Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building (MD1), 12 Science Drive 2, Singapore, 117549, Singapore.
Centre for Biomedical Ethics, National University of Singapore, Yong Loo Lin School of Medicine, Block MD11, Clinical Research Centre, #02-03, 10 Medical Drive, Singapore, 117597, Singapore.
BMC Med Ethics. 2022 Jun 7;23(1):57. doi: 10.1186/s12910-022-00798-5.
Health screening is undertaken to identify individuals who are deemed at higher risk of disease for further diagnostic testing so that they may possibly benefit from interventions to modify the natural course of disease. In Singapore, screening tests are widely available in the form of a package, which bundles multiple tests in one session and commonly includes non-recommended tests. There are various ethical issues associated with such testing as they may not be clinically appropriate and can result in more harm than benefit. This article describes the practice of health screening packages, identifies the ethical issues arising from such packages and discusses the implications of these ethical issues on policy and practice of screening in Singapore.
A content analysis of the websites of providers offering general health screening packages to individuals was conducted. A total of 14 health screening package providers were analysed for how packages were conducted and promoted, how clinically appropriate screening tests were, and the price range and composition of screening packages. A normative ethical analysis based on the four principles approach of beneficence, non-maleficence, autonomy and justice in biomedical ethics was used.
Twelve of the 14 providers included non-recommended tests such as tumour markers, treadmill stress tests and MRI scans in their general health screening packages. Package prices ranged from S$26 to S$10,561, with providers charging higher when more tests were included. Health screening packages were broadly conducted in three stages: (1) the offer and selection of a health screening package; (2) medical assessment and performance of screening tests; (3) a post-screening review. While material provided by all providers was factual, there was no information on the potential risks or harms of screening.
Several ethical issues were identified that should be addressed with regard to health screening packages in Singapore. A key issue was the information gap between providers and patients, which may result in patients undergoing inappropriate testing that may be more harmful than beneficial. Health screening packages can stimulate unnecessary demand for healthcare and contribute to an inequitable distribution of healthcare resources.
健康筛查旨在识别被认为患有疾病风险较高的个体，以便进行进一步的诊断测试，从而可能受益于干预措施来改变疾病的自然进程。在新加坡，筛查测试以套餐的形式广泛提供，这种套餐将多项测试合并在一次就诊中，通常包括非推荐的测试。这种测试存在各种伦理问题，因为它们可能不符合临床实际情况，而且可能弊大于利。本文描述了健康筛查套餐的实践，确定了此类套餐带来的伦理问题，并讨论了这些伦理问题对新加坡筛查政策和实践的影响。
对向个人提供一般健康筛查套餐的提供商的网站进行了内容分析。对 14 家健康筛查套餐提供商进行了分析，内容包括套餐的开展和推广方式、筛查测试的临床适宜性，以及筛查套餐的价格范围和组成。采用了生物医学伦理中基于效益、不伤害、自主和公正四项原则的规范伦理分析。
14 家提供商中有 12 家在其一般健康筛查套餐中包含了非推荐的测试，如肿瘤标志物、跑步机压力测试和 MRI 扫描。套餐价格从 26 新元到 10561 新元不等，包含的测试越多，提供商的收费就越高。健康筛查套餐通常分三个阶段进行：（1）提供和选择健康筛查套餐；（2）进行医学评估和进行筛查测试；（3）筛查后复查。虽然所有提供商提供的材料都是事实性的，但没有关于筛查潜在风险或危害的信息。
确定了新加坡健康筛查套餐中存在的几个伦理问题，需要加以解决。一个关键问题是提供者和患者之间的信息差距，这可能导致患者接受不适当的测试，弊大于利。健康筛查套餐可能会刺激不必要的医疗需求，并导致医疗资源分配不均。
