Since the mid-20th century, with the largely eliminated of infectious diseases and the emergence of non-communicable chronic diseases as primary public health concerns, various approaches have been developed to prevent these conditions. Prevention and protection strategies in healthcare are of paramount importance for disease prevention, early diagnosis, treatment, rehabilitation, and health promotion. The fundamental aim of preventive approaches is to avert diseases, and these approaches can be examined under four main headings: Primordial, primary, secondary, and tertiary prevention. Primordial prevention aims to eliminate health risks, while primary prevention focuses on preventing the occurrence of diseases. Secondary prevention seeks to shorten the duration of illness or improve quality of life, whereas tertiary prevention aims to mitigate the effects of diseases.
In addition to these levels of prevention, there is another lesser-known approach: quaternary prevention, which forms the central theme of this study. This study addresses the conceptual aspects of quaternary prevention, the factors that give rise to it, and its relationship with medical ethics.
Quaternary prevention aims to prevent the risks of overmedicalization and to promote ethically acceptable interventions. This concept emerged as a critique of the risks posed by excessive medical interventions in modern medicine. It signals a shift from the traditional disease-centered model of care to a patient-centered and relationship-based model of preventive care.
The rapid development of modern medicine has given rise to the concept of quaternary prevention. Although modern medicine has brought significant advancements, these developments sometimes lead to overdiagnosis and overtreatment, causing harm to patients. Factors contributing to overdiagnosis include advanced medical technologies, commercial interests, the broadening of disease definitions, defensive medicine, incentives in healthcare system, cultural beliefs, and excessive reliance on early diagnosis. Advanced screening and diagnostic technologies often detect insignificant abnormalities, while economic motivations in the healthcare sector and tendencies among professional groups to increase diagnoses and treatments categorize more individuals as patients. Additionally, legal regulations that penalize healthcare professionals for underdiagnosis but overlook overdiagnosis encourage unnecessary tests and treatments. The societal belief that early diagnosis is always beneficial further exposes individuals to unnecessary interventions.
The overutilization of medical interventions not only threatens individual health but also wastes healthcare system resources and increases costs.
All these issues lead us to the question: How can overdiagnosis, overtreatment, and excessive medicalization be reduced? This question points us toward the principles of medical ethics, particularly the principle of non-maleficence and patient-centered approaches.
By focusing on the principle of "do no harm", this approach seeks solutions to unnecessary interventions. The concept of quaternary prevention is closely linked to the fundamental ethical principle of “primum non nocere” (first, do no harm) in terms of its origins and objectives.
Quaternary prevention is not merely a new term or systematic framing of the "first, do no harm" principle. It aims to encourage healthcare professionals to critically evaluate their decisions and to question ethical boundaries within healthcare systems. Its ultimate goal is to align clinical practices with medical ethics and bioethical principles. Quaternary prevention is grounded in the four fundamental principles of medical ethics: Non-maleficence (preventing unnecessary interventions and resource waste), beneficence (ensuring definitive benefit to patients through evidence-based practices), respect for autonomy (enabling patient participation in clinical decision-making), and justice (fair allocation of resources).
Additionally, by emphasizing the importance of the patient-physician relationship, quaternary prevention advocates for respect for the autonomy of both patients and physicians. Shared decision-making can reduce defensive medicine and overdiagnosis. As an ethical responsibility of modern medicine, quaternary prevention seeks to address unnecessary medical interventions and their potential harms, thereby contributing to the improvement of healthcare quality and standards.
Unlike other prevention approaches, quaternary prevention adopts a patient-centered approach rather than a biomedical perspective. It addresses unnecessary medical interventions and the ethical issues they may cause, critically questioning medical practices. It considers psychosocial impacts and highlights its increasing significance in modern healthcare through its focus on ethical principles.
Quaternary prevention represents one of the most tangible applications of the principle of non-maleficence in modern medicine. It should be regarded as a fundamental duty for all healthcare professionals involved in the delivery of healthcare services at every stage. This is because the “unnecessary interventions” that quaternary prevention seeks to prevent are practical issues that can arise at all levels of healthcare services and medical practice. Therefore, the scope of quaternary prevention should be expanded to encompass practices across all levels of healthcare services. Preventing unnecessary and excessive medical interventions is critical not only for individual health but also for public health and the equitable distribution of healthcare resources. Quaternary prevention fosters a more humane and patient-centered modern medical practice.
This study lays the groundwork for a broader perspective on the quaternary prevention. Future research may focus on defensive medicine, evidence-based medicine, personalized medicine, and patient-centered approaches in relation to quaternary prevention, as well as on expanding the scope of quaternary prevention. Such research can contribute to the development of Turkish literature in this field.
