Screening technology, citizens’ autonomy and public health

Stacy M. Carter1

1 Centre for Values, Ethics and the Law in Medicine

The use of technologies to screen for risk of non-communicable disease in asymptomatic people sits on the boundary between public health and clinical health care. This leaves open the question of whether principles from clinical ethics or public health ethics are more directly applicable to evaluating the offer and provision of such services. I will argue that, in the case of screening for non-communicable diseases, screening is only weakly public. If this is accepted, then the central principle from clinical ethics of respecting and/or supporting autonomy will become normatively relevant. What this requires, however, depends on how autonomy is conceptualised. Using the work of Catriona Mackenzie, I will argue that a unidimensional, decisional conception of autonomy is insufficient for the task of ensuring that screening technologies are offered to citizens in a justified way. A multi-dimensional, relational conception of autonomy encourages attention to a wider range of normatively relevant concerns, and is more appropriately restrictive of offers of technologically-driven screening services.


Stacy’s background is in public health, and her research focuses on public health ethics. She is currently working on: normative dimensions of screening, especially cancer screening; overdiagnosis and too much medicine; de-prescribing in older people; relational conceptions of paternalism; normative dimensions of health promotion; methodology for empirical bioethics; and deliberative methods. Stacy is a qualitative researcher, and supervises a range of empirical public health ethics projects. She has a particular interest and expertise in grounded theory. She is currently a chief investigator in Wiser Healthcare, an NHMRC-funded collaboration to reduce overdiagnosis and overtreatment ( She tweets sporadically @stacymcarter.