PT  - JOURNAL ARTICLE
AU  - Leonard Michael Fleck
TI  - Just caring: screening needs limits
AID  - 10.1136/medethics-2019-105884
DP  - 2020 Apr 01
TA  - Journal of Medical Ethics
PG  - 253--254
VI  - 46
IP  - 4
4099  - http://jme.bmj.com/content/46/4/253.short
4100  - http://jme.bmj.com/content/46/4/253.full
SO  - J Med Ethics2020 Apr 01; 46
AB  - This personal narrative tugs at the heart strings. However, personal narratives are not sufficient to justify public funding for any screening policy. We have to take seriously the ‘just caring’ problem. We have only limited resources to meet virtually unlimited health care needs. No doubt, screening tests often save lives. The author wants public funding for prostate-specific antigen screening for prostate cancer. However, why only prostate cancer? Numerous cancers at various stages can be screened for. Are all of them equally deserving of public funding? What about screening for a very long list of other life-threatening medical disorders? There is nothing ethically special about cancer. Where does the money come from to pay for all these screening tests? Do we reduce expensive life-prolonging care for patients in late-stage diseases? Ultimately, a balance must be struck between saving statistical lives through screening and saving identifiable lives in the intensive care unit. Achieving a just balance requires rational democratic deliberation as justification for these choices, not personal narratives.