Overdiagnosis is an emerging problem in health policy and practice: we address its definition and ethical implications. We argue that the definition of overdiagnosis should be expressed at the level of populations. Consider a condition prevalent in a population, customarily labelled with diagnosis A. We propose that overdiagnosis is occurring in respect of that condition in that population when the condition is being identified and labelled with diagnosis A in that population ; this identification and labelling would be accepted as (...) correct in a relevant professional community; but the resulting label and/or intervention carries an unfavourable balance between benefits and harms. We identify challenges in determining and weighting relevant harms, then propose three central ethical considerations in overdiagnosis: the extent of harm done, whether harm is avoidable and whether the primary goal of the actor/s concerned is to benefit themselves or the patient, citizen or society. This distinguishes predatory, misdirected and tragic overdiagnosis; the degree of harm moderates the justifiability of each type. We end with four normative challenges: methods for adjudicating between professional standards and identifying relevant harms and benefits should be procedurally just; individuals, organisations and states are differently responsible for addressing overdiagnosis; overdiagnosis is a matter for distributive justice: the burdens of both overdiagnosis and its prevention could fall on the least-well-off; and communicating about overdiagnosis risks harming those unaware that they may have been overdiagnosed. These challenges will need to be addressed as the field develops. (shrink)

Some forty years on from the great events of the Second Vatican Council, there is still much debate about the interpretation of the Council and its documents. In recent years there has been what might be termed a hermeneutical project: to develop an understanding of the complex processes involved in the genesis of the texts and to explore the interactions of the various individuals and groups that helped to shape the Council. What has emerged is a view of the Council (...) as something organic and dynamic. This article seeks to outline the questions that this hermeneutical project has raised; such as the various sources that can be used to interpret the Council, the impact of various theological strands of tradition present at the Council, the authorship of the texts and the methodologies adopted by the Council. It also provides a review of the work that has taken place with this project, especially in the last ten years or so. (shrink)