Medical-Ethical Dimensions of Preventive Medicine

Abstract

“Why is preventive medicine exempted from ethical constraints?” Petr Skrabanek asked in 1990 in a provoking paper in the Journal of Medical Ethics.1 He noticed that, while ethical norms in clinical medicine and medical experimentation grew more explicit and stringent, interventions in preventive medicine were left relatively free of constraints. The expression “prevention is better than cure” seemed to rule common opinion on preventive medicine and health promotion. The absence of established ethical guidelines for preventive medicine is indeed remarkable. Although in the past two decades a number of authors pointed out moral problems concerning prevention and public health, there have been few systematic analyses leading to specific ethical guidelines for preventive medicine and health promotion. A notably early exception is Wilson and Jungner’s list of principles for screening and case-finding (1968), although they probably considered their principles as methodological — not ethical — guidelines.2 The ethical guidelines for health promotion, as published by the American Journal of Preventive Medicine in 1994, are a more recent example, yet these guidelines lack any explication and justification.3 This is not to say that all fields in medicine should have their own principles. The practical meaning of charters of ethical guidelines should not be overestimated. Nevertheless, in some areas it is important to formulate moral rules which can be justified and which can count on support of most people concerned (professionals as well as ‘clients’).