Gram Emma Grundtvig, Jønsson Alexandra Brandt Ryborg, Brodersen John Brandt, Damhus Christina Sadolin
Center of General Practice, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark.
Primary Health Care Research Unit, 4100 Region Zealand, Denmark.
Healthcare (Basel). 2023 Apr 26;11(9):1230. doi: 10.3390/healthcare11091230.
Participation in medical screening programs is presented as a voluntary decision that should be based on an informed choice. An informed choice is often emphasized to rely on three assumptions: (1) the decision-maker has available information about the benefits and harms, (2) the decision-maker can understand and interpret this information, and (3) the decision-maker can relate this information to personal values and preferences. In this article, we empirically challenge the concept of informed choice in the context of medical screening. We use document analysis to analyze and build upon findings and interpretations from previously published articles on participation in screening. We find that citizens do not receive neutral or balanced information about benefits and harms, yet are exposed to manipulative framing effects. The citizens have high expectations about the benefits of screening, and therefore experience cognitive strains when informed about the harm. We demonstrate that decisions about screening participation are informed by neoliberal arguments of personal responsibility and cultural healthism, and thus cannot be regarded as decisions based on individual values and preferences independently of context. We argue that the concept of informed choice serves as a power technology for people to govern themselves and can be considered an implicit verification of biopower.
参与医疗筛查项目被视为一项应基于充分知情选择的自愿决定。人们常常强调，充分知情的选择依赖于三个假设：（1）决策者能够获取有关利弊的信息；（2）决策者能够理解和解读这些信息；（3）决策者能够将这些信息与个人价值观和偏好联系起来。在本文中，我们通过实证对医疗筛查背景下的充分知情选择概念提出质疑。我们运用文献分析来分析并借鉴先前发表的关于参与筛查的文章中的研究结果和解读。我们发现，公民并未获得关于利弊的中立或平衡的信息，而是受到了操纵性的框架效应影响。公民对筛查的益处抱有很高期望，因此在得知危害时会经历认知压力。我们证明，关于是否参与筛查的决定受到新自由主义关于个人责任和文化健康主义观点的影响，因此不能被视为独立于背景、基于个人价值观和偏好的决定。我们认为，充分知情选择的概念是一种让人们自我管理的权力技术，可被视为对生命权力的一种隐性验证。
