title: [Would you mind a little bit less? Methodological and ethical challenges posed by the reduction of overtreatment].
abstract: The present paper outlines two central challenges that should be taken into account when making a concerted effort to reduce excessive medical care (overdiagnosis and overtreatment): first, the inevitability of value judgements in the risk-benefit assessment of medical treatment measures in conjunction with the need to go beyond the individual doctor-patient relationship and make these value judgements while, at least in part, assuming the role of acting deputy; and second, the need for a sufficient level of competence and trust in evidence-based medicine on the part of both physicians and patients. The paper will explain how one can say in a methodologically reasonable and ethically acceptable manner that a certain medical measure - in the context of the regular care setting - will objectively cause a "net harm" to the patient. Relevant institutions in the German healthcare system will be described that are currently conducting risk-benefit assessments (by different means and with different purposes). Taking the known entity of clinical guidelines as an example, the paper will demonstrate that the subjects of overdiagnosis and overtreatment as well as shortage of medical care can be more explicitly communicated by employing certain additional methodological tools. Finally, some central implementation barriers to a successful application of "Less is more!" will be presented and critically discussed. (As supplied by publisher).
authors.affiliation: Medizinische Hochschule Hannover, Centre for Ethics and Law in the Life Sciences, Institut für Geschichte, Ethik und Philosophie der Medizin, Hannover. strech.daniel@mh-hannover.de
authors.forename: Daniel
authors.initials: D
authors.lastname: Strech
mesh_terms: D003933:Diagnosis; D055088:Early Detection of Cancer / Q000941:ethics / Q000379:methods; D004992:Ethics, Medical; D005260:Female; D005858:Germany; D015276:Health Care Rationing / Q000941:ethics* / Q000379:methods*; D006300:Health Services Misuse / Q000517:prevention & control; D006801:Humans; D008297:Male; D009313:National Health Programs / Q000941:ethics* / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000941:ethics / Q000379:methods; D018570:Risk Assessment / Q000941:ethics / Q000379:methods; D013812:Therapeutics / Q000941:ethics* / Q000379:methods*; D019564:Unnecessary Procedures / Q000941:ethics* / Q000379:methods*