Gunnarson Martin, Kapeller Alexandra, Zeiler Kristin
Department of Thematic Studies, Division of Technology and Social Change, Linköping University, Linköping, Sweden.
Centre for Studies in Practical Knowledge, School of Culture and Learning, Södertörn University, Huddinge, Sweden.
Health Care Anal. 2021 Dec;29(4):343-359. doi: 10.1007/s10728-021-00431-3. Epub 2021 Mar 16.
While the value of early detection of dementia is largely agreed upon, population-based screening as a means of early detection is controversial. This controversial status means that such screening is not recommended in most national dementia plans. Some current practices, however, resemble screening but are labelled "case-finding" or "detection of cognitive impairment". Labelled as such, they may avoid the ethical scrutiny that population-based screening may be subject to. This article examines conceptualizations of screening and case-finding. It shows how the definitions and delimitations of the concepts (the what of screening) are drawn into the ethical, political, and practical dimensions that screening assessment criteria or principles are intended to clarify and control (the how of screening, how it is and how it should be performed). As a result, different conceptualizations of screening provide the opportunity to rethink what ethical assessments should take place: the conceptualizations have different ethico-political implications. The article argues that population-based systematic screening, population-based opportunistic screening, and case-finding should be clearly distinguished.
虽然早期发现痴呆症的价值在很大程度上已达成共识，但基于人群的筛查作为一种早期发现手段却存在争议。这种有争议的状况意味着在大多数国家的痴呆症计划中并不推荐此类筛查。然而，目前的一些做法类似于筛查，但被称为“病例发现”或“认知障碍检测”。如此命名，它们可能会避免基于人群的筛查可能面临的伦理审查。本文探讨了筛查和病例发现的概念。它展示了这些概念的定义和界限（筛查的内容）是如何被纳入到筛查评估标准或原则旨在阐明和控制的伦理、政治和实践维度中的（筛查的方式，即它是如何进行的以及应该如何进行）。因此，不同的筛查概念化为重新思考应该进行哪些伦理评估提供了机会：这些概念化具有不同的伦理政治含义。本文认为，基于人群的系统筛查、基于人群的机会性筛查和病例发现应该明确区分。
