Various legal and ethical principles should also apply to public health screening programs (Faden et al., 1991). As a general principle, the least burdensome approach (from a legal and ethical viewpoint) that meets public health goals should always be preferred.
Programs must conform, first of all, to the requirements of the United States and state constitutions, common law, and statutory provisions. Targeted screening programs, for instance, must avoid problems of denial of equal protection inherent in focusing upon particular groups for testing. Moreover, the means to achieve otherwise acceptable social objectives must be narrowly tailored to avoid interference with the exercise of other important liberties, such as privacy. Screening programs must also comply with existing legal requirements concerning informed consent and confidentiality, duties to treat, and standards of professional negligence (Faden et al., 1991).
Moral considerations not protected by laws must also be taken into account. Three broad principles—beneficence, autonomy, and social justice—guide these considerations. Beneficence relates to the need to balance the benefits of public health measures (chiefly the protection from disease) against the harms (which could be physical or involve the loss of privacy or autonomy). Respect for autonomy emphasizes the importance of individual freedom and choice, both for political life and for personal decisions. Justice relates to the fair distribution of benefits and burdens of a public health program. None of these principles can be