ETHICAL ISSUES IN MAMMOGRAPHY SCREENING PROGRAMS AND WOMEN'S DECISION-MAKING

The dissertation deals with the ethics of mammography screening programs and related individual women’s decision-making regarding whether to participate the program. While, on the one hand, mammography screening is proven beneficial in reducing breast cancer mortality at the population level, on the other hand routine screening also entails potential harmful outcomes for individuals such as false positive results and overdiagnosis. Intrinsic difficulties in evaluating the magnitude of benefits and harms of mammography, as well as in the identification of the target population, gave rise to a tremendous scientific, political and social debate. The latest up-to-date Western countries’ guidelines recognize the complexity of assessing the net benefit of routine mammography screening, especially for women aged 40 to 49 who, nevertheless are eligible to participate programs on the basis of their personal evaluation and preferences. This dissertation argues that shared decision-making constitutes the most effective way of respecting women’s autonomy and incorporating their values in the decision-making process. Among different ethical theories, the dissertation claims that care ethics represents the most suitable normative ethical approach to justify and provide a concrete guide to SDM, which can also be applied to the inquiry of older women’s mammography screening as well as to other clinical contexts. Finally, in order to provide physicians with a practical tool for eliciting women’s values and preferences, the major themes of women experiencing breast cancer identified through a critical interpretative literature review are systematically presented and proposed as a basis for an empirical qualitative research on the issue.