Stol Yrrah H, Asscher Eva C A, Schermer Maartje H N
Department of Medical Ethics and Philosophy, ErasmusMC, Na building, room Na 21.197 Postbus, 2040 3000, CA, Rotterdam, The Netherlands.
BMC Med Ethics. 2017 Oct 2;18(1):55. doi: 10.1186/s12910-017-0213-x.
Health checks identify (risk factors for) disease in people without symptoms. They may be offered by the government through population screenings and by other providers to individual users as 'personal health checks'. Health check providers' perspective of 'good' health checks may further the debate on the ethical evaluation and possible regulation of these personal health checks.
In 2015, we interviewed twenty Dutch health check providers on criteria for 'good' health checks, and the role these criteria play in their practices.
Providers unanimously formulate a number of minimal criteria: Checks must focus on (risk factors for) treatable/preventable disease; Tests must be reliable and clinically valid; Participation must be informed and voluntary; Checks should provide more benefits than harms; Governmental screenings should be cost-effective. Aspirational criteria mentioned were: Follow-up care should be provided; Providers should be skilled and experienced professionals that put the benefit of (potential) users first; Providers should take time and attention. Some criteria were contested: People should be free to test on any (risk factor for) disease; Health checks should only be performed in people at high risk for disease that are likely to implement health advice; Follow up care of privately funded tests should not drain on collective resources. Providers do not always fulfil their own criteria. Their reasons reveal conflicts between criteria, conflicts between criteria and other ethical values, and point to components in the (Dutch) organisation of health care that hinder an ethical provision of health checks. Moreover, providers consider informed consent a criterion that is hard to establish in practice.
According to providers, personal health checks should meet the same criteria as population screenings, with the exception of cost-effectiveness. Providers do not always fulfil their own criteria. Results indicate that in thinking about the ethics of health checks potential conflicts between criteria and underlying values should be explicated, guidance in weighing of criteria should be provided and the larger context should be taken into account: other actors than providers need to take up responsibility, and ideally benefits and harms of health checks should be weighed against other measures targeting (risk factors for) disease.
健康检查可在无症状人群中识别疾病（的风险因素）。政府可通过人群筛查提供健康检查，其他机构也可向个人用户提供“个人健康检查”。健康检查提供者对“优质”健康检查的看法可能会推动关于这些个人健康检查的伦理评估及可能的监管的讨论。
2015年，我们采访了20家荷兰健康检查提供者，了解“优质”健康检查的标准以及这些标准在他们实践中的作用。
提供者一致制定了一些最低标准：检查必须关注可治疗/可预防疾病的（风险因素）；检测必须可靠且具有临床有效性；参与必须是知情且自愿的；检查带来的益处应大于危害；政府筛查应具有成本效益。提到的理想标准有：应提供后续护理；提供者应是将（潜在）用户利益放在首位的技术娴熟且经验丰富的专业人员；提供者应投入时间和精力。一些标准存在争议：人们应可自由检测任何疾病的（风险因素）；健康检查应仅针对可能实施健康建议的高疾病风险人群进行；私人资助检测的后续护理不应消耗集体资源。提供者并非总是能满足他们自己的标准。他们的理由揭示了标准之间的冲突、标准与其他伦理价值之间的冲突，并指出了（荷兰）医疗保健组织中阻碍道德提供健康检查的因素。此外，提供者认为知情同意是一项在实践中难以确立的标准。
据提供者称，个人健康检查应符合与人群筛查相同的标准，但成本效益除外。提供者并非总是能满足他们自己的标准。结果表明，在思考健康检查的伦理问题时，应阐明标准与潜在价值之间的潜在冲突，提供权衡标准的指导，并考虑更大的背景：除提供者外的其他行为者需要承担责任，理想情况下，应将健康检查的利弊与针对疾病（风险因素）的其他措施进行权衡。
