PoPulationand Public HealtH etHics

practice
principle should only be taken into consideration when significant adverse
effects on women are expected. We cannot conclude there will be any actual
breaches in women’s privacy. The only expected adverse effects are those
related to the psychological impacts of receiving a reminder that includes
expert recommendations on the usefulness of the screening. The mere appeal
to the principle of not using data from RaMq and laboratories is not a justification
for inaction, if no negative consequences (other than those connected
to mail solicitation) are expected on the people on the list. The principle of
non-maleficence therefore does not apply.
However, other types of negative consequences can be foreseen. For example,
it is important that the letter be written so that the women who receive it
experience the least amount of worry and stress. As long as the letter is not
followed up in any other way (phone follow-up), and its form and content are
not guilt-provoking, stress-inducing or moralistic, the negative impacts will
be kept to a minimum. The risks of stigmatizing or discriminating against
women who refuse to take the screening test are non-existent, considering the
decision to take the test remains personal and confidential. We also surmise
that having a Pap smear does not have any proven impact on the physical
health of women who accept to have it done, and that the only impacts to
consider are psychological in nature. However, in its opinion, the CesP 2
states that, according to some studies, interventions aimed at identifying
precancerous lesions can potentially be tied to an increase in miscarriages
or preterm labour. Should new scientific evidence support this, and if the
impacts affected a significant proportion of women who underwent screening,
the ethical opinion would need to be seriously reconsidered. However,
this would affect not only the pilot project on personalized invitations, but
also the entire screening strategy set in place by physicians who prescribe
the test in their practice. In short, it does not appear as if this preventative
intervention, based on sending a letter encouraging women to participate
in a cervical cancer screening test, significantly and unjustifiably infringes
upon the core values that define, in the view of Quebec society, an ethically
acceptable intervention. Even if the interests of the population are given
priority over individual interests, just as with any other public health intervention,
the project remains ethically justifiable within the scope of ethics
applied to populational interventions, 3 in a society that readily delegates
great responsibility for prevention to public health officials. The interference
in private life and the infringement of liberal principles are justified
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