The primary of prevention

56 rather than (unnecessarily) treated in the emergency department. Most parents express satisfaction with this service. Few physicians have used the telephone consultation service. P H I L O S O P H I C A L AND E T H I C A L ISSUES There is hardly a part of the health-care process or a single health discipline that does not face difficult ethical and philosophical problems related to patient care and the patient education and counselling component of that care. For our readers, the reports from the United States and West Germany reveal such issues that occur, particularly those faced in the fields of genetics and prevention. 20) The p r i m a c y of prevention TERRIS, M. Journal Publ. Hlth. Policy, 23 Pheasant Way, South Bur!ington, VT, U.S.A. Pref,. Med. 10(6), 689-699, 1981 The.most important forces that have lowered morbidity and mortality from infectious diseases during the past 100!years are economic and social changes, environmental control measures, immunization, health educationi and other public health activities; treatment services have played a secondary role. Similarly, the contribution of medical care to lowering mortality and morbidity from noninfectious diseases has been useful but

limited; although curative in some, it is only partially effective or ineffective in most of these diseases. The second epidemiological revolution has provided the basis for preventive measures to eliminate the leading noninfectious diseases. These measures will have three basic components: control of the environment, screening, and health education. It is estimated that an effective preventive program will entail minor costs in comparison with the major benefits resulting from the prevention of illness, disability and death, and reduction in the costs of medical care.

21) Ethical conflicts in genetic counselling during pregnancies ( G e r m a n ) SCHROEDER, T.M. Inst. Humangenet., Univ. Heidelberg, West Germany Monatsschr. Kinderheilkd. 130(2), 71-74, 1982 Two examples from our genetic counselling are used to demonstrate the ethical conflict that may arise from diverging basic opinions about the quality of life, the significance of interrupting the pregnancy, and the valuation of a genetic disease, as seen individually in each case. Emphasis is given to the role of the counsellor for the decisions of the expectant mother. Furthermore, the change in ethical values is pointed out, which originate from the emerging new technical possibilities in prenatal diagnosis appearing particularly after the legal changes in article 218 StGb.

PATIENT COUNSELLING AND HEALTH EDUCATION