Ethico-Political Aspects of Opportunistic Screening: Clinical Judgment at a Geriatric Ward in Sweden
Prof Kristin Zeiler and Dr Martin GunnarsonZoom
Population-based opportunistic screening for cognitive impairment takes place at a hospital in Sweden. According to the local policy, all patients over the age of 65 who are admitted to the geriatric ward, and who have not been tested for cognitive impairment within the last six months nor been previously diagnosed with mild cognitive impairment, should be offered testing. However, our analysis shows, the policy in place is not universally and mechanically applied. Due to a number of situational and contextual circumstances shaping the practice, the professionals – particularly the occupational therapist – develop and exercise a distinct form of professional judgment, a form of judgment that is not visible in the written routine and which involves decisions about who to test, when to offer the tests, and how to explain and perform them. In doing so, the professionals have to take into account the political context of the practice, in which issues such as the aged population’s place in society, stigmas and taboos concerning dementia, and screening for disease are at stake. Thus, the type of judgment developed and exercised has ethical and political dimensions, the latter of which has received much less attention than the former in discussions about professional judgement.