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- Munthe, Christian, 1962
(author)
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Informed Consent and Quality of Available Information
- 1998
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In: Fourth World Congress of the International Association of Bioethics, Tokyo, November 4-7, 1998.
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Conference paper (other academic/artistic)abstract
- Standard versions of the requirement of informed consent state that patients who are offered to enter a clinical trial of a medical procedure should be informed about risks and possible benefits of this procedure (compared to available alternatives) in order to facilitate a rational decision whether or not to participate. However, in many real cases where new medical procedures are to be clinically tested for the first time the information available for such communication to prospective patients is very scarce, vague and/or uncertain. This phenomenon is illustrated by the clinical introduction of new procedures in reproductive medicine, such as preimplantation genetic diagnosis (PGD). Regarding such procedures, it has ben argued that, in such cases, the quality of the available information may be too low for the obtaining of informed consent to be possible, even if it is successfully communicated. Others, instead, holds that informed consent may always be obtained regardless of the quality of the available information. Unfortunately, the standard litterature on informed consent give no clue as to which of these interpretations is correct. This issue is explored by connecting the concept of informed consent to ethical ideas of respect for autonomy and ideas of rational decision making. It is argued, first, that low quality of available information regarding the risks and possible benefits of a medical procedure may indeed make the obtaining of informed consent from patients to undergo this procedure impossible even in theory. However, it is also argued that whether or not this is the case must be relativized to the actual needs and desires of individual patients. Thus, regarding one and the same procedure, informed consent may be impossible to obtain from some patients due to the low quality of the available information regarding this procedure, but still be possible to obtain from other patients.
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- Munthe, Christian, 1962
(author)
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Pure Selection. The Ethics of Preimplantation Genetic Diagnosis and Choosing Children without Abortion
- 1999
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Book (other academic/artistic)abstract
- Preimplantation ge¬netic diagnosis (PGD) is taken to mark the starting-point of a new phase in human reproduction, where the possibility of choosing children on genetic grounds without having to resort to ethi¬cally controversial procedures (such as abortion) will grad¬ually increase. Ethical and political issues actu¬alised by this develop¬ment are addressed. The discussion touches upon issues regarding the moral status of em¬bryos and gametes, the moral import of respecting individual auton¬omy and its implications for the requirement of informed consent in health-care, the connec¬tion between sickness, dis¬ability and the value of life, the moral status of possible future people, and the connection between choosing children and eugenic policies of the past. Practical policy issues are adressed on the basis of this, as well as an empirical case-study of the intro¬duction of PGD in Sweden. The book ends up in a set of recommendations regarding the management of re¬search on, introduction and routine use of procedures for pure se¬lection, both within health care and from the point of view of society as a whole. It is argued that research on such procedures should be allowed and supported by society. However, tight restrictions regarding the clinical introduction of new procedures in this area is highly desirable. A rough model for implementing such re¬strictions is also pre¬sented. It is further asserted that, although reasons of economy and safety should limit the access to pure se¬lection, society should not apply any explicit restrictions based on ideasregarding how different traits affect a person’s quality of life. It is stressed that, in order to to avoid a re¬sur¬rection of eugenic policies of the past, the development in this field un¬der¬lines the need for continued and strengthen public support to the sick, dis¬abled and mentally retarded.
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- Lundälv, Jörgen, 1966
(author)
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Det talande offret. Journalistik vid olyckor och katastrofer
- 1999
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Book (other academic/artistic)abstract
- Det talande offret är en skildring av tillståndet i svensk krisjournalistik och en diskussion om hur väl förberedda journalister är i kontakterna med den sårade och lidande människan. I boken berättar reportrar och fotografer om sina erfarenheter från olycks- och katastrofplatser. Två viktiga metoder framkommer: "kompostering" och "återvinning" av kriserfarenheter. Boken ger även råd om hur räddningspersonal mfl i sin yrkesroll bör bemöta pressen när en katastrof inträffat. Boken, som är den första i sitt slag i Sverige, kan användas som studiematerial inom journalist-, medicin-, vård-, socionom-, polis-, och räddningstjänstutbildningarna.
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| 7. |
- Berg, Marie, 1955
(author)
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Master thesis in Nursing: Vårdrelation och födande : kvinnors möte med barnmorskan under förlossningen på en ABC-enhet. Caring relationship and childbirth: Women´s encounter with the midwife at an Alternative Birth Center Unit
- 1999
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Other publication (other academic/artistic)abstract
- The purpose of this essay was to describe the nature of encounters in health care with focus on women´s encounters with the midwife during childbirth. The physical and mental wellbeing of the future mother has a direct impact on the health of the family, specially the child´s wellbeing. It´s therefore important that the woman has a positive experience of pregnancy and childbirth. In a qualitative study using phenomenological approach the objective was to describe women´s experience of the encounter with the midwife during childbirth at an Alternative Birth Care Centre (ABC). The essential structure of the studied phenomenon was described as "presence" ad included three themes: 1) to be seen as an individual 2) to have a trusting relationship and 3) to be supported and guided on ones own terms. If any of the mentioned features were lacking the women felt that the midwife was absently-present which run the risk of a negative birthing experience. The need to be seen as an individual can be realized by affirmation and familiarity with the midwife and surrounding. A trusting relationship can be obtained by good communication and proficient behavior. By providing a sense of control the women can be supported and guided on their own terms. The intersubjective encounter between patient and caregiver is the essence in all health care, even in the care of the pregnant and birthing woman irrespective of race and culture. Syftet med föreliggande arbete var att beskriva vårdrelationens innebörd med fokus på mötet mellan den födande kvinnan och barnmorskan under förlossningen. Det fysiska och psykiska välbefinnandet hos den blivande modern påverkar hela familjen och i synnerhet barnet. Det är därför viktigt att upplevelsen i samband med graviditet, förlossning och puerperium (barnsängtid) blir positiv. I en kvalitativ studie med fenomenologisk ansats har kvinnors upplevelse av mötet med barnmorskan under förlossningen på en ABC-enhet (Alternative Birth Care) undersökts. Det essentiella i mötet kan uttryckas i tre teman: 1) att bli sedd, 2) att ha en förtroendefull relation och 3) att få stöd och bli styrd på egna villkor. Begreppet "närvaro" abstraherades som en gemensam beståndsdel i dessa teman. Behovet av att bli sedd förverkligades genom att bli bekräftad och bemött med respekt. En förtroendefull relation utvecklades genom god kommunikation och genom att barmorskan förmedlade professionell kunskap, säkerhet, vänlighet, tillmötesgående, tillgänglighet och intutition. Genom en känsla av bibehållen kontroll kunde kvinnorna ta emot stöd och bli styrda på egna villkor. Om något av de ovanstående saknades kunde kvinnorna uppleva en känsla av att barnmorskan var "icke-närvarande". Vårdrelationen, mötet mellan patienten och vårdgivaren, är kärnan i den stora vårdorganisationen, även i vården av den gravida, födande och nyförlösta kvinnan, oavsett ras- och kulturtillhörighet.
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- Ahlman, Håkan, 1947, et al.
(author)
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The relevance of somatostatin receptors in thyroid neoplasia.
- 1997
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In: The Yale journal of biology and medicine. - 0044-0086. ; 70:5-6, s. 523-33
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Journal article (other academic/artistic)abstract
- 111In-octreotide scintigraphy in patients with persistent medullary thyroid carcinoma (MTC) visualized tumors in about half of the surgically explored sites. Tumor visualization correlated with rapid tumor growth and large tumor volume as judged from calcitonin levels. The 111In concentration ratio between tumor (T) and blood (B) in surgically excised lymph node metastases of MTC showed a large variation, with low values for microscopic and high values for macroscopic metastases in individual patients. Three cases of MTC, Hürthle cell adenoma and papillary thyroid cancer are reported with preoperative scintigraphy, T/B ratios and Northern analyses of the surgical biopsies. Visualization of tumors was possible in the absence of sstr2 (the high affinity receptor for octreotide) with the exception of microscopic tumor growth. T/B values in the patient with Hürthle cell adenoma were similar to those found in the contralateral thyroid lobe with goitre. The relatively high uptake of 111In in benign thyroid conditions probably limits the use of octreotide scintigraphy in the diagnosis of primary tumors. The technique has certain advantages over radioiodine scintigraphy after the surgical treatment of thyroid tumors: no need for withdrawal of thyroxin substitution; a possibility to diagnose metastases of tumors that do not concentrate radioiodine (MTC, Hürthle cell cancer); and complementary information about metastatic sites of non-medullary thyroid cancer (papillary and follicular tumors).
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