In the Netherlands, citizens who want to learn more about their future health are highly dependent on their doctor or have to go abroad. Access to predictive health checks is strictly regulated – by the State as well as by professional groups. The Dutch health authorities and professional groups don’t want to expose citizens to health examinations that are not validated and may cause false health concerns.
The protection of health, part of the human right to health, thus prevails over the right to self-determination, when it comes to individuals interested in their future health but for whom a GP or medical specialist does not see a medical reason for performing a test. This approach is contested. Many consider this to be paternalistic, doubting the capacity of citizens to behave responsibly. Liberal Health Minister Edith Schippers concurs with the latter view. In a recent letter sent to Parliament (in Dutch), she favours a different balance between health protection and self-determination. Schippers suggests making access to health checks dependent on the risks they pose: health checks without any medical risks will become available to all; health checks with medical risks will be regulated through professional medical standards and health checks aimed at revealing severe and untreatable diseases will be subject to a licence system, to regulate access.
This sounds like a reasonable and sympathetic response to a burning question. Yet, I am not convinced that the system the Health Minister proposes introducing will solve the main dilemmas.
First, in her letter the Minister suggests that we can make a distinction between the medical and non-medical consequences of predictive tests. I truly do not know how to make such a difference. I also wonder whether the (potential) medical consequences should be our main concern. I think that we should above all be worried about a lack of good and objective information for citizens who are considering undergoing a health check, as well as understandable and accurate assistance on how to interpret the test results. The fears that tests may arouse are sometimes more detrimental to the health and wellbeing of a person than the test result itself.
Secondly, I foresee that those citizens who want to have access to a category 2 and 3 health check will, also in the future, be able to bypass doctors and the licence system: almost any health check can be ordered through the internet and undergoing a test often only entails sending in a hair or some saliva.
The system the Health Minister proposes is therefore not the right, let alone a comprehensive solution for a genuine dilemma concerning protection and self-determination. Health checks are already available to all. What is expected is that the government makes, together with others, efforts to warn citizens about the risks of non-validated health checks and the importance of accurate information and counselling. Health is too precious to be subjected to the wrong test.