Chapter 1 12 cognitive assessment as they find it a hassle, too demanding or deem it ‘much ado about nothing’. Sometimes, they do not want to be confronted or diagnosed with cognitive impairment. This can be due to multiple reasons, ranging from fear of losing their driving licence to denial of the impairment. Another situation is that the patient is not aware of their cognitive decline and only afterwards realises the consequences of a diagnosis. However, this right to ignore can result in dangerous situations, such as cooking at home resulting in the cooking stove not being turned off afterwards. Is this a problem for the doctor to resolve? Is it only his or her concern or responsibility if a complaint or problem leads to a medical problem? Doctors primarily want to help. However, the Hippocratic Oath states “First, do no harm” (Latin: Primum non nocere). To what extent is helping the individual lead to harming others, for example, by screening all patients to find a few cases and using scarce resources? Or ‘helping’, that is, not diagnosing a patient on their request so they won’t be stigmatised. Therefore, avoiding a ban on driving but perhaps becoming a risk for all traffic participants? This is plenty of material to consider and debate. On many levels, medical, ethical, philosophical, political, and so on, all the way up to the (patients) kitchen table. Therefore, this debate is far from over. The debate varies across subjects and settings, ranging from clinical themes (e.g. diseases) to social (e.g. loneliness) or financial (e.g. healthy food) issues. One must bear in mind that the outcome of the debate will be different for screening individual patients than for screening the general population. In clinical practice, doctors often use guidelines that give them something to hold on to. One of these ‘guidelines’ is a list of requirements, or rather criteria, for screening populations, which was drawn up in 1968 on behalf of the World Health Organization WHO (Wilson and Jungner, 1968). They were still relevant up until today (Sturdy et al., 2020). These criteria are summarized by the RIVM (Dutch national health institute) as follows: ‘....a screening that falls under the national population screening programmust be of benefit to participants, voluntary, and scientifically based. To determine whether a screening is justified, international criteria were drawn up by Wilson and Jungner in 1968’.
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