Journal of medical ethics
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Journal of medical ethics · Nov 2016
A definition and ethical evaluation of overdiagnosis: response to commentaries.
It is a privilege to have respected colleagues engage with our definition and ethical evaluation of overdiagnosis. In our response to the commentaries, we first deal with paradigmatic issues: the place of realism, the relationship between diagnostic standards and correctness and the distinction between overdiagnosis and both false-positives and medicalisation. We then discuss issues arising across the commentaries in turn. ⋯ We reaffirm that overdiagnosis, for the foreseeable future, must be estimated at a population level and defend the importance of good-quality risk communication for individuals. We acknowledge that a lot turns on the relevance of professional communities in our definition and expand our reasoning in this regard then conclude with a note on the difference between intentions and goals. We expect that it will be some time before these matters are settled and we look forward to continue debating these matters with our colleagues.
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The first aim of this article is to offer a framework for constructive and rigorous discussions of the ethics of doctors' strikes, beginning with an in-principle distinction between the questions of how one should conduct oneself while working as a doctor and when and how one can suspend that work. The second is to explore how that framework applies to the contemporary British case of strikes by English junior doctors, with my suggestion being that those strikes do meet all of the criteria proposed. In closing, I gesture towards a further ethical dimension to strikes which is too often overlooked: namely, the responsibilities of employers and others not to misrepresent or demonise those doctors who are engaged in or considering taking industrial action.