PoPulationand Public HealtH etHics

legitimately use all means of disease prevention. In Quebec’s social, cultural
and political context, people voluntarily delegate a large part of responsibility
for prevention to the State. Where a competent, publicly funded public
health system with ample resources is concerned, not intervening could
easily be construed as shirking responsibilities. However, even though the
Quebec sociopolitical context justifies greater intervention than what would
appear justifiable in a society that gives priority to individual responsibility
and private involvement in the health sector (most U.S. states), there are still
ethical limitations with regard to unwarranted interventionism, the invasion
of privacy and solicitation to participate in such prevention programs. These
limitations fall within two main categories: those relating to respecting the
values and ethical principles that the population shares and those related to
the usefulness and efficiency of the interventions in question.
The second category of ethical imperatives therefore has to do with how a
personalized invitation for screening may potentially violate the fundamental
values that the target population shares. We believe that most of these values
are only subject to minor infringements. This includes social justice when
screening is done universally for free and access to treatment is also free. It
also does not appear as though the expected benefits to the community as a
whole would place the onus (especially psychologically) of the intervention
on the shoulders of a minority, as the intervention would target all women
aged 21 to 74. The autonomy and free will of these women is not infringed
upon as, after receiving the letter of invitation, the women are free to accept
or decline the invitation and may even ask that their name be removed
from the invitation system. If a customized database were created for the
purpose of sending a letter of invitation, followed by a reminder 90 days
later addressed to women who had not acted after receiving the first letter,
there would be a clear violation of privacy and confidentiality of personal
information. However, as this database would be used for the sole purpose
of sending out invitations and could be consulted only by those responsible
for the screening, any consequences on women would be negligible. In addition,
public health ethics, as opposed to bioethical logic, requires that we
accept a certain level of infringement on individual interests in favour of the
interests of the community as a whole. 1 Contrary to the argument raised in
the literature of ethics, which considers the confidentiality of personal information
inviolable and which was in part mirrored in an opinion produced
by the CesP (Québec Public Health Ethics Committee), we believe that this
Using personalized letters of invitation to increase participation in cervical cancer screening
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