Press Release 02/2009

The German Ethics Council holds a public meeting on preventive medicine

The legal and ethical aspects of preventive medicine were the subject of the second public evening meeting of the German Ethics Council in the "Bioethics Forum" series, which was held in Berlin on 25 February.

Preventive medicine could contribute to reducing the incidence of illness and to the prolongation of life. This was emphasized by Julika Loss, of Bayreuth University's Department of Medical Management and Health Sciences, in her introductory address. A considerable number of preventive measures had been proven to have beneficial effects on individual health. Information, education and advice could in certain circumstances effectively influence attitudes and health-related behaviour. The speaker gave examples of the advantages and disadvantages not only of action on infrastructure and of incentive systems, but also of restrictive measures. In her view, the costly nature of effective prevention was no argument for parsimony in this field.

The contribution of Harald T. Schmidt, a philosopher at the Nuffield Council on Bioethics (UK), was devoted to a consideration of the ethical dimension of prevention and the role of the State in this field. He favoured a combination of State provision and individual self-determination, with a view to giving each member of the public access to medical care and ensuring that health risks were minimized. Mr Schmidt drew attention to the growing number of private firms offering genetic analysis and imaging tests: while these providers stressed the value of their services for a self-determined lifestyle, they often produced data of dubious scientific validity and clinical relevance. In his view, it was arguable that State regulation was in order here.

Stefan Huster, a specialist in public and social law from the Ruhr University at Bochum, spoke about the ethico-legal aspects of preventive medicine. Stressing that prevention was at least as important as care where health and equity in health matters were concerned, he said that an effective policy for promoting health and health equity must be integrative and had to cover all the relevant sectors. After all, socioeconomic factors too impacted significantly on an individual's state of health even where a substantially egalitarian system of medical care existed. The relationship between care and prevention was ambivalent: on the one hand, reforms of the care system should not impose a burden on population groups that were already disadvantaged socially and in terms of health for other reasons; but on the other, investment in preventive medicine was the best way of achieving health equity.

Questions about the relative allocation of resources to preventive measures and to treatment featured in the ensuing discussion with the audience. Arguments adduced in favour of preventive medicine were the resulting health benefits and the cost saving as compared with treatment. However, it was difficult to measure the actual saving and hence equally difficult to make the appropriate political decisions. The call for an increased role for the individual could be satisfied by improvements at the interface between State and individual responsibility.