Ethics and Preventive Medicine: The Case of Borderline Hypertension

Abstract

In what has been called a second public health revolution in the United States, greater attention and resources are being devoted to preventing disease.1 It is, of course, hard to be against such a goal. From both a medical and a social viewpoint, prevention is preferable to cure. It spares an individual the suffering and disabilities of disease; it spares society the increasing costs of caring for people with severe or chronic health problems. The present consensus is buttressed by past experience. Systematic preventive approaches to health problems stem from the nineteenth century. Not only did better nutritional standards lead to better health, but the dramatic reduction in the incidence of infectious disease was also a consequence of two different sorts of preventive practice: one was a social advance-the improvement of living conditions and public hygiene; the other was technical-immunization against specific diseases.2 As with any consensus, problems arise on more detailed examination. Agreement about what specifically ought to be done to prevent disease and illness is harder to come by than the general proposition that something ought to be done. Because such views are grounded in political, economic, and moral outlooks as well as in scientific and medical knowledge, and because the preventive practices proposed or rejected affect the well-being of numerous individuals, it is important to examine the normative dimensions of preventive medical practice as they evolve. The purpose of this article is to explore, in a tentative way, ethical and social issues that ought to be considered in connection with the prevention and treatment of one of the most prevalent conditions in the United States-borderline hypertension. We are concerned with this condition for two reasons. First, hypertension is the third most prevalent disease of adults in the United States; it affects, depending on