Guidance

UK NSC ethical framework for screening

Published 10 August 2021

The ethical principles of health screening are encompassed within the UK National Screening Committee (UK NSC) criteria for assessing the viability, effectiveness and appropriateness of a screening programme. To further clarify and explain the overarching goals of screening, the UK NSC has developed an ethical framework for screening, which is comprised of 4 broad ethical principles. The principles are all equally as important as each other.

Deciding how these ethical principles apply in any given situation is unlikely to be straightforward and often there will be a need for balancing across them. The ethical principles can be in tension with each other and create difficult dilemmas, particularly in the balancing of individual and collective interests.

For example, there is a possibility that public health interventions and restrictions, being designed to serve the collective interest by improving the health and wellbeing of the population, will come into tension with the principle of treating people with respect (this being understood as respecting the interest of individuals in making their own choices in relation to their own health and well-being).

It is the task of the UK NSC to consider evidence and views in each case and make judgements, ensuring it works in accordance with the UK NSC values. UK NSC recommendations about screening are always made on a case-by-case basis and involve consideration of alternative options for reducing the effect of the disease on the population.

Principle 1: improve health and wellbeing

The general purpose of public health screening programmes should be to improve the health and wellbeing of the population. No screening programme should be adopted unless its potential benefits (to health and wellbeing) outweigh any potential harms. The focus should be on the individuals who will be offered screening. If there is a prospect for screened individuals to benefit, the benefits and harms for others and society more broadly can also be taken into consideration.

Potential benefits include prevention of death and disease, improvements in physical and mental health, and improved quality of life. Potential harms include unnecessary and harmful tests or treatment, uncertainty of screening results, false reassurance, and increased anxiety. Efforts should be made to reduce any risks of harms.

Principle 2: treat people with respect

People’s rights, wishes and feelings as individuals should be respected. This involves enabling people to make informed choices about screening that align with their personal values and acknowledging the role that relationships with family members and others can play. People’s choices about screening must be respected and supported.

Where screening is offered to people who are not able to make choices for themselves, those who make choices on their behalf should be appraised of the balance of benefits and harms to the screened individual. Policy decisions about screening programmes should take account of the views of those affected and the reasons for policy decisions should be clearly communicated.

Principle 3: promote equality and inclusion

Screening programmes should not act to increase health inequalities and should aim to reduce them. Access to and delivery of screening should be as equitable and inclusive as possible. Any potential wider consequences of screening for society in the initiation and implementation of screening, both in the short and long term, should be considered.

Principle 4: use public resources fairly and proportionately

The entire cost of a screening programme should entail the fair and proportionate use of available public resources. Decisions about screening should have regard to evidence from cost-effectiveness analyses.