The ethics of prevention: old twists and new.

The medical profession's tendency to equate 'the greatest good for the greatest number' with proactive care is here challenged; and the idea that we can always get more for our money with an ounce of prevention than with a pound of cure is scrutinized from an ethical point of view. It is suggested that preventive measures are often exempted from such scrutiny because they make medicine appear selfless and are aimed at the postponement of death-always an urgent matter. Indeed, our screening efforts can assume the proportions of a crusade against life's natural termination and we must make sure that they do not emanate from the needs of medical science for publicity and funding. The costs of what has been called 'healthism', something that has almost become a new morality, are frequently underestimated and its side effects overlooked. There are conditions for which effective palliation, sometimes enormously expensive, is available. The automatic assumption that money spent on such palliation could be better used for, say, immunization, is not warranted.