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DOI: Copyright - © 2011 Palmer et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Last updated - 2013-06-28[1] Beauchamp TL, Childress JF, Principles of biomedical ethics New York: Oxford University Press 6,2009[2] Beauchamp TL, Methods and principles in biomedical ethicsIn J Med Ethics,2003,29:269-274.[3] Bloch S, Green SA, An ethical framework for psychiatryIn Br J Psychiatry,2006,188:7-12.[4] Kenny NP, Sherwin SB, Baylis FE, Re-visioning public health ethics: a relational perspectiveIn Can J Public Health,2010,101:9-11.[5] Childress JF, Faden RR, Gaare RD, Gostin LO, Kahn J, Bonnie RJ, Kass NE, Mastroianni AC, Moreno JD, Nieburg P, Public health ethics: mapping the terrainIn The Ethics of Public Health Edited by: Freeman MDA. Burlington, VT Ashgate Pub. Co.,2010,1:55-64.[6] DeVries R, Kane Low L, Bogdan-Lovis E, Choosing surgical birth: desire and the nature of bioethical adviceIn Naturalized bioethics: toward responsible knowing and practice Edited by: Lindemann H, Verkerk M, Walker MU Cambridge; New York: Cambridge University Press,201042-64.[7] MacMillan HL, Wathen CN, Jamieson E, Boyle MH, Shannon HS, Ford-Gilboe M, Worster A, Lent B, Coben JH, Campbell JC, McNutt LA, Screening for intimate partner violence in health care settings: a randomized trialIn J Am Med Assoc,2009,302:493-501.[8] Shakespeare J, Blake F, Garcia J, A qualitative study of the acceptability of routine screening of postnatal women using the Edinburgh Postnatal Depression ScaleIn The British journal of general practice : the journal of the Royal College of General Practitioners,2003,53:614-619.[9] Buist A, Condon J, Brooks J, Speelman C, Milgrom J, Hayes B, Ellwood D, Barnett B, Kowalenko N, Matthey S, Acceptability of routine screening for perinatal depressionIn J Affect Disord,2006,93:233-237.[10] Spangaro J, Zwi AB, Poulos R, The elusive search for definitive evidence on routine screening for intimate partner violenceIn Trauma, violence & abuse,2009,10:55-68.[11] Pencheon D, Guest C, Melzer D, Gray M, Oxford handbook of public health practice Oxford: Oxford University Press,2001[12] Taft A, To screen or not to screen - is this the right question?: quality care, intervention and women's agency in health care responses to partner violence and abuseIn Women Against Violence: An Australian Feminist Journal,200141-46.[13] Flitcraft A, From public health to personal health: violence against women across the life spanIn Ann Intern Med,1995,123:800-802.[14] Hegarty K, Gunn J, Chondros P, Small R, Association between depr[cut]
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Background: Intervention studies for depression and intimate partner violence (IPV) commonly incorporate screening to identify eligible participants. The challenge is that current ethical evaluation is largely informed by the four principle approach applying principles of beneficence, non-maleficence, and respect for justice and autonomy. We examine three intervention studies for IPV, postnatal depression (PND) and depression that used screening from the perspective of principlism, followed by the perspective of a narrative and relational approach. We suggest that a narrative and relational approach to ethics brings to light concerns that principlism can overlook. Discussion: The justification most commonly used to incorporate screening is that the potential benefits of identifying intervention efficacy balance the risk of individual harm. However, considerable risks do exist. The discovery of new information may result in further depression or worries, people might feel burdened, open to further risk, unsure of whether to disclose information to family members and disappointed if they are allocated to a control group. This raises questions about study design and whether the principle of equipoise remains an adequate justification in studies with vulnerable groups. In addition, autonomy is said to be respected because participants give informed consent to participate. However, the context of where recruitment is undertaken has been shown to influence how people make decisions. Summary: The four principles have been subjected to criticisms in recent years but they remain prominent in public health and medical research. We provide a set of simple, interrogative questions that are narrative and relationally driven which may assist to further evaluate the potential impacts of using screening to identify eligible research participants in intervention studies. A narrative and relational based approach requires seeing people as situated within their social and cultural contexts, and as existing within relationships that are likely to be affected by the results of screening information.
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Type: Journal Article
Title: Ethical complexities of screening for depression and intimate partner violence (IPV) in intervention studies
Other Titles: BMC Public Health
Authors: Taft, Angela J
Palmer, Victoria J
Yelland, Jane S
Year: 2011
Publisher: BioMed Central
Citation: No Suppl 5 Vol.: 11
ISSN: 14712458
Appears in Collections:Journal Articles

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