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- Brülde, Bengt, 1959
(författare)
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On defining “mental disorder”: Purposes and conditions of adequacy
- 2010
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Ingår i: Theoretical Medicine and Bioethics. - 1386-7415. ; 31:1, s. 19-33
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Tidskriftsartikel (refereegranskat)abstract
- All definitions of mental disorder are backed up by arguments that rely on general criteria (e.g., that a definition should be consistent with ordinary language). These desiderata are rarely explicitly stated, and there has been no systematic discussion of how different definitions should be assessed. To arrive at a well-founded list of desiderata, we need to know the purpose of a definition. I argue that this purpose must be practical; it should, for example, help us determine who is entitled to publicly funded health care. I then propose eight conditions of adequacy that can be used to assess competing definitions (e.g., the ordinary language condition, the coherence condition, and the condition of normative adequacy). These conditions pull in different directions, however, and we must decide which are most important. I also suggest that there is no single definition that can help us deal with all the relevant practical issues.
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| 2. |
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| 3. |
- Friberg-Fernros, Henrik, 1972
(författare)
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Clashes of consensus: on the problem of both justifying abortion of fetuses with Down syndrome and rejecting infanticide
- 2017
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Ingår i: Theoretical Medicine and Bioethics. - : Springer Science and Business Media LLC. - 1386-7415 .- 1573-1200. ; 38:3, s. 195-212
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Tidskriftsartikel (refereegranskat)abstract
- Although the abortion of fetuses with Down syndrome has become commonplace, infanticide is still widely rejected. Generally, there are three ways of justifying the differentiation between abortion and infanticide: by referring to the differences between the moral status of the fetus versus the infant, by referring to the differences of the moral status of the act of abortion versus the act of infanticide, or by separating the way the permissibility of abortion is justified from the way the impermissibility of infanticide is justified. My argument is that none of these ways justifies the abortion of fetuses diagnosed with Down syndrome while simultaneously rejecting infanticide. Either the justification for abortion is consistent with infanticide, or it is implausible to justify abortion while rejecting infanticide. I conclude the article by making some preliminary remarks about how one might manage the situation posed by my argument.
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| 4. |
- Hansson, Mats
(författare)
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Where should we draw the line between quality of care and other ethical concerns related to medical registries and biobanks?
- 2012
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Ingår i: Theoretical Medicine and Bioethics. - : Springer Science and Business Media LLC. - 1386-7415 .- 1573-0980 .- 1573-1200. ; 33:4, s. 313-323
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Tidskriftsartikel (refereegranskat)abstract
- Together with large biobanks of human samples, medical registries with aggregated data from many clinical centers are vital parts of an infrastructure for maintaining high standards of quality with regard to medical diagnosis and treatment. The rapid development in personalized medicine and pharmaco-genomics only underscores the future need for these infrastructures. However, registries and biobanks have been criticized as constituting great risks to individual privacy. In this article, I suggest that quality with regard to diagnosis and treatment is an inherent, morally normative requirement of health care, and argue that quality concerns in this sense may be balanced with privacy concerns.
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| 5. |
- Hansson, Sven Ove
(författare)
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Uncertainty and the ethics of clinical trials
- 2006
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Ingår i: Theoretical Medicine and Bioethics. - : Springer Science and Business Media LLC. - 1386-7415 .- 1573-0980 .- 1573-1200. ; 27:2, s. 149-167
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Tidskriftsartikel (refereegranskat)abstract
- A probabilistic explication is offered of equipoise and uncertainty in clinical trials. In order to be useful in the justification of clinical trials, equipoise has to be interpreted in terms of overlapping probability distributions of possible treatment outcomes, rather than point estimates representing expectation values. Uncertainty about treatment outcomes is shown to be a necessary but insufficient condition for the ethical defensibility of clinical trials. Additional requirements are proposed for the nature of that uncertainty. The indecisiveness of our criteria for cautious decision-making under uncertainty creates the leeway that makes clinical trials defensible.
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| 7. |
- Herlitz, Anders, 1981
(författare)
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Indeterminacy and the principle of need
- 2017
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Ingår i: Theoretical Medicine and Bioethics. - : Springer Science and Business Media LLC. - 1386-7415 .- 1573-1200. ; 38:1, s. 1-14
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Tidskriftsartikel (refereegranskat)abstract
- The principle of need-the idea that resources should be allocated according to need-is often invoked in priority setting in the health care sector. In this article, I argue that a reasonable principle of need must be indeterminate, and examine three different ways that this can be dealt with: appendicizing the principle with further principles, imposing determinacy, or empowering decision makers. I argue that need must be conceptualized as a composite property composed of at least two factors: health shortfall and capacity to benefit. When one examines how the different factors relate to each other, one discovers that this is sometimes indeterminate. I illustrate this indeterminacy in this article by applying the small improvement argument. If the relation between the factors are always determinate, the comparative relation changes by a small adjustment. Yet, if two needs are dissimilar but of seemingly equal magnitude, the comparative relation does not change by a small adjustment of one of the factors. I then outline arguments in favor of each of the three strategies for dealing with indeterminacy, but also point out that all strategies have significant shortcomings. More research is needed concerning how to deal with this indeterminacy, and the most promising path seems to be to scrutinize the position of the principle of need among a plurality of relevant principles for priority setting in the health care sector.
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| 8. |
- Jerkert, Jesper
(författare)
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Negative mechanistic reasoning in medical intervention assessment
- 2015
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Ingår i: Theoretical Medicine and Bioethics. - : Springer Netherlands. - 1386-7415 .- 1573-0980 .- 1573-1200. ; 36:6, s. 425-437
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Tidskriftsartikel (refereegranskat)abstract
- Traditionally, mechanistic reasoning has been assigned a negligible role in standard EBM (evidence-based medicine) literature, although some recent authors have argued for an upgrading. Even so, mechanistic reasoning that has received attention has almost exclusively been positive – both in an epistemic sense of claiming that there is a mechanistic chain and in a health-related sense of there being claimed benefits for the patient. Negative mechanistic reasoning has been neglected, both in the epistemic and in the health-related sense. I distinguish three main types of negative mechanistic reasoning and subsume them under a new definition of mechanistic reasoning in the context of assessing medical interventions. This definition is wider than a previous suggestion in the literature. Each negative type corresponds to a range of evidential strengths, and it is argued that there are differences with respect to the typical evidential strengths. The variety of negative mechanistic reasoning should be acknowledged in EBM, and presents a serious challenge to proponents of so-called medical hierarchies of evidence.
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| 10. |
- Johansson, Mats, et al.
(författare)
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Turning failures into successes: a methodological shortcoming in empirical research on surrogate accuracy.
- 2008
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Ingår i: Theoretical Medicine and Bioethics. - : Springer Science and Business Media LLC. - 1386-7415 .- 1573-1200. ; 29:1, s. 17-26
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Tidskriftsartikel (refereegranskat)abstract
- Decision making for incompetent patients is a much-discussed topic in bioethics. According to one influential decision making standard, the substituted judgment standard, a surrogate decision maker ought to make the decision that the incompetent patient would have made, had he or she been competent. Empirical research has been conducted in order to find out whether surrogate decision makers are sufficiently good at doing their job, as this is defined by the substituted judgment standard. This research investigates to what extent surrogates are able to predict what the patient would have preferred in the relevant circumstances. In this paper we address a methodological shortcoming evident in a significant number of studies. The mistake consists in categorizing responses that only express uncertainty as predictions that the patient would be positive to treatment, on the grounds that the clinical default is to provide treatment unless it is refused. We argue that this practice is based on confusion and that it risks damaging the research on surrogate accuracy.
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