so doing, there must be a good understanding of the efficacy and safety of the screening tests, and patients should similarly be informed of the possible consequences of false positive and false negative results following screening.

A test procedure that is ethically justifiable on diagnostic grounds may not necessarily be applicable when used for screening asymptomatic people. Holland points out that there is lack of evidence that some health screening procedures are beneficial.13 Indeed, there is positive evidence that they may lead to increased anxiety, illness behaviour, and also inappropriately utilize and deplete healthcare resources.

From a preventive perspective, the energy and expense of general health screening could perhaps be better diverted to promote measures to encourage proper diet, weight control, regular exercise, smoking cessation, moderation in alcohol consumption, and stress management, or control of workplace hazards. Modifications in lifestyle behaviour require motivation and effort on the part of the individual, whereas health screening is essentially a passive process, where an individual is seemingly reassured that all is well after a negative examination. This is perhaps the reason why general health screening has popular appeal.

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