Electrocardiographic Screening Should Not Be Implemented for Children and Adolescents Between Ages 1 and 19 in the United States
“A billion here, a billion there and pretty soon you’re talking real money” is a quote attributed to the late Senator Everett Dirksen. Whether or not he actually spoke those words, it is believed that, if he did not, he would have heartily approved having been quoted as such. At this time in American history, this quote as it relates to medical spending is appropriate to the debate. No doubt, this is a complex issue at face value. We have philosophical, ethical, and moral issues surrounding this debate and the 2 types of EBM—evidence-based medicine and emotional-based medicine—as well. Biases and heuristics flavor the decision making and cloud the public policy issues that are central to how we decide what to do and for whom. The role of this column is to present the reader with the information that would allow a prudent practitioner to make an informed decision about whether to advocate for universal screening of children and adolescents with an ECG to prevent sudden cardiac death (SCD).
Response by Vetter p 702
Philosophy, Ethics, and Moral Values
Two opposing schools of thought—utilitarianism and deontology—are central to this debate. Utilitarianism was favored by Jeremy Bentham (1748–1832) and John Stuart Mill (1806–1873) who were consequentialists who believed that whether or not an act is morally right depends on its consequences with respect to utility, thus the term utilitarianism. The essence of their belief system was the Greatest Happiness Principle or, more plainly speaking, the greatest good for the greatest number of people. Deontology, on the other hand, is based on the Greek word todeon meaning duty. This line of thinking was promulgated by Immanuel Kant (1724–1804). The central theme here is explained by 2 imperatives—hypothetical and categorical. The hypothetical imperative belies the concept of finding a means to an end, and the categorical says imperative …