Ethical aspects of prevention.

Within the very large area of ethical concerns, the following issues are considered in this paper: (i) intellectual and career-oriented ambition, combined with the pressure that the competition for funds exerts, may push certain scientists to make dubious compromises with their conscience; (ii) exaggerated priority is sometimes given to the smooth running of a trial, even at the cost of ignoring some ethical requirements; (iii) it is questionable whether preventive intervention can adequately and systematically replace primary prevention based on the cessation of exposure to carcinogens; (iv) it is of the utmost importance to ensure that preventive treatment that is to be administered for long periods has no adverse effects or that the benefits by far outweigh the possible risks; (v) the informed consent of participants to the trials is essential and it should be obtained on the basis of correct, complete and clear information; (vi) a different type of informed consent is that of all citizens with regard to risks to which they may be exposed voluntarily or involuntarily; (vii) there is no justification for, and it is profoundly unethical to omit, delay, or hide information that may be relevant to the protection of health. Four examples were chosen to illustrate the preceding points.