Ethical Principles and Quaternary Prevention: is it possible not to protect the exercise of the principle of autonomy?
DOI:
https://doi.org/10.5712/rbmfc9(31)852Keywords:
Mass Screening, Mammography, Medicalization, Breast Neoplasms, Personal AutonomyAbstract
This article aims to discuss the ethical principles and Quaternary Prevention using a policy adopted by the Uruguayan government as example. This policy, which was created in 2006, instituted mass screening for breast cancer by means of compulsory mammography every two years, for women workers aged 40 to 59 years old. However, currently there is an international controversy over the relevance of breast cancer early detection programs, and some authors and institutions are raising concerns about the exercise of individual autonomy within a context that promotes the medicalization of life. In this context, it is fundamental that family physicians use an individualized approach that respects personal autonomy.
Downloads
Metrics
References
Sacket D. Hormone replacement therapy: the arrogance of preventive medicine. CMAJ. 2002;67(4):363-364. Disponible en: http://www.cmaj.ca/content/167/4/363.full.pdf.
Arie S. Uruguay’s mandatory breast cancer screening for working women aged 40-59 is challenged. BMJ. 2013;346:f1907. http://dx.doi.org/10.1136/bmj.f1907 DOI: https://doi.org/10.1136/bmj.f1907
Ministerio de Salud Pública (UY); Archivo Presidencia de la República Oriental. Decreto nº 571/006. Montevideo: Ministerio de Salud Pública; 2013 [última consulta el 2013 Nov 10]. Disponible en: http://archivo.presidencia.gub.uy/_Web/decretos/2006/12/S253_15_09_2006_00001.PDF.
Ministerio de Salud Pública (UY). Decreto nº 571/006: carné de salud básico a las mujeres. Expedición. Montevideo: El Derecho Digital; 2013 [última consulta el 2013 Nov 10]. Disponible en: http://www.elderechodigital.com.uy/smu/legisla/D0600571.html.
Ministerio de Salud Pública (UY). Ordenanza nº 402, 11 de julio de 2006. Montevideo: Ministerio de Salud Pública; 2006 [última consulta el 2013 Nov 10]. Disponible en: http://www2.msp.gub.uy/andocasociado.aspx?5684,24733
Horton R. Screening mammography: an overview revisited. Lancet. 2001;358(9290):1284-1285. Disponible en: http://www.miniseminaires.com/wp-content/uploads/2009/05/4-screening-mammography-is-justifiable.pdf http://dx.doi.org/10.1016/S0140-6736(01)06452-2 DOI: https://doi.org/10.1016/S0140-6736(01)06452-2
Gøtzsche P, Olsen O. Is screening for breast cancer with mammography justifiable? Lancet. 2000;355(9198):129-134. http://dx.doi.org/10.1016/S0140-6736(99)06065-1 DOI: https://doi.org/10.1016/S0140-6736(99)06065-1
Zahl P, Gøtzsche P, Mæhlen J. Natural history of breast cancers detected in the Swedish mammography screening programme: a cohort study. Lancet Oncol. 2011;12(12):1118-1124. http://dx.doi.org/10.1016/S1470-2045(11)70250-9 DOI: https://doi.org/10.1016/S1470-2045(11)70250-9
Gøtzsche P, Jørgensen J. Screening for breast cancer with mammography. Cochrane Database Syst Rev. 2013;(6):CD001877. http://dx.doi.org/10.1002/14651858.CD001877.pub5 DOI: https://doi.org/10.1002/14651858.CD001877.pub5
Márquez S, Meneu R. La medicalización de la vida y sus protagonistas. GCS. 2003;5(2):47-53 Disponible en: http://www.iiss.es/gcs/gestion16.pdf.
Sistema Nacional Integrado de Salud (UY). Ley nº 18.211. Normativa referente a su creación, funcionamiento y financiación. Montevideo: Sistema Nacional Integrado de Salud; 2007. Disponible en: http://www.parlamento.gub.uy/leyes/AccesoTextoLey.asp?Ley=18211&Anchor=.
Hart JT. The inverse care law. Lancet. 1971;1:405-412. Disponible en: http://www.juliantudorhart.org/papers/Paper11.pdf. DOI: https://doi.org/10.1016/S0140-6736(71)92410-X
Kuehlein T, Sghedoni D, Visentin G, Gervas J, Jamoulle M. Prevención cuaternaria, actividad del médico general. Prim Care. 2010;10(18):350 354. Disponible en: http://www.primary-care.ch/docs/primarycare/archiv/de/2010/2010-18/2010-18-368_ELPS_esp.pdf. DOI: https://doi.org/10.4414/pc-d.2010.08739
Nève J, Bernstein J, Terra MA. Prevención cuaternaria, una tarea explícita del médico generalista: una entrevista con Marc Jamoulle. AMFG. 2013;10(2):23-26. Disponible en: http://archivos.famfyg.org/revista/index.php/amfyg/article/view/130.
Jamoulle M, Gomes L. Prevenção quaternária e limites em medicina. In: 18º Congresso Nacional de MGF, 12º Encontro Nacional de Internos de MGF e Jovens MF; 2013, Covilha.
Pizzanelli M. Estan cambiando los tiempos. Uruguay; 2013 [última consulta el 2013 Nov 10]. Disponible en: http://estancambiandolostiempos.blogspot.com.br/2013/02/cribado-cancer-de-mama-un-poco-mas-de.html.
Pizzanelli M. O rastreamento do câncer de mama e a política adotada pelo Uruguai. In: 12° Congresso Brasileiro de Medicina de Família e Comunidade; 2013, Belém do Pará. Disponible en: http://www.slideshare.net/MiguelPizzanelli/cribado-cancer-mamabelem2013.
Lopes JMC. Consulta e abordagem centrada na pessoa. In: Gusso GDF, Lopes JMC. Tratado de medicina de família e comunidade: princípios, formação e prática. Porto Alegre: Artmed; 2012. p. 113-123.
Downloads
Published
How to Cite
Issue
Section
License
By submitting a manuscript to the RBMFC, authors retain ownership of the copyright in the article, and authorize RBMFC to publish that manuscript under the Creative Commons Attribution 4.0 license and identify itself as the vehicle of its original publication.
