A study found that women participating in mammography screening were content with the programme and the paternalistic invitations that directly encourage participation and include a pre-specified time of appointment. We argue that this merely reflects that the information presented to the invited women is seriously biased in favour of participation. Women are not informed about the major harms of screening, and the decision to attend has already been made for them by a public authority. This short-circuits informed decision-making and the (...) legislation on informed consent, and violates the autonomy of the women. Screening invitations must present both benefits and harms in a balanced fashion, and should offer, not encourage, participation. It should be stated clearly that the choice not to participate is as sensible as the choice to do so. To allow this to happen, the responsibility for the screening programmes must be separated from the responsibility for the information material. (shrink)

The idea that it is acceptable to ‘nudge’ people to opt for the ‘healthy choice’ is gaining currency in health care policy circles. This article investigates whether researchers evaluating Abdominal Aortic Aneurysm Screening Programmes (AAASP) attempt to influence decision makers in ways that are similar to popular ‘nudging’ techniques. Comparing two papers on the health economics of AAASP both published in the BMJ within the last 3 years, it is shown that the values chosen for the health economics modelling are (...) not representative of the literature and consistently favour the conclusions of the articles. It is argued (1) that this and other features of these articles may be justified within a Libertarian Paternalist framework as ‘nudging’ like ways of influencing decision makers, but also (2) that these ways of influencing decision makers raise significant ethical issues in the context of democratic decision making. (shrink)

I sin udmærkede kommentar til vores artikel «En etisk diskussion af screening for kræftsygdomme» beskriver Geir Hoff den udtalte mangel på evidens vedrørende nytteværdien af screeningsprogrammer for kræftsygdomme baseret på randomiserede studier. Ydermere fremhæver Geir Hoff misforholdet mellem den manglende evidens ved screening og de strenge krav, der er til evidensen i den farmaceutiske industri. Dette er en velkommen kritik, pga. en udtalt ukritisk og uvidenskabelig tilgang til anvendelse af screening for denne eller hin sygdom eller risikofaktor.