Although preventive services are a cornerstone of primary care medicine, few currently used screening tests have been demonstrated to be beneficial. Insurance organizations, the media, public advocacy groups, and patient concerns often pressure physicians to provide screening tests of controversial value. Ethical analysis provides the basis for responding to screening requests in a responsible way. Physicians may use an evidence-based medicine strategy to approach controversial screening tests. When physicians educate patients on the relative benefits and harms of controversial screening tests, it is prudent to emphasize that a screening test can assure neither a disease-free nor a risk-free state. Such preventive ethics efforts could discourage against the use of controversial screening tests. Physicians may articulate the boundaries of their own professional integrity in this process, for patients cannot compel physicians to render services that run counter to their best professional and ethical judgment.
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