Medical ethics and the public health.

The development of preventive medicine is reviewed from an historical perspective. In its third and current stage of development preventive medicine has become involved in the life cycle of individual diseases and this presents a number of ethical difficulties for doctors and not least those concerned with the public health. Some proposed responses are considered and rejected. It is concluded that participants should be given more detailed information about screening tests and that doctors are under an ethical obligation to consider with the utmost care any contra-indications to a particular vaccination or a screening procedure in an individual patient. Serious reservations are expressed about the ethics and scientific justification of some government preventive medicine programmes currently in operation or projected.