Greenhalgh asks ‘If it’s ethical for someone to decline an offer of an opportunistic check or an invitation to screening, surely it is also ethical for a patient to ask not to receive such offers in the first place?’.1 First, whether or not a patient should be allowed to ask not to receive offers of opportunistic screening is hardly an ethical one. It is clearly ethical for a patient to make such a request.
The real ethical issue relates to the targets of the Quality and Outcomes Framework that are related to uptake. The evidence that any of these opportunistic tests have net benefits either for an individual (informs the individual decision whether to opt to take up the test or not) or for a population (should the test be offered by the NHS or not) is scanty at best. It is thus entirely rational and reasonable for a person (not a patient) to choose not to have the test. It then becomes unethical for uptake of that test to be a criterion by which quality is measured as it creates conflict of interest in the clinician which is clearly counter to the concept of informed patient choice and decision making. The only reasonable target in such a situation would be the proportion of patients making a decision (yes or no) based on informed consent. That the NHS persists in having targets for uptake of tests of debatable value to the population or to the individual is simply unethical.
- © British Journal of General Practice 2013
