Assessment of the Scientific Information for the Radiation Exposure Screening and Education Program (2005) / Chapter Skim
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8 Ethical Framework
8 Ethical Framework
Pages 205-218
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· The ethics of medical and compensational screening. We discuss each of those aspects of the ethical framework in the sections below to bring some clarity to the concerns expressed to us by the many people who shared them with us.
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206 RADIATION EXPOSURE SCREENING AND EDUCATION PROGRAM THE ETHICS OF A COMPENSATION PROGRAM: RECTIFICATORY AND DISTRIBUTIVE JUSTICE1 Justice is the part of ethics that is concerned with fairness. In his work Nicomachean Ethics, the Greek philosopher Aristotle introduces us to justice as a multifaceted phenomenon (Aristotle, Book V)
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ETHICAL FRAMEWORK 207 As one scholar puts it, "If I take something of yours over which you have the power to exclude and alienate, then I wrong you. On the other hand, if I take something of yours over which you have a power only to demand compensation, then (provided I compensate you)
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Some people who lived in areas downwind of or were participants at the nuclear test sites, worked in mines or mining operations, or transported the ore may have been wronged. They might not, however, have experienced any loss of health because of the unjust action; they might not have contracted a disease.
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The medical screening and education program provided by RESEP can be understood as a remedy by forestalling (early diagnosis and care) or ameliorating a loss of health that may have resulted from the government's actions.
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210 RADIATION EXPOSURE SCREENING AND EDUCATION PROGRAM expressed in the following statement by Senator Orrin Hatch (R-Utah) on the eve of passage of PL 1515: I am extremely grateful to the interested and concerned constituents who helped in the drafting of the RECA amendments.
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ETHICAL FRAMEWORK 211 reason enough for the US government to compensate individual citizens and their families. Veteran compensation programs are generally based on that reasoning.
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Can we say that there is a reasonably close causal connection between the activities of uranium mining, milling, and ore transporting and lung cancer, and other nonradiogenic diseases? We are able to make that claim for miners' activities, on the basis of the amount of exposure and the observed disease in the miners, but we are less so with respect to the lower doses and risks posed by fallout.
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ETHICAL FRAMEWORK 213 Through advances in science, we now know so much more about the effects of that radiation than we did in the late 1950s and 1960s. In fact, we know so much more today than we did in 1990 when Congress passed the original com pensation program, the Radiation Exposure Compensation Act.
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THE ETHICS OF MEDICAL AND COMPENSATIONAL SCREENING The RESEP legislation proposes screening for 19 malignancies in downwinders and seven malignant and nonmalignant conditions in uranium miners, millers, and ore transporters (see Chapter 2)
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and in Chapter 9 that routine medical screening is generally not recommended for RECA diseases except for cancers of the breast and colon and for chronic renal disease; screening for other cancers is medically problematic. The criteria used to determine whether a cancer screening program is useful are the general principles of screening adopted by most medical practitioners.
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Valuing autonomy is not necessarily in conflict with valuing utility. Nonetheless, the stakeholder may persist in his or her request for a screening test.
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Hard paternalism, however, is generally more difficult to defend when informed consent is reliable, because it requires that the stakeholder's autonomy be overridden in favor of the medical practitioner's judgment of potential harm.10 The ethics of screening is further complicated by compensational screening. The stakeholder who wishes to be screened (or the grantee who creates screening programs with establishment of eligibility as the primary purpose)
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These concerns are included in two main subjects: the ethics of a compensation program and the ethics of medical and compensational screening.
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