to unnecessary treatment interventions and the associated anxiety and uncertainty. A
false-negative result may lead to an illness remaining undetected, untreated and con-
sequently progressing without medical intervention. In addition, a false-negative result
may lead to subsequent signs of illness (e.g. a breast lump, vaginal discharge) being
ignored by the patient.
Social harm Zola (1972) has argued that medicine is a means of social control and
suggested that there is a danger if individuals become too reliant on experts. In terms of
screening, monitoring and surveillance of populations could be seen as a forum for not
only examining individuals but controlling them. This argument is also made by Illich
(1974) in his book Medical Nemesis, where he argued that medicine is taking over the
responsibility for people’s health and creating a society of medical addicts. Screening
epitomizes this shift towards social control in that not only are the ill seen by the medical
profession but also the healthy as all individuals are now ‘at risk’ from illness (Armstrong
1995). Skrabanek (1988: 1155) argued that screening and the medicalization of health
‘serves as a justification for State intrusion into people’s private lives, and for stigmatising
those who do not conform’.
The possibility that screening may exacerbate existing stigma of particular social
groups is particularly relevant to the screening for genetic disorders. At present, society
is constituted of a variety of individuals, some of whom have genetic deficits such as
Down’s syndrome, cystic fibrosis and sickle-cell anaemia. Although these individuals
may be subjected to stereotyping and stigma, society provides treatment and support and
attempts to integrate them into the rest of the population. It is possible, however, that
screening for such disorders would lead to terminations of pregnancy and a reduction in
this stigmatized population. Although this would lead to fewer individuals with these
disorders (this may be a positive consequence, as no one wants to suffer from sickle-cell
anaemia) the individuals who are born with these problems may face increased stigma as
they would be part of a greatly reduced minority existing in a world with reduced social
provisions for support and treatment.
Autonomy – the patient has a right to choose
The third ethical principle is that of autonomy. This is based on the view that ‘mentally
competent and mature individuals should make decisions about their own future, subject
to the constraints required to ensure social order’ (Burke 1992). Proponents of screening
argue that screening is central to promoting autonomy in that the individual has a
right to have access to information about their health status. According to this model
of screening, the doctor is the patient’s gatekeeper to relevant information. However,
screening may also undermine an individual’s autonomy if it is construed as a form of
social control and doctors are seen as ‘lifestyle police’.
Justice – the equal distribution of resources
The fourth ethical principle of justice refers to the need for an equal distribution of
resources. This principle is relevant because screening programmes may be costly and
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