You Failed to Screen for Cancer? You Got Cancer? There's a Penalty for That

An article in the British Medical Journal for October 28, 2006 relates that the German government as part of a package of health reform legislation, yet to be passed, has a law that would penalize cancer patients who did not undergo screening for the cancer before the cancer was diagnosed. Patients with chronic illness currently pay up to a 1% maximum of their gross income for their health care, whereas the cancer patients who did not screen would have to pay up to a 2% maximum.. The screening tests advised for adult Germans include fecal occult blood testing and colonoscopy for colon cancer, cervical smear tests for cervical cancer and breast exams and mammography for breast cancer detection in women and rectal exams for prostate cancer. My reading of the age to begin testing and the frequency of the testing appears similar to criteria in the United States. But the ethical issue is whether patients who are suffering the emotional and physical pains of cancer should have another burden, a penalty of not having been screened for their disease. The ethical principles involved here, in my opinion, would be that of justice vs beneficence. Presumably, the rationale for this law is to have the patients be responsible, and not society, for the presumed added costs for treatments which is felt they brought on themselves because of their failure to be screened. The other rationale would be, through this penalty, to encourage people to participate in cancer screening for their own personal benefit. Both of these rationales would have to be based on the assumption that all cancer screenings would be sensitive and specific enough to detect the cancer in every patient who was later to become symptomatic of the cancer. How about penalizing patients with other diseases which are related to personal poor health habits: alcohol, tobacco, illicit drugs, overeating and ??? riding motorcycles. What is your take on this issue? ..Maurice.