| 1. |
- Andersson, Andreas, et al.
(författare)
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Public support for healthcare-mediated disclosure of hereditary cancer risk information: Results from a population-based survey in Sweden
- 2020
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Ingår i: Hereditary Cancer in Clinical Practice. - : Springer Science and Business Media LLC. - 1731-2302 .- 1897-4287. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Targeted surveillance of at-risk individuals in families with increased risk of hereditary cancer is an effective prevention strategy if relatives are identified, informed and enrolled in screening programs. Despite the potential benefits, many eligible at-risk relatives remain uninformed of their cancer risk. This study describes the general public's opinion on disclosure of hereditary colorectal cancer (CRC) risk information, as well as preferences on the source and the mode of information. Methods A random sample of the general public was assessed through a Swedish citizen web-panel. Respondents were presented with scenarios of being an at-risk relative in a family that had an estimated increased hereditary risk of CRC; either 10% (moderate) or 70% (high) lifetime risk. A colonoscopy was presented as a preventive measure. Results were analysed to identify significant differences between groups using the Pearson's chi-square (chi(2)) test. Results Of 1800 invited participants, 977 completed the survey (54%). In the moderate and high-risk scenarios, 89.2 and 90.6% respectively, would like to receive information about a potential hereditary risk of CRC (chi 2,p = .755). The desire to be informed was higher among women (91.5%) than men (87.0%, chi 2,p = .044). No significant differences were found when comparing different age groups, educational levels, place of residence and having children or not. The preferred source of risk information was a healthcare professional in both moderate and high-risk scenarios (80.1 and 75.5%). However, 18.1 and 20.1% respectively would prefer to be informed by a family member. Assuming that healthcare professionals disclosed the information, the favoured mode of information was letter and phone (38.4 and 33.2%). Conclusions In this study a majority of respondents wanted to be informed about a potential hereditary risk of CRC and preferred healthcare professionals to communicate this information. The two presented levels of CRC lifetime risk did not significantly affect the interest in being informed. Our data offer insights into the needs and preferences of the Swedish population, providing a rationale for developing complementary healthcare-assisted communication pathways to realise the full potential of targeted prevention of hereditary CRC.
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| 2. |
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| 3. |
- Grill, Kalle, 1976-
(författare)
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Advice on vaping in the face of empirical and ethical uncertainty
- 2022
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Ingår i: American Journal of Bioethics. - : Taylor & Francis. - 1526-5161 .- 1536-0075. ; 22:10, s. 20-22
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- One central role of the American Federal Drug Administration (FDA) is to provide research-based health information and advice to professionals and public. Regarding vaping, the FDA currently emphasizes its possible harms rather than its relatively low risks compared to smoking, for any individual user. Larisa Svirsky, Dana Howard and Micah L Berman defend this uncompromising strategy by invoking the uncertain long-term public health outcomes of vaping and pointing to the many roles of the FDA. I agree that there are empirical uncertainties and multiple roles. I also mention some ethical uncertainties. However, I propose that the FDA in its role as advisor should, given these uncertainties, communicate individual health risks truthfully and straightforwardly, and that such communication does not conflict with its other roles.
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| 4. |
- Grill, Kalle, 1976-
(författare)
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Anti-paternalism and Invalidation of Reasons
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Annan publikation (populärvet., debatt m.m.)abstract
- Anti-paternalism can fruitfully be interpreted as a principle of invalidation of reasons. That a reason for an action is invalid means that the reason is blocked from influencing the moral status of the action. More specifically, anti-paternalism blocks personal good reasons from influencing the moral status of certain interfering actions. Actions are only interfering in this sense if they target choice or action that is sufficiently voluntary. Antipaternalism so interpreted is unreasonable on three grounds. First, it essentially entails that the degree to which a person acts voluntarily determines whether or not her good provides reasons for action. This leads to wrong answers to moral questions. Second, anti-paternalism entails peculiar jumps in justifiability at the threshold of voluntary enough. Third, anti-paternalism imposes a distinction in kind between the value of respecting choices that are sufficiently voluntary and choices that are not. This distinction is untenable and diverts our attention away from the relative strength of reasons. Invalidation in general is unreasonable on the same grounds.
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| 5. |
- Grill, Kalle, 1976-
(författare)
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Anti-paternalism and invalidation of reasons
- 2010
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Ingår i: Public Reason. - 2065-7285 .- 2065-8958. ; 2:2, s. 3-20
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Tidskriftsartikel (refereegranskat)abstract
- I first provide an analysis of Joel Feinberg’s anti-paternalism in terms of invalidation of reasons. Invalidation is the blocking of reasons from influencing the moral status of actions, in this case the blocking of personal good reasons from supporting liberty-limiting actions. Invalidation is shown to be distinct from moral side constraints and lexical ordering of values and reasons. I then go on to argue that anti-paternalism as invalidation is morally unreasonable on at least four grounds, none of which presuppose that people can be mistaken about their own good: First, the doctrine entails that we should sometimes allow people to unintentionally severely harm or kill themselves though we could easily stop them. Second, it entails that we should sometimes allow perfectly informed and rational people to risk the lives of themselves and others, though they are in perfect agreement with us on what reasons we have to stop them for their own good. Third, the doctrine leaves unexplained why we may benevolently coerce less competent but substantially autonomous people, such as young teens, but not adults. Last, it entails that there are peculiar jumps in justifiability between very similar actions. I conclude that as liberals we should reject anti-paternalism and focus our efforts on explicating important liberal values, thereby showing why liberty reasons sometimes override strong personal good reasons, though never by making them invalid.
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| 6. |
- Grill, Kalle, 1976-
(författare)
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Anti-paternalism and Invalidation of Reasons
- 2010
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Ingår i: Public Reason. - 2065-7285 .- 2065-8958. ; 2:2, s. 3-20
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Tidskriftsartikel (refereegranskat)abstract
- Joel Feinberg’s anti-paternalism can be interpreted as a doctrine of invalidation of reasons, implying that reasons which concern a person’s good are excluded, on moral grounds, from influencing the moral status of actions that limit her liberty. Invalidation of this kind is distinct from moral side constraints and from lexical ordering of values and reasons. Anti-paternalism as invalidation, though a relatively favourable interpretation, is morally unreasonable on at least four grounds, even if we accept people’s view of their own good at face value. First, it entails that we should sometimes allow people to severely harm or kill themselves though we could easily stop them and they don’t intend to harm themselves. Second, it entails that we should sometimes disregard reasons that concern a person’s good, even if the person herself is in perfect agreement on the strength and validity of the reasons, and is judging and acting perfectly voluntary. Third, it entails that there are peculiar jumps in justifiability between very similar actions where one is barely sufficiently voluntary and the other not quite sufficiently voluntary. Fourth, it indirectly entails a disregard for the liberty of those who all agree should sometimes be coerced in their own interest, but who nevertheless are partially autonomous, such as people in their lower teens. For all of these reasons, we liberals should reject anti-paternalism and focus our efforts on explicating important liberal values, thereby showing why liberty reasons sometimes override strong personal good reasons, though never by making them invalid.
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| 7. |
- Grill, Kalle, 1976-
(författare)
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Anti-paternalism and Public Health Policy
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis is an attempt to constructively interpret and critically evaluate the liberal doctrine that we may not limit a person’s liberty for her own good, and to discuss its implications and alternatives in some concrete areas of public health policy. The thesis starts theoretical and goes ever more practical. The first paper is devoted to positive interpretation of anti-paternalism with special focus on the reason component – personal good. A novel generic definition of paternalism is proposed, intended to capture, in a generous fashion, the object of traditional liberal resistance to paternalism – the invocation of personal good reasons for limiting of or interfering with a person’s liberty. In the second paper, the normative aspect of this resistance is given a somewhat technical interpretation in terms of invalidation of reasons – the blocking of reasons from influencing the moral status of actions according to their strength. It is then argued that normative anti-paternalism so understood is unreasonable, on three grounds: 1) Since the doctrine only applies to sufficiently voluntary action, voluntariness determines validity of reasons, which is unwarranted and leads to wrong answers to moral questions. 2) Since voluntariness comes in degrees, a threshold must be set where personal good reasons are invalidated, leading to peculiar jumps in the justifiability of actions. 3) Anti-paternalism imposes an untenable and unhelpful distinction between the value of respecting choices that are sufficiently voluntary and choices that are not. The third paper adds to this critique the fourth argument that none of the action types typically proposed to specify the action component of paternalism is such that performing an action of that type out of benevolence is essentially morally problematic. The fourth paper ignores the critique in the second and third papers and proposes, in an anti-paternalistic spirit, a series of rules for the justification of option-restricting policies aimed at groups where some members consent to the policy and some do not. Such policies present the liberal with a dilemma where the value of not restricting people’s options without their consent conflicts with the value of allowing people to shape their lives according to their own wishes. The fifth paper applies the understanding of anti-paternalism developed in the earlier papers to product safety regulation, as an example of a public health policy area. The sixth paper explores in more detail a specific public health policy, namely that of mandatory alcohol interlocks in all cars, proposed by the former Swedish government and supported by the Swedish National Road Administration. The policy is evaluated for cost-effectiveness, for possible diffusion of individual responsibility, and for paternalistic treatment of drivers. The seventh paper argues for a liberal policy in the area of dissemination of information about uncertain threats to public health. The argument against paternalism is based on common sense consequentialist considerations, avoiding any appeal to the normative anti-paternalism rejected earlier in the thesis.
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| 8. |
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| 9. |
- Grill, Kalle, 1976-
(författare)
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Antipaternalism as a filter on reasons
- 2015
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Ingår i: New perspectives on paternalism and health care. - Cham : Springer. - 9783319179599 - 9783319179605 ; , s. 47-63
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Bokkapitel (refereegranskat)abstract
- The charge of paternalism is a common objection to the actions of political and other authorities. Sometimes the charge is only that the authority has undervalued typical liberal values like freedom and autonomy relative to other values, such as physical, mental or financial wellbeing. Making this objection is consistent with accepting that in some cases, wellbeing outweighs freedom and autonomy and should be furthered at their expense. Other times, however, the charge of paternalism is more principled. The objection is not that wellbeing considerations are overstated, but that they are allowed to weigh in on the matter at all. This is the sort of antipaternalism that I will analyze in this article. My discussion and my proposals are meant to be helpful to the antipaternalist, and to anyone who wants to understand her. However, I should state at the outset that the antipaternalist position I describe and develop is not one I endorse.
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| 10. |
- Grill, Kalle, 1976-
(författare)
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Asymmetric population axiology : deliberative neutrality delivered
- 2017
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Ingår i: Philosophical Studies. - : Springer. - 0031-8116 .- 1573-0883. ; 174:1, s. 219-236
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Tidskriftsartikel (refereegranskat)abstract
- Two related asymmetries have been discussed in relation to the ethics of creating new lives: First, we seem to have strong moral reason to avoid creating lives that are not worth living, but no moral reason to create lives that are worth living. Second, we seem to have strong moral reason to improve the wellbeing of existing lives, but, again, no moral reason to create lives that are worth living. Both asymmetries have proven very difficult to account for in any coherent moral framework. I propose an impersonal population axiology to underpin the asymmetries, which sidesteps the problematic issue of whether or not people can be harmed or benefited by creation or non-creation. This axiology yields perfect asymmetry from a deliberative perspective, in terms of expected value. The axiology also yields substantial asymmetry for large and realistic populations in terms of their actual value, beyond deliberative relevance.
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