Assessment of Scientific Information for the Radiation Exposure Screening and Education Program: Interim Report (2003)

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2. SCREENING OVERVIEW 16 2.2. ETHICS AND FOLLOW-UP SERVICES The committee notes that the Bureau of Primary Health Care (BPHC) Policy Information Notice 2002–17 mandates that the required core services be adequately and persuasively described. Among those core services are referrals for medical treatment. The same notice expects the applicant to demonstrate an appropriate system for follow-up of patients. Public Law 106–245 (July 10, 2000) also requires that competitive grants issued to entities include the provision of “appropriate referrals for medical treatment of individuals screened under paragraph (1) and to ensure, to the extent practicable, the provision of appropriate follow-up services.” The committee believes that the HRSA program entails an ethical obligation to address how these referrals and follow-up services will be provided for people who have detected diseases, both compensable and noncompensable. The detection of a disease among RECA populations in impoverished or remote areas raises ethical concerns for this committee regarding nonmaleficence and beneficence. Both the strong obligation in medical practice “to do no harm” and the obligation “to provide good” to participants must be observed. RECA legislation appears to disavow any obligation under “Health Coverage Plans Unaffected”, but the committee asks that HRSA inquire of its applicants the details of follow-up plans for all its targeted populations. On the basis of the above discussion, the committee finds that 1. Currently, there is no evidence to support the notion that screening for radiogenic diseases in this population will result in measurable health benefit for eligible participants. In fact, a screening program could be harmful because of false-positive test results (for example, the physical risks that their work-up entails and the psychological and social consequences of labeling individuals as potentially affected), as well as other factors. In cases where populations involved in the RECA screening program may be medically underserved or reluctant to make contact with the medical system, it might be more beneficial to provide additional resources to facilitate such contact rather than to devote resources to enhanced screening. 2. The RECA legislation provides compensation for radiogenic and nonradiogenic diseases. We recognize that people may wish to be evaluated to establish eligibility for compensation. Informed decision-making by them acting with a physician is needed because these evaluations have potential benefits and harms. An explicit statement on a plan for appropriate follow-up services for compensable and noncompensable diseases is needed.