We propose that both the right and the duty are elevated by the seriousness and urgency associated with particular disease groups. Thus, in the context of screening, priority should be given to appropriate assessments of the potential and

suitability of a disease, as Selleck AZD3965 opposed to the ongoing delays that seem to characterize many potential screening situations. The three-part framework of Bernheim et al. (2007) would seem very apt for this situation. In the New Zealand context, one such example of an intervention of rights and duty in a policy decision was the Health & Disability Commissioner’s ruling on antenatal HIV screening that occurred in June 2005. The National Health committee considered the https://www.selleckchem.com/products/4-hydroxytamoxifen-4-ht-afimoxifene.html case for an antenatal screening programme for HIV and recommended against such a step, but a complaint to the Health and Disability Commissioner resulted in his review of the rights of patients under the Health and Disability Consumers Code of Rights, and concluding: “Given the state of knowledge about HIV infection and the availability of treatment to prevent perinatal transmission, in my view, women receiving antenatal care in New Zealand in 1999 were entitled to a comprehensive pregnancy risk assessment that included assessment of the risk of HIV infection” (Health and Disability Commissioner 2005). The comments from the

Commissioner relate to a particular set of circumstances, but they may well be as applicable to newborn metabolic screening as they are to antenatal screening.

Indeed, they could hold particular significance for many potential screening initiatives around the antenatal and newborn period, as well as those recently implemented, including newborn hearing, antenatal fetal aneuploidy, antenatal HIV and expanded newborn metabolic screening. Most of those were very slow to reach implementation, and it appears that whilst there was a GSK2118436 in vitro significant level of data and evidence to support their application, in practice, bureaucratic malaise was the major impediment to the start of these programmes. Conclusion—a paradigm shift This article identifies what appears to be a paradigm shift in the implementation of newborn screening. Other authors have noted this, but with varying degrees Florfenicol of acceptance that issues such as the interests of the patient’s family should be part of the decision criteria (Seymour et al. 1997). This participation is supported by the principle of acceptability to those screened, or to those consenting on their behalf, as well as consistency with many other trends in decision making in society. In the New Zealand context, decisions to implement antenatal HIV screening programmes and cabinet decisions on antenatal Down syndrome screening also demonstrate that formulaic application of screening criteria is not enough (New Zealand Ministry of Health, 2007).