Eur J Cancer. 2017 Sep 4;85:1-5. doi: 10.1016/j.ejca.2017.07.056. [Epub ahead of print]

Avoiding harm and supporting autonomy are under-prioritised in cancer-screening policies and practices.

Parker L1, Carter S2, Williams J3, Pickles K4, Barratt A5.

Author information

1

Sydney Health Ethics, Sydney School of Public Health, Medical Foundation Building, University of Sydney, NSW 2006, Australia. Electronic address: lisa.parker@sydney.edu.au.

2

Sydney Health Ethics, Sydney School of Public Health, Medical Foundation Building, University of Sydney, NSW 2006, Australia. Electronic address: stacy.carter@sydney.edu.au.

3

Sydney Health Ethics, Sydney School of Public Health, Medical Foundation Building, University of Sydney, NSW 2006, Australia. Electronic address: jane.h.williams@sydney.edu.au.

4

Sydney Health Ethics, Sydney School of Public Health, Medical Foundation Building, University of Sydney, NSW 2006, Australia. Electronic address: kristen.pickles@sydney.edu.au.

5

Sydney School of Public Health, University of Sydney, NSW 2006, Australia. Electronic address: alexandra.barratt@sydney.edu.au.

Abstract

The ethical principles of avoiding harm and supporting autonomy are relevant to cancer-screening policy. We argue that more attention needs to be given to implementing them. Cancer screening may deliver excessive harms due to low-value or outdated screening programs and from poorly communicated screening options that leave people with heavy burdens of decision-making. Autonomy is inadequately supported due to limited opportunities for people to understand downsides of screening and because of institutional and societal pressures in favour of screening. Members of screening policy committees may have differing ideas about the goals of screening or have conflicts of interest that prevent them from addressing policy questions in a neutral way. We recommend the following: 1. Committees should be required to discern and discuss the values of individual members and the wider public; 2. Committee membership and voting procedures should be more carefully constructed to reduce the likelihood that committee members' interests are placed above public interests; 3. Committees should explain their policy decisions with reference to values as well as evidence, so that values considered in decision-making can be interrogated and challenged if necessary. These changes would increase the likelihood that cancer-screening policy decisions are in keeping with public views about what is important.