Public Health and Ethics Health Ethics Stream

Question: Discuss about the Report for Public Health and Ethics of Health Ethics Stream. Answer: 1. The first and foremost aim of any public health program as per public health ethics stream by Australian Association of Bioethics and Health (AABHL) is to minimise the consequences of targeted disease that can be infectious, chronic or any other disease harnessing health of public (1). The BreastScreen NSW is a breast-screening program that uses mammogram technique for the detection of breast cancer in the target population. As this program works to detect a chronic health condition that is breast cancer it can be surely considered as a public health program (2). This BreastScreen NSW program using mammogram technology possesses the capability to identify breast cancer at a very initial stage of its development in human body. Therefore, by getting a mammogram test you can assure your safety breast cancer. The mammogram technology detects cancer long before it spreads in the body. The mammogram is an X-ray detection process using low energy ionising radiation to detect normal and abnormal conditions in the breast of individual women by using it as a screening tool. Therefore, BreastScreen program is a clinical service provided in the form of public health program. Even the outcome this program shows very promising approaches where women detected with breast cancer in BreastScreen program at NSW shows highest chances of cancer survival globally (2). 2. There is always a conflict between the norms of public health ethics with the clinical ethics to justify cancer-screening programs as ethically reliable, but these programs are now honouring both public and clinical health ethics. The BreastScreen NSW program justifies public health ethics by providing a National program, public funding support, and tool to improve general public health. Further, the program suit clinical ethics situation where it works for common public welfare, population level reasoning, no harm is provided to individual, individual autonomy is respected and screening is performed as per the interest of the individual. Therefore, it can be stated that this BreastScreen NSW screening program is a public symbol to screening program. The mammographic screening offers population the most effective clinical interventions as per the outcomes of screening evaluation. The program works to progress in a manner to gain faith in the health system by honest communication and public participation entertained in the screening program. Hence, this program completely justifies the clinical service ethics criteria. Further, as a public health program, BreastScreen program ensures public aspects of screening, protect public rights and dignity, confirms autonomy and beneficence ethics to function as public health activity. Hence, this screening program is both a clinical service and public health activity as per ethical evaluation (3,4). 3. The potential benefits and harms of mammographic screening are described below: - Benefit The mammographic screening is a quick detection of cancerous conditions in women body that can help to minimise the mortality rate of breast cancer Mammography has potential to detect the smallest form or indication of breast cancer even before the lump or tumour appearance The early stage detection of breast cancer helps to improve the survival possibilities of individual. Harms The mammographic screening is not 100% accurate test having the possibility of giving false alarms or false positive breast cancer result or false negative breast cancer result in case breast cancer is present. The mammographic screening is considered as overdiagnosis because it can detect both cancerous and non-cancerous non-invasive tumour (DCIS). The cancerous DCIS requires treatment to avoid life-threatening conditions but the non-cancerous DCIS does not always require a treatment and lead to overtreatment. Even the doctors are not able to distinguish between cancerous and non-cancerous DCIS. In the mammography screening involves a small radiation exposure in the form of X-ray to the human breast. The breast regions consist of soft tissues that are very sensitive to radiation exposure. Hence, X-ray exposure in mammography also persists capacity to develop cancer in the body (5,7). Costs The cost of mammography varies between $51 and $150 per mammogram indicating an out-of-pocket amount for normal people (3) The potential benefits of mammography have always overweighed the harms of this screening process. In the case of false positive or negative outcomes, you can confirm breast cancer by undergoing further diagnosis like ultrasound, biopsy etc. To overrule the risk of radiation exposure you can concern the healthcare physician before getting a screening test done in your body. In this manner, the harms of mammography can be managed but its benefits make it an essential process of health check up (6,7,1). 4. Above the potential benefits, harms and cost of mammographic the other ethical considerations are its potential to reduce the overall physical harm and provides a good physical health. The major priority of screening program is to avoid physical health harms that work as a beneficence ethics of healthcare. Further, breast screening provides psychological wellbeing by assuring the absence of disease in the individual body. This helps to reduce the anxiety and trauma usually found in women concerning about their health in older ages. Screening also supports autonomy to gain, distribute and share information regarding once health which women are usually afraid to share. By implementing the breast-screening program, women share issues related to health with medical professional which they usual do not share in the situation of personal evaluation. The screening program provides a healthy, reliable and supporting environment to participants that support autonomy (8). 5. The mammographic screening programs provide an overall ethically justified intervention with a purpose to detect and address the issue of chronic breast cancer in target populations. Such programs minimise the financial strain occurring due to high costs of screening evaluation that are usually not affordable to low socio-economic groups like aboriginal Australian. Thus, the program works to conserve the healthcare ethics of low-socio economic group by providing equal opportunity for the health evaluation. Further, the ethical autonomy and beneficence of population are addressed with such screening programs where the rights of people are protected in providing them healthcare services beneficial for their all-around physical stability. However, the literature related to ethics of screening still requires a further exposure and development. But, as per this study the screening programs work in a balanced manner to meet the determined public health betterment and clinical services goals established in program. All principles meant for clinical and public health ethics are addressed in this BreastScreen NSW program for screening breast cancer. References list Kerridge I. Ethics and law for the health professions. 1998. Kerri's Story (BreastScreen NSW) [Internet]. Breastscreen.nsw.gov.au. 2016 [cited 9 August 2016]. Available from: https://www.breastscreen.nsw.gov.au/campaigns/kerris-story/ National Cancer Institute. 2016 [cited 9 August 2016]. Available from: https://www.cancer.gov/types/breast/mammograms-fact-sheet#q3 Staunton PJ, Chiarella M. Law for nurses and midwives. Elsevier Australia; 2012. Verweij M, Dawson A. The meaning of publicin public health. Ethics, prevention, and public health. 2007 Jan 18:13-29. Grainger J, Ozoliņ  JT. Foundations of Healthcare Ethics. Cambridge University Press; 2015 Apr 8. Kalager, M., Zelen, M., Langmark, F., Adami, H. O. (2010). Effect of screening mammography on breast-cancer mortality in Norway. New England Journal of Medicine, 363(13), 1203-1210 Ortmann LW, Barrett DH, Saenz C, Bernheim RG, Dawson A, Valentine JA, Reis A. Public Health Ethics: Global Cases, Practice, and Context. InPublic Health Ethics: Cases Spanning the Globe 2016 (pp. 3-35). Springer International Publishing.