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- Munthe, Christian, 1962, et al.
(författare)
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Questioning the patient in person centred care: ethical aspects: children, forensic psychiatry, and public health
- 2017
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Ingår i: Medical Argumentation and Patient Centred Care, University of Amsterdam, October 26-27, 2017..
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The paper explores the room, both conceptually and ethically, for questioning, contradicting and adapting positions to patients in three specific areas: care of patients with vulnerable cpapcities for taking responsibility (adolescents and psychiatry), contexts of constrained autonomy (forensic care), and public health (antobiotic resistance stewardship and vaccination). These areas in various ethically relevant ways exhibit non-standard settings, compared to usual assumptions about the nature of patients and institutional contexts made when person centredness and shared decision-making are held out as primarily emancipating concepts. The paper probes to what extent that ethical idea may be maintained also in such non-standard settings.
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- Munthe, Christian, 1962
(författare)
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If Forensic Psychiatry is the Science, What is its Object of Study? If it is a Branch of Medicine, What is the Disease? If it is a Specialty, What is its Topic of Expertise?
- 2015
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Ingår i: 34th International Congress on Law and Mental Health, Vienna, July 12-17, 2015.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- This paper analyses, from a normative and taxonomical standpoint, the apparent fact that what forensic psychiatry (FP) as a science or a branch of medicine focus on is necessarily socially constructed in a specific way relating to positive law. FP busies itself with conditions which are (a) mental health problems (in itself partly socially determined) and (b) linked to criminality – especially severe criminality – in turn a concept determined by actual legal statutes in a given society. This notion of what FP ”is about" has to be held distinct from the idea of FP researching the possible causal connection between mental health factors and specific crimes of behaviour types, or that of FP employing mental health care interventions to influence the tendency of criminal or other sort of behaviour. While FP may certainly (attempt to) do these things (implying an interest in specific parts of nature, specific expertise, etc), the issue of how to characterize its generic object of study, interest or action is more profoundly conceptual in that it may inform us about what FP is and what object may or may not be properly studied or intervened upon based on FP. This, in turn, will also provide an answer to what exactly the expertise of an FP specialist is supposed to be about, as well as pertain to disputes over the proper social authority and impact of knowledge coming out of the FP area. The paper will explore and compare three distinct strategies for providing an answer to this question, which are both criticised from a normative and philosophical perspective. First, FP might try to characterise its object of interest by embracing the socio-political relativity implied by the fact that criminal law, implying that the object of FP changes with every difference between jurisdiction across countries as well as over time. This seems to imply that there is no such thing as one object of FP, no specific FP expertise, and so on and thus undermines the idea of FP as a science, specific health care speciality or expertise. Second, FP may adopt a very abstract definition of its object, possible to include all jurisdictional variations one might imagine. This, however, seems to imply a problematic boundlessness: the idea that practically any behaviour or human condition is a proper concern of FP (since any such may be criminalized in some jurisdiction). This, in turn implies normative problems both with regard to the claims about a particular FP expertise and with regard to the ethical integrity of FP as a scientific and medical field.
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- Munthe, Christian, 1962
(författare)
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Patient Collaboration and Person Centeredness in Forensic Psychiatric Care: An Ethical Map
- 2017
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Ingår i: 35th International Congress on Law and Mental Health, July 9-14, 2017, Prague. Abstracts of the XXX Vth International Congress on Law and Mental Health / David N. Weisstub Editor.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- There is increasing interest in applying ideas from person centred care (PCC) in forensic psychiatry, including increased room for patients to collaborate in the care design. However, standard ethical assumptions in PCC about capacities of patients, as well as a traditional health care ethical context, departs significantly from the forensic psychiatric situation. Forensic psychiatric care is beset with restrictions of personal freedom and motivated partly by patients' incapacity to take responsibility brought by mental ill-health, usually within limits from criminal law, public safety and court orders. The care is supposed to change patients to become more autonomous and responsible in order for the restrictions on freedom to be justifiably relaxed or removed. Doing so may involve some room for independent decision-making by patients, using their responsibility capacities, but PCC opens up for much more far-reaching empowerment of patients, e.g., regarding the goals of care and the acceptance of applied methods. Therefore, there is a manifold increase of the ethical complexity creating tensions for PCC already in standard health care. This presentation provides a map of these ethical complexities, focusing especially on the issue of how the central notions of patient empowerment and shared decision-making should imply within forensic psychiatric care.
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- Munthe, Christian, 1962, et al.
(författare)
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Person centredness and shared decision-making in forensic care, social services and public health
- 2016
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Ingår i: 30th European Conference of the Philosophy of Medicine and Healthcare, Zagreb, August 17-20, 2016.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Shared decision-making and person centred care (PCC/SDM) are increasingly embraced framework conceptions on how to organise health care's interaction with patients. Although underlying ethical motivation may vary, PCC/SDM holds ideals of a greater adaption of health care to individual circumstances, and of recognising patients as collaborators in clinical decision-making. The PCC/SDM notion has migrated quickly across many areas where it is less clear how it applies, due to patients being in non-standard conditions with regard to personal capacities or care context, and detected to offer a number of peculiar ethical and practical challenges. But the migration has also reached areas with even less similarity to the original PCC/SDM landscape of somatic hospital care. In this presentation, we describe – based on comissioned and work in a Swedish context and ongoing research studies – three examples of this expansion and survey these for extra ethical complications: forensic care, social services and public health (outside of health care institutions). Each area offers peculiar extra ethical challenges for PCC/SDM, as they depart extensively from standard assumptions by, in various ways, embracing goals not built on the standard individualist assumptions of health care ethics. It is possible to implement adapted forms of PCC/SDM to these areas, but these cannot be assumed to serve ideals of emancipating, empowering or recognising individuals as persons. Rather, they have to be viewed though a lens of public goods aimed for in the respective areas. Clients and patients are entitled to be made aware of this fact, but regardless of this, the mentioned perspective-shift will pose particular challenges for health professionals. At the same time, PCC/SDM strategies may also open up for approaches to resolving these tensions and meet typical challenges that would otherwise have remained out of reach.
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- Trägårdh, Karin, et al.
(författare)
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Risk Profiles of Female Perpetrators of Severe Violence
- 2019
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Ingår i: 13th Nordic Symposium on Forensic Psychiatry. August 20-22, Gothenburg, Sweden.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Female offenders without a severe mental disorder show more criminogenic factors than those with. Both groups are characterized by mental health problems. We need to further characterize female offenders. Background Offenders of lethal/severe violence are in a majority of cases male, about 90% (Falk et al., 2014), and research has to a considerable extent focused on male violent offenders. Although less is known about female violent offenders than male offenders, previous research has indicated significant differences between male and female offenders of lethal/severe violence (Trägårdh et al., 2016; Yourstone et al., 2008). Since a majority of female perpetrators of lethal violence undergo a forensic psychiatric investigation (RPU/FPI), these documents contains important information about this group. Purpose The aim of this ongoing study is to characterize female perpetrators of severe violent crimes, and to compare female perpetrators sentenced to forensic psychiatric compulsory care with those sentenced to correctional treatment. Method This is an exploratory and descriptive study with a cross-sectional design. All forensic evaluations (FPI) made in Sweden between 2000-2014 (from The National Board of Forensic Medicine/RMV), and the subsequent court verdicts, in cases where women had used lethal/severe violence (n≈180) where used as the basis for data collection in this study. The present preliminary analyses (2-tests and ANOVA) contains approx. 26% (n=47) of the total group. Group differences were investigated regarding: Mental health (FPI) Risk factors (HCR-20 and PCL-R) Victim relation (FPI) Criminal behavior (FPI) Results Female offenders with and without a Severe mental disorder (SMD) seems to differ in some respects. For female offenders with a SMD, the crime was more likely to have been conducted in a less criminal context (see Table). For female offenders without a SMD, the following characteristics were more frequently present: Victim gender – male Substance abuse + Under the influence of substance (offender and victim) Previous violence between victim and offender Previous registered criminality Also, several common features between the SMD and non-SMD group of female offenders were found. The majority of all female offenders had: Previous psychiatric contact and diagnoses Previously attempted suicide No previously registered criminality Conclusions Preliminary results of the female perpetrators who had underwent a FPI seems to identify both substantial differences and similarities between those with versus without a SMD, where those without show more criminogenic factors. Both groups were also characterized by a high amount of mental illness. Also, these results supports previous research that female and male offenders of severe violence differ in important ways. Since a majority of female perpetrators of lethal violence undergo a forensic psychiatric investigation, these results should be generalizable to this group as a whole in Sweden. Based on these results, a great need to further characterize female offenders of severe/lethal violence remain.
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- Munthe, Christian, 1962
(författare)
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The Return of Lombroso? Ethical and Philosophical Aspects of (Visions of) Forensic Screening
- 2013
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Ingår i: 33rd International Congress of Law and Mental Health, Amsterdam, July 14-19, 2013.
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Konferensbidrag (refereegranskat)abstract
- Italian nineteenth century criminologist Cesare Lombroso is notorious for his seminal ideas about criminality and anti-social behaviour resulting from physiological anomalies that should be detected by society and used for forensic preventive purposes. After an extended period of disrepute following World War II, similar ideas have been resurrected in psychiatry, genetics, neurology and criminology in the past decade or two. In particular, there is a growing focus on early detection and application of preventive measures. This development actualizes a complex web of ethics and policy issues having to do with the well-known fact that screening and prevention in the health area are far from ethically clear-cut activities and actualize vivid prospects of doing extensive harm to individuals as well as society. Also, taken to its extreme, it actualizes the idea of using prenatal or preimplantation testing to preselect against children with a predisposition for criminal or antisocial behaviour. In the forensic case, such screening-prevention strategies will connect further to a complicated issue about the proper use of risk-assessment models for societal decision-making for precautionary purposes. Based on former work in all of these areas, this presentation will outline and analyze the basic issue of the defensibility of activities of this sort, with the perspective of forestalling unintentional harm to individuals and society.
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