We’ve published a Legal Framework Group Report as part of our work to support the health service in establishing a new and more patient-centred approach to the management of interval cancers.
The report was commissioned as part of the HSE’s response to the Scoping Inquiry into the CervicalCheck Screening Programme and a recommendation from the subsequent Expert Reference Group Reports 2020 for a review of the legal framework within which cancer screening operates in Ireland.
It addresses how Ireland’s legal processes could give better regard to the reality of the screening experience to minimise the effect court proceedings have on patients who seek redress. It finds that processes could be much improved for both patients and clinicians alike by the adoption of other legal mechanisms to address harm.
Interval cancers are a statistical certainty for any population screening programme. This is not unique to Ireland. Screening programmes benefit the population, but because of the limits of screening, they do not benefit everyone. This inherent contradiction within screening - that it can also cause harm to some - can raise questions for patients. Our report is a further endorsement of providing an opportunity for patients to have those questions answered in a supportive, collaborative and non-confrontational environment.
The Legal Framework Group Report highlights that because interval cancers are an inherent component of any programme, they cannot automatically be attributable to the negligence or failure on the part of the screening programme. Published evidence tells us that interval cancers attributable to negligence is rare, and the Irish legal system is designed around the necessity to find negligence to prove a harm has occurred. The report concluded that the Irish legal environment is not suited to resolving disputes about interval cancer cases and supports the introduction of alternative measures to enhance patient care.
In coming to its conclusions and recommendations the Legal Framework Group took account of:
- legislation underpinning medical care in Ireland
- individual Constitutional rights
- previous medico-legal reports
- published rulings and case law commentary
- the 2022 National Cancer Registry Ireland report on national cancer trends
- Wilson and Junger screening criteria
- the known limitations of cancer screening
- globally comparative cancer screening programmes.
The conclusions of the Legal Framework Group’s report are supported and reinforced by the recommendations of a report on best practices in cervical screening published by the World Health Organization’s International Agency for Research on Cancer. It notes that most legal and ethical frameworks in healthcare were developed in the context of an individual patient’s diagnosis and treatment but not population-based programmes, for example, cancer screening programmes or vaccination programmes. The conclusions also align with the findings of the 2024 Interdepartmental Working Group report on the rising cost of health-related claims which called for the introduction of alternative legal processes for medical negligence actions.
The Legal Framework Group report concludes that a new legal framework for population cancer screening in Ireland is necessary. It calls for alternative legal processes to be introduced which can accommodate the reality that the harms of population screening are a recognised and normal part of this type of medical practice.
The Legal Framework Group was chaired by Professor David Keegan and included patient representatives, medical staff, advocacy members, civil servants and legal and medical ethicists.