Public policies in neonatal screening and bioethics: United States, United Kingdom and Colombia

Introduction: Thinking about how the neonatal screening should be requires revealing the relevance of the involved bioethical factors. Objective: To understand the relationship of bioethical considerations to the way in which neonatal screening is performed and to identify its relevance in the Colombian legislation of this activity. Materials and methods: A comparative study of public policies in the United States (USA) and United Kingdom (UK) was carried out, because they correspond to extreme cases of neonatal screening. Based on similarities and differences, the influence of bioethical principles was interpreted. With this information, locally affected bioethical considerations were identified in the Colombian legislation of neonatal screening. Results: In UK, paternal autonomy prevails, causing risks such as not performing compulsory actions of beneficence. In USA, beneficence prevails with a large obligatory offer of anomalies to be screened, increasing the likelihood of false positives and causing a high opportunity cost. There are also similarities between UK and USA partially accepted in Colombia as the claim of equity of access. Others such as specialized professional advice or the possibility of refusing screening are not taken into account in the Colombian legislation of neonatal screening. Additionally; there are circumstances such as different approaches of justice for inclusion of abnormalities in the screening and lack of harmony between norms that prevent an efficacious detection. Conclusion: Bioethical considerations not only explain the differences between countries but sometimes prevail in the conception of public policies of neonatal screening. In Colombia, it is proposed their inclusion in high-level norms for effective screening.