Intended for healthcare professionals

Letters Decision aids and screening

Editorial was amoral

BMJ 2010; 341 doi: (Published 23 November 2010) Cite this as: BMJ 2010;341:c6648
  1. Craig B Dalton, public health physician and conjoint senior lecturer1
  1. 1School of Medical Practice and Public Health, University of Newcastle, Callaghan NSW 2308, Australia
  1. craig.dalton{at}

The editorial is amoral.1 Neither immoral or moral, but written with no moral sensibility, in an ethics-free zone. It suggests that an aid to improve decision making may be inappropriate because it reduces uptake in the better informed. But this is just fine. The editorial notes that faecal occult testing is evidence based, and because screening programmes aim to increase uptake it would be more appropriate to “structure the facts” to effect “a policy of informed uptake rather than informed decision making.” Really? Surely informed decision making always trumps informed uptake from an ethical perspective?

This worrisome contention reflects a view encapsulated in the following statement: “Decision aids are appropriate when there is insufficient evidence to indicate the best medical choice, patients’ preferences are central to the choice, or the consequences of the options involve serious risks (or a combination of all three).”

When are the patient’s preferences not central to the choice of screening? A huge sociocultural chasm exists between the public and those who research and operate screening services. Across that chasm huge differences occur in how risks are perceived and tolerated and in the valuing of present and future scenarios. We public health practitioners sometimes envision a society that is structured in the image of our work. While health screening is elevated to a moral good for us, for the autonomous other it is just a lifestyle choice.


Cite this as: BMJ 2010;341:c6648


  • Competing interests: None declared.


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