| 1. |
|
|
| 2. |
|
|
| 3. |
- Bernfort, Lars, 1967-
(författare)
-
Decisions on Inclusion in the Swedish Basic Health Care Package - Roles of Cost-Effectiveness and Need
- 2003
-
Ingår i: Health Care Analysis. - : Kluwer Academic Publishers. - 1065-3058 .- 1573-3394. ; 11:4, s. 301-308
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Inclusion or not of a treatment strategy in the publicly financed health care is really a matter of prioritisation. In Sweden priority setting decisions are governed by law in which it is stated that decisions should be guided by firstly the principle of need and secondly the principle of cost-effectiveness. Objective: The purpose of the paper is to discuss and illustrate the roles of need and cost-effectiveness in decisions on inclusion or not of treatment strategies in the publicly financed health care. Methods: The theoretical backgrounds of need and cost-effectiveness are discussed in short, both with respect to their meaning and to their potential roles in decisions on priority setting. Four treatment strategies, Viagra, Rivastigmine, statins, and lung transplants, are analysed with respect to whether either cost-effectiveness or need, or both, seem to have played a role in the decisions of inclusion or not in the basic health care package. Results: Both need and cost-effectiveness are important and should be important aspects when making decisions on priority setting. From the examples of the four treatment strategies it seems that decisions are almost exclusively made with reference to the principle of need. Conclusions: The most evident conclusion to be drawn from this study is that decisions on priority setting are almost solely based on the principle of need. This implies that the principle of cost-effectiveness is given very little space, which is a problem as this means an obvious risk of inefficient resource use.
|
|
| 4. |
- Bullington, Jennifer
(författare)
-
Embodiment and chronic pain : implications for rehabilitation practice
- 2009
-
Ingår i: Health Care Analysis. - 1065-3058 .- 1573-3394. ; 17:2, s. 100-109
-
Tidskriftsartikel (refereegranskat)abstract
- Throughout the Western world people turn towards the health care system seeking help for a variety of psychosomatic/psychosocial health problems. They become "patients" and find themselves within a system of practises that conceptualizes their bodies as "objective" bodies, treats their ill health in terms of the malfunctioning machine, and compartmentalizes their lived experiences into medically interpreted symptoms and signs of underlying biological dysfunction. The aim of this article is to present an alternative way of describing ill health and rehabilitation using the philosophy of Maurice Merleau-Ponty in order to deepen our understanding of the rehabilitation process. I will explore how the experience of chronic pain ruptures the natural connection between body and world and how the rehabilitation process can be understood as the re-insertion of the body into the flow of experience, where the body "disappears" into its natural silence in order to allow the world to once again unfold. The experience of chronic pain places the painful body in focus, resulting in a diminished articulation of both self and world. Persons with illness suffer not only from the physical aspects of pain and discomfort but also from a loss of identity where one feels alienated and detached from things that used to give meaning to ones life. Rehabilitation must not only address the material (medical) body but also the diminished sense of self as well as the retreat from the world outside of the painful body.
|
|
| 5. |
- Bäckryd, Emmanuel
(författare)
-
Pain as the Perception of Someone: An Analysis of the Interface Between Pain Medicine and Philosophy
- 2019
-
Ingår i: Health Care Analysis. - : SPRINGER. - 1065-3058 .- 1573-3394. ; 27:1, s. 13-25
-
Tidskriftsartikel (refereegranskat)abstract
- Based largely on the so-called problem of asymmetry in concept application, philosopher Murat Aydede has argued for a non-perceptual view of pain. Aydede is of course not denying basic neurobiological facts about neurons, action potentials, and the like, but he nonetheless makes a strong philosophical case for pain not being the perception of something extramental. In the present paper, after having stated some of the presuppositions I hold as a physician and pain researcher, and after having shortly described Aydedes critique of perceptual theories of pain, I make a constructive proposal centred around the concept of pain as the perception of some-one, not some-thing. In doing so, I propose that there often is a problematic duality at work when we think about pain, namely the mental/extramental duality. This pre-reflective mindset creates difficulties when reflecting over pain. Instead, I propose the body/world duality as being more helpful. Two neologisms, cosmoception and egoception, are presented as an alternative to the twin concepts of exteroception and interoception. It is argued that the new concepts have the advantage of not pushing our thought into a mental/extra-mental dichotomy. Hence, when in pain (which is an instance of egoception), I get epistemic access to the body that is I, to how I fare in this world. From that perspective, pain is not the perception of something, but of someone-namely, the self. In the final part of the paper, this proposal is discussed in dialogue with a paper from phenomenological thinker Jennifer Bullington.
|
|
| 6. |
- Cutas, Daniela, et al.
(författare)
-
"I am your mother and your father!" : in vitro derived gametes and the ethics of solo reproduction
- 2017
-
Ingår i: Health Care Analysis. - : Springer. - 1065-3058 .- 1573-3394. ; 25:4, s. 354-369
-
Tidskriftsartikel (refereegranskat)abstract
- In this paper, we will discuss the prospect of human reproduction achieved with gametes originating from only one person. According to statements by a minority of scientists working on the generation of gametes in vitro, it may become possible to create eggs from men’s non-reproductive cells and sperm from women’s. This would enable, at least in principle, the creation of an embryo from cells obtained from only one individual: ‘solo reproduction’. We will consider what might motivate people to reproduce in this way, and the implications that solo reproduction might have for ethics and policy. We suggest that such an innovation is unlikely to revolutionise reproduction and parenting. Indeed, in some respects it is less revolutionary than in vitro fertilisation as a whole. Furthermore, we show that solo reproduction with in vitro created gametes is not necessarily any more ethically problematic than gamete donation - and probably less so. Where appropriate, we draw parallels with the debate surrounding reproductive cloning. We note that solo reproduction may serve to perpetuate reductive geneticised accounts of reproduction, and that this may indeed be ethically questionable. However, in this it is not unique among other technologies of assisted reproduction, many of which focus on genetic transmission. It is for this reason that a ban on solo reproduction might be inconsistent with continuing to permit other kinds of reproduction that also bear the potential to strengthen attachment to a geneticised account of reproduction. Our claim is that there are at least as good reasons to pursue research towards enabling solo reproduction, and eventually to introduce solo reproduction as an option for fertility treatment, as there are to do so for other infertility related purposes.
|
|
| 7. |
- Cutas, Daniela
(författare)
-
Looking for the meaning of dignity in the bioethics convention and the cloning protocol
- 2005
-
Ingår i: Health Care Analysis. - : Kluwer Academic Publishers. - 1065-3058 .- 1573-3394. ; 13:4, s. 303-313
-
Tidskriftsartikel (refereegranskat)abstract
- This paper is focused on the analysis of two documents (the Council of Europe's Bioethics Convention and the Additional Cloning Protocol) inasmuch as they refer to the relationship between human dignity and human genetic engineering. After presenting the stipulations of the abovementioned documents, I will review various proposed meanings of human dignity and will try to identify which of these seem to be at the core of their underlying assumptions. Is the concept of dignity proposed in the two documents coherent? Is it morally legitimate? Is it, as some might assume, of Kantian origin? Does it have any philosophical roots?
|
|
| 8. |
- El-Alti, Leila, 1986, et al.
(författare)
-
Person Centered Care and Personalized Medicine: Irreconcilable Opposites or Potential Companions?
- 2019
-
Ingår i: Health Care Analysis. - : Springer Science and Business Media LLC. - 1065-3058 .- 1573-3394. ; 27:1, s. 45-59
-
Tidskriftsartikel (refereegranskat)abstract
- In contrast to standardized guidelines, personalized medicine and person centered care are two notions that have recently developed and are aspiring for more individualized health care for each single patient. While having a similar drive toward individualized care, their sources are markedly different. While personalized medicine stems from a biomedical framework, person centered care originates from a caring perspective, and a wish for a more holistic view of patients. It is unclear to what extent these two concepts can be combined or if they conflict at fundamental or pragmatic levels. This paper reviews existing literature in both medicine and related philosophy to analyze closer the meaning of the two notions, and to explore the extent to which they overlap or oppose each other, in theory or in practice, in particular regarding ethical assumptions and their respective practical implications.
|
|
| 9. |
- El-Alti, Leila, 1986
(författare)
-
Shared Decision Making in Psychiatry: Dissolving the Responsibility Problem
- 2023
-
Ingår i: Health Care Analysis. - : Springer Science and Business Media LLC. - 1065-3058 .- 1573-3394. ; 31:2, s. 65-80
-
Tidskriftsartikel (refereegranskat)abstract
- Person centered care (PCC) invites ideas of shared responsibility as a direct result of its shared decision making (SDM) process. The intersection of PCC and psychiatric contexts brings about what I refer to as the responsibility problem, which seemingly arises when SDM is applied in psychiatric settings due to (1) patients' potentially diminished capacities for responsibility, (2) tension prompted by professional reasons for and against sharing responsibility with patients, as well as (3) the responsibility/blame dilemma. This paper aims to do away with the responsibility problem through arguing for a functional approach to mental illness, a blameless responsibility ascription to the person with mental illness, as well as a nuanced understanding of SDM as part of an emancipation-oriented PCC model.
|
|
| 10. |
- Färdow, Joakim, et al.
(författare)
-
Responsibility for Funding Refractive Correction in Publicly Funded Health Care Systems: An Ethical Analysis
- 2021
-
Ingår i: Health Care Analysis. - : Springer Science and Business Media LLC. - 1573-3394 .- 1065-3058. ; 29:1, s. 59-77
-
Tidskriftsartikel (refereegranskat)abstract
- Allocating on the basis of need is a distinguishing principle in publicly funded health care systems. Resources ought to be directed to patients, or the health program, where the need is considered greatest. In Sweden support of this principle can be found in health care legislation. Today however some domains of what appear to be health care needs are excluded from the responsibilities of the publicly funded health care system. Corrections of eye disorders known as refractive errors is one such domain. In this article the moral legitimacy of this exception is explored. Individuals with refractive errors need spectacles, contact lenses or refractive surgery to do all kinds of thing, including participating in everyday activities, managing certain jobs, and accomplishing various goals in life. The relief of correctable visual impairments fits well into the category of what we typically consider a health care need. The study of refractive errors does belong to the field of medical science, interventions to correct such errors can be performed by medical means, and the skills of registered health care professionals are required when it comes to correcting refractive error. As visual impairments caused by other conditions than refractive errors are treated and funded within the public health care system in Sweden this is an inconsistency that needs to be addressed.
|
|
| 11. |
- Gottvall, Maria, et al.
(författare)
-
Informed Consent for HPV Vaccination : A Relational Approach
- 2015
-
Ingår i: Health Care Analysis. - : Springer Science and Business Media LLC. - 1065-3058 .- 1573-3394. ; 23:1, s. 50-62
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to explore the relational aspects of the consent process for HPV vaccination as experienced by school nurses, based on the assumption that individuals have interests related to persons close to them, which is not necessarily to be apprehended as a restriction of autonomy; rather as a voluntary and emotionally preferred involvement of their close ones. Thirty Swedish school nurses were interviewed in five focus groups, before the school based vaccination program had started in Sweden. The empirical results were discussed in light of theories on relational autonomy. The school nurses were convinced that parental consent was needed for HPV vaccination of 11-year-old girls, but problems identified were the difficulty to judge when a young person is to be regarded as autonomous and what to do when children and parents do not agree on the decision. A solution suggested was that obtaining informed consent in school nursing is to be seen as a deliberative process, including the child, the parents and the nurse. The nurses described how they were willing strive for a dialogue with the parents and negotiate with them in the consent process. Seeing autonomy as relational might allow for a more dialogical approach towards how consent is obtained in school based vaccination programs. Through such an approach, conflicts of interests can be made visible and become possible to deal with in a negotiating dialogue. If the school nurses do not focus exclusively on accepting the individual parent's choice, but strive to engage in a process of communication and deliberation, the autonomy of the child might increase and power inequalities might be reduced.
|
|
| 12. |
- Grill, Kalle, 1976-, et al.
(författare)
-
Ethical frameworks in public health decision-making : defending a value-based and pluralist approach
- 2017
-
Ingår i: Health Care Analysis. - : Springer. - 1065-3058 .- 1573-3394. ; 25:4, s. 291-307
-
Tidskriftsartikel (refereegranskat)abstract
- A number of ethical frameworks have been proposed to support decision-making in public health and the evaluation of public health policy and practice. This is encouraging, since ethical considerations are of paramount importance in health policy. However, these frameworks have various deficiencies, in part because they incorporate substantial ethical positions. In this article, we discuss and criticise a framework developed by James Childress and Ruth Bernheim, which we consider to be the state of the art in the field. Their framework distinguishes aims, such as the promotion of public health, from constraints on the pursuit of those aims, such as the requirement to avoid limitations to liberty, or the requirement to be impartial. We show how this structure creates both theoretical and practical problems. We then go on to present and defend a more practical framework, one that is neutral in avoiding precommitment to particular values and how they ought to be weighted. We believe ethics is at the very heart of such weightings and our framework is developed to reflect this belief. It is therefore both pluralist and value-based. We compare our new framework to Childress and Bernheim's and outline its advantages. It is justified by its impetus to consider a wide range of alternatives and its tendency to direct decisions towards the best alternatives, as well as by the information provided by the ranking of alternatives and transparent explication of the judgements that motivate this ranking. The new framework presented should be useful to decision-makers in public health, as well as being a means to stimulate further reflection on the role of ethics in public health.
|
|
| 13. |
- Grit, Kor, et al.
(författare)
-
Making Markets in Long-Term Care : Or How a Market Can Work by Being Invisible
- 2017
-
Ingår i: Health Care Analysis. - : Springer. - 1065-3058 .- 1573-3394. ; 25:3, s. 242-259
-
Tidskriftsartikel (refereegranskat)abstract
- Many Western countries have introduced market principles in health- care. The newly introduced financial instrument of ‘‘care-intensity packages’’ in the Dutch long-term care sector fit this development since they have some character- istics of a market device. However, policy makers and care providers positioned these instruments as explicitly not belonging to the general trend of marketisation in healthcare. Using a qualitative case study approach, we study the work that the two providers have done to fit these instruments to their organisations and how that enables and legitimatises market development. Both providers have done various types of work that could be classified as market development, including creating accounting systems suitable for markets, redefining public values in the context of markets, and starting commercial initiatives. Paradoxically, denying the existence of markets for long-term care and thus avoiding ideological debates on the marketi- sation of healthcare has made the use of market devices all the more likely. Making the market invisible seems to be an operative element in making the market work. Our findings suggest that Dutch long-term care reform points to the need to study the ‘making’ rather than the ‘liberalising’ of markets and that the study of healthcare markets should not be confined to those practices that explicitly label themselves as such.
|
|
| 14. |
- Gunnarson, Martin, 1979-, et al.
(författare)
-
Ethico-Political Aspects of Conceptualizing Screening : The Case of Dementia
- 2021
-
Ingår i: Health Care Analysis. - : Springer. - 1065-3058 .- 1573-3394. ; 29, s. 343-359
-
Tidskriftsartikel (refereegranskat)abstract
- While the value of early detection of dementia is largely agreed upon, populationbased screening as a means of early detection is controversial. This controversial status means that such screening is not recommended in most national dementia plans. Some current practices, however, resemble screening but are labelled “casefinding” or “detection of cognitive impairment”. Labelled as such, they may avoid the ethical scrutiny that population-based screening may be subject to. This article examines conceptualizations of screening and case-finding. It shows how the definitions and delimitations of the concepts (the what of screening) are drawn into the ethical, political, and practical dimensions that screening assessment criteria or principles are intended to clarify and control (the how of screening, how it is and how it should be performed). As a result, different conceptualizations of screening provide the opportunity to rethink what ethical assessments should take place: the conceptualizations have different ethico-political implications. The article argues that population- based systematic screening, population-based opportunistic screening, and case-finding should be clearly distinguished.
|
|
| 15. |
- Gustavsson, Erik
(författare)
-
From Needs to Health Care Needs
- 2014
-
Ingår i: Health Care Analysis. - : Springer. - 1065-3058 .- 1573-3394. ; 22:1, s. 22-35
-
Tidskriftsartikel (refereegranskat)abstract
- One generally considered plausible way to allocate resources in health care is according to people’s needs. In this paper I focus on a somewhat overlooked issue, that is the conceptual structure of health care needs. It is argued that what conceptual understanding of needs one has is decisive in the assessment of what qualifies as a health care need and what does not. The aim for this paper is a clarification of the concept of health care need with a starting point in the general philosophical discussion about needs. I outline three approaches to the concept of need and argue that they all share the same conceptual underpinnings. The concept of need is then analyzed in terms of a subject x needing some object y in order to achieve some goal z. I then discuss the relevant features of the object y and the goal z which make a given need qualify as a health care need and not just a need for anything.
|
|
| 16. |
- Gustavsson, Erik, 1982-, et al.
(författare)
-
Principles of Need and the Aggregation Thesis
- 2019
-
Ingår i: Health Care Analysis. - : Springer. - 1065-3058 .- 1573-3394. ; 27:2, s. 77-92
-
Tidskriftsartikel (refereegranskat)abstract
- Principles of need are constantly referred to in health care priority setting. The common denominator for any principle of need is that it will ascribe some kind of special normative weight to people being worse off. However, this common ground does not answer the question how a plausible principle of need should relate to the aggregation of benefits across individuals. Principles of need are sometimes stated as being incompatible with aggregation and sometimes characterized as accepting aggregation in much the same way as utilitarians do. In this paper we argue that if one wants to take principles of need seriously both of these positions have unreasonable implications. We then characterize and defend a principle of need consisting of sufficientarian elements as well as prioritarian which avoids these unreasonable implications.
|
|
| 17. |
- Holm, S, et al.
(författare)
-
Access to health care in the scandinavian countries : Ethical aspects
- 1999
-
Ingår i: Health Care Analysis. - 1065-3058 .- 1573-3394. ; 7:4, s. 321-330
-
Tidskriftsartikel (refereegranskat)abstract
- The health care systems are fairly similar in the Scandinavian countries. The exact details vary, but in all three countries the system is almost exclusively publicly funded through taxation, and most (or all) hospitals are also publicly owned and managed. The countries also have a fairly strong primary care sector (even though it varies between the countries), with family physicians to various degrees acting as gatekeepers to specialist services. In Denmark most of the GP services are free. For the patient in Norway and Sweden there are out-of-pocket co-payments for GP consultations, with upper limits, but consultations for children are free. Hospital treatment is free in Denmark while the other countries use a system with out-of-pocket co-payment. There is a very strong public commitment to access to high quality health care for all. Solidarity and equality form the ideological basis for the Scandinavian welfare state. Means testing, for instance, has been widely rejected in the Scandinavian countries on the grounds that public services should not stigmatise any particular group. Solidarity also means devoting special consideration to the needs of those who have less chance than others of making their voices heard or exercising their rights. Issues of limited access are now, however, challenging the thinking about a health care system based on solidarity.
|
|
| 18. |
- Höglund, Anna T, 1960-, et al.
(författare)
-
Ethical Dilemmas and Ethical Competence in the Daily Work of Research Nurses
- 2010
-
Ingår i: Health Care Analysis. - : Springer Science and Business Media LLC. - 1065-3058 .- 1573-3394. ; 18:3, s. 239-251
-
Tidskriftsartikel (refereegranskat)abstract
- In spite of the growing interest in nursing ethics, few studies have focused on ethical dilemmas experienced by nurses working with clinical studies as ‘research nurses’. The aim of the present study was to describe and explore ethical dilemmas that Swedish research nurses experience in their day-to-day work. In a qualitative study a purposeful sample of six research nurses from five wards of differing disciplines in four Swedish hospitals was interviewed. The analysis displayed several examples of ethical dilemmas, primarily tensions between the nurses’ obligations to the study and to the patients involved. A guiding moral principle for the nurses was patient-centeredness, where the interest of research must not override the interest of the patient. In situations where tensions between research and patient interests occurred, and doctors and nurses disagreed upon the judgement, the nurses sometimes chose to follow the doctors’ advice, and thus acted against their own moral judgment. Such situations seemed to create feelings of moral distress among the nurses. They described their profession as being ‘invisible’ and as lacking opportunities for ethical competence building. The conclusion is that research nurses frequently experience severe and difficult ethical dilemmas in their daily work. They need to be acknowledged as a particular profession in the health care organisation and encouraged to develop their specific ethical competence.
|
|
| 19. |
- Jaarsma, Pier, 1960-, et al.
(författare)
-
Autism as a Natural Human Variation : Reflections on the Claims of the Neurodiversity Movement
- 2012
-
Ingår i: Health Care Analysis. - Dordrecht : Springer. - 1065-3058 .- 1573-3394. ; 20:1, s. 20-30
-
Tidskriftsartikel (refereegranskat)abstract
- Neurodiversity has remained a controversial concept over the last decade. In its broadest sense the concept of neurodiversity regards atypical neurological development as a normal human difference. The neurodiversity claim contains at least two different aspects. The first aspect is that autism, among other neurological conditions, is first and foremost a natural variation. The other aspect is about conferring rights and in particular value to the neurodiversity condition, demanding recognition and acceptance. Autism can be seen as a natural variation on par with for example homosexuality. The broad version of the neurodiversity claim, covering low-functioning as well as high-functioning autism, is problematic. Only a narrow conception of neurodiversity, referring exclusively to high-functioning autists, is reasonable. We will discuss the effects of DSM categorization and the medical model for high functioning autists. After a discussion of autism as a culture we will analyze various possible strategies for the neurodiversity movement to claim extra resources for autists as members of an underprivileged culture without being labelled disabled or as having a disorder. We will discuss their vulnerable status as a group and what obligation that confers on the majority of neurotypicals.
|
|
| 20. |
- Johansson, Mats, et al.
(författare)
-
Empirical Fallacies in the Debate on Substituted Judgment.
- 2014
-
Ingår i: Health Care Analysis. - : Springer Science and Business Media LLC. - 1573-3394 .- 1065-3058. ; 22:1, s. 73-81
-
Tidskriftsartikel (refereegranskat)abstract
- According to 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. This standard has received a fair amount of criticism, but the objections raised are often wide of the mark. In this article we discuss three objections based on empirical research, and explain why these do not give us reason to abandon the Substituted Judgment Standard.
|
|
| 21. |
- Johnson, Ericka, et al.
(författare)
-
Viagra Selfhood: Pharmaceutical Advertising and the Visual Formation of Swedish Masculinity
- 2009
-
Ingår i: Health Care Analysis. - : Springer Science and Business Media LLC. - 1065-3058 .- 1573-3394. ; 17:2, s. 144-159
-
Tidskriftsartikel (refereegranskat)abstract
- Using material from the Pfizer sponsored website providing health information on erectile dysfunction to potential Swedish Viagra customers (www.potenslinjen.se), this article explores the public image of masculinity in relation to sexual health and the cultural techniques for creating pharmaceutical appeal. We zoom in on the targeted ideal users of Viagra, and the nationalized, racialized and sexualized identities they are assigned. As part of Pfizer’s marketing strategy of adjustments to fit the local consumer base, the ways in which Viagra is promoted for the Swedish setting is telling of what concepts of masculinity are so stable and unassailable that they can withstand the association with a drug that is, in essence, an acknowledgement of ‘failed’ masculinity and ‘dysfunctional’ sexuality. With comparative national examples, this study presents a take on the ‘glocalized’ cultural imaginary of Viagra, and the masculine subject positions it engenders.
|
|
| 22. |
- Juth, N
(författare)
-
Challenges for principles of need in health care
- 2015
-
Ingår i: Health care analysis : HCA : journal of health philosophy and policy. - : Springer Science and Business Media LLC. - 1573-3394. ; 23:1, s. 73-87
-
Tidskriftsartikel (refereegranskat)
|
|
| 23. |
|
|
| 24. |
- Liss, Per-Erik
(författare)
-
The significance of the goal of health care for the setting of priorities
- 2003
-
Ingår i: Health Care Analysis. - 1065-3058 .- 1573-3394. ; 11:2, s. 161-169
-
Tidskriftsartikel (refereegranskat)abstract
- The purpose of the article is to argue for the significance of a clarified goal of health care for the setting of priorities. Three arguments are explored. First, assessment of needs becomes necessary in so far as the principle of need should guide the priority-setting. The concept of health care need includes a goal component. This component should for rational reasons be identical with the goal of health care. Second, in order to use resources efficiently it is necessary to assess the effects of health care. It is not, however, a question of assessing whether there is an effect but a question of assessing whether there is the right effect. And what constitutes the right effect can only be determined in relation to the goal of the enterprise. Third, the health sector involves several groups of actors such as politicians, administrators, doctors, nurses, physiotherapists, occupational therapists, educationists and patients. It is common knowledge that successful teamwork requires an understanding of a common goal. The article ends with an example of a goal chosen from ethics.
|
|
| 25. |
|
|
| 26. |
- Malmqvist, Erik, 1980-
(författare)
-
Kidney sales and the analogy with dangerous employment
- 2015
-
Ingår i: Health Care Analysis. - New York : Springer Science+Business Media B.V.. - 1065-3058 .- 1573-3394. ; 23:2, s. 107-121
-
Tidskriftsartikel (refereegranskat)abstract
- Proponents of permitting living kidney sales often argue as follows. Many jobs involve significant risks; people are and should be free to take these risks in exchange for money; the risks involved in giving up a kidney are no greater than the risks involved in acceptable hazardous jobs; so people should be free to give up a kidney for money, too. This paper examines this frequently invoked but rarely analysed analogy. Two objections are raised. First, it is far from clear that kidney sales and dangerous jobs involve comparable risks on an appropriately broad comparison. Second, and more importantly, even if they do involve comparable risks it does not follow that kidney sales must be permitted because dangerous jobs are. The analogy assumes that kidney sales are banned for paternalistic reasons. But there may be other, non-paternalistic reasons for the ban. And paternalists, too, can consistently defend the ban even if kidney sales are no riskier than occupations that they find acceptable. Soft paternalists may want to protect would-be vendors from harms that they have not voluntarily chosen. Egalitarian hard paternalists may want to protect already badly off vendors from further worsening their situation. For neither species of paternalist is the size of the risk prevented decisive. I conclude that the analogy with dangerous jobs, while rhetorically powerful, pulls little real argumentative weight. Future debates on living kidney sales should therefore proceed without it.
|
|
| 27. |
- Munthe, Christian, 1962, et al.
(författare)
-
Person centred care and shared decision making: Implications for ethics, public health and research
- 2012
-
Ingår i: Health Care Analysis. - : Springer Science and Business Media LLC. - 1065-3058 .- 1573-3394. ; 20:3, s. 231-249
-
Tidskriftsartikel (refereegranskat)abstract
- This paper presents a systematic account of ethical issues actualised in different areas, as well as at different levels and stages of health care, by introducing organisational and other procedures that embody a shift towards person centred care and shared decision-making (PCC/SDM). The analysis builds on general ethical theory and earlier work on aspects of PCC/SDM relevant from an ethics perspective. This account leads up to a number of theoretical as well as empirical and practice oriented issues that, in view of broad advancements towards PCC/SDM, need to be considered by health care ethics researchers. Given a PCC/SDM-based reorientation of health care practice, such ethics research is essential from a quality assurance perspective.
|
|
| 28. |
- Murano, Maria Cristina, 1988-
(författare)
-
A Disability Bioethics Reading of the FDA and EMA Evaluations on the Marketing Authorisation of Growth Hormone for Idiopathic Short Stature Children
- 2020
-
Ingår i: Health Care Analysis. - : Springer. - 1065-3058 .- 1573-3394. ; 28:3, s. 266-282
-
Tidskriftsartikel (refereegranskat)abstract
- The diagnosis of idiopathic short stature (ISS) refers to children who are considerably shorter than average without any identified medical reason. The US Food and Drug Administration (FDA) authorised marketing of recombinant human growth hormone (hGH) for ISS in 2003, while the European Medicines Agency (EMA) refused it in 2007. This paper examines the arguments for these decisions as detailed in selected FDA and EMA documents. It combines argumentative analysis with an approach to policy analysis called ‘What’s the problem represented to be’. It argues that the FDA presents its approval as an argument for equity of access to the treatment (given that hGH was already authorised for other indications), describing short stature as a potential disadvantage, and assuming that height normalisation is a clinically meaningful result. The EMA, instead, refuses marketing authorisation with an argument that there is an imbalance of risks and benefits, describing ISS as a healthy condition, and arguing that hGH should provide some psychosocial and/or quality of life benefits to children with ISS other than height gain. This paper then discusses how these arguments could be read through different models of disability, particularly through the medical model of disability and the relational, experiential, and cultural understandings of disability.
|
|
| 29. |
- Nordenfelt, Lennart
(författare)
-
Editorial Material: Ill Health or Illness: A Reply to Hofmann
- 2013
-
Ingår i: Health Care Analysis. - : SPRINGER, VAN GODEWIJCKSTRAAT 30, 3311 GZ DORDRECHT, NETHERLANDS. - 1065-3058 .- 1573-3394. ; 21:4, s. 298-305
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- In this article I respond to Bjorn Hofmanns criticism of some elements in my theory of health. Hofmanns main objective is to question "Nordenfelts basic premise that you can be ill without having negative first-person experiences, and to investigate the consequences of abandoning the premise." One of Hofmanns critical points is that my theory of health does not lend voice to the individual. My response is essentially conducted in four steps: (1) I question the aim of conceptual analysis that Hofmann proposes for the analysis of the notion of health. (2) I maintain that my analysis, in spite of Hofmanns contention, lends voice to the individual. It does so via my notion of subjective illness but also via my notion of vital goal. (3) I argue that conditions, such as coma, paralysis and mania are salient instances of ill health and that these may become neglected if the use of the terms "ill" and "illness" is restricted to instances where negative subjective experiences are present. (4) I rehearse my main arguments for selecting disability as the core element of ill health and respond to Hofmanns contention that persons who are in great pain can sometimes nevertheless perform perfectly.
|
|
| 30. |
- Nordenfelt, Lennart, 1945-
(författare)
-
On chronic illness and quality of life
- 1995
-
Ingår i: Health Care Analysis. - 1065-3058 .- 1573-3394. ; 3, s. 290-298
-
Tidskriftsartikel (refereegranskat)
|
|
| 31. |
- Nordenfelt, Lennart
(författare)
-
On the goals of medicine, health enhancement and social welfare
- 2001
-
Ingår i: Health Care Analysis. - 1065-3058 .- 1573-3394. ; 9:1, s. 15-23
-
Tidskriftsartikel (refereegranskat)abstract
- Bengt Brulde in his article "The Goals of Medicine. Towards a Unified Theory'' has proposed a normative theory of the goals of medicine within which the concept of quality of life plays a crucial role. In Brulde's analysis, however, the very concept of medicine is deliberately left quite vague and it is therefore difficult to see how the goals of medicine are related to the goals of closely allied enterprises such as health promotion and social welfare. In this reply I therefore propose an analysis of these related conceptual areas. I do this mainly in two respects. (1) Following the nomenclature in a previously published article (Nordenfelt, 1998) I propose a systematic conceptual framework for all varieties of health enhancement and distinguish different notions of medicine within this framework. A consequence of this analysis is, for instance, that the means and also the immediate goals of medicine in its broadest sense are more diversified than the means and immediate goals of medicine in its narrowest sense. (2) From this position I expand the topic further by comparing medicine and health enhancement with social welfare and try to trace the basic features between - as well as the common properties of - these different enterprises.
|
|
| 32. |
- Nordenfelt, Lennart
(författare)
-
The varieties of dignity
- 2004
-
Ingår i: Health Care Analysis. - 1065-3058 .- 1573-3394. ; 12:2, s. 69-81
-
Tidskriftsartikel (refereegranskat)abstract
- As a part of a research project on Dignity and Older Europeans ( Fifth Framework (Quality of Life) Programme(3)) I explore in this paper a set of notions of human dignity. The general concept of dignity is introduced and characterized as a position on a value scale and it is further specified through its relations to the notions of right, respect and self-respect. I present four kinds of dignity and spell out their differences: the dignity of merit, the dignity of moral or existential stature, the dignity of identity and the universal human dignity (Menschenwurde). Menschenwurde pertains to all human beings to the same extent and cannot be lost as long as the persons exist. The dignity of merit depends on social rank and position. There are many species of this kind of dignity and it is very unevenly distributed among human beings. The dignity of merit exists in degrees and it can come and go. The dignity of moral stature is the result of the moral deeds of the subject, likewise it can be reduced or lost through his or her immoral deeds. This kind of dignity is tied to the idea of a dignified character and of dignity as a virtue. The dignity of moral stature is a dignity of degree and it is also unevenly distributed. The dignity of identity is tied to the integrity of the subject's body and mind, and in many instances, although not always, also dependent on the subject's self-image. This dignity can come and go as a result of the deeds of fellow human beings and also as a result of changes in the subject's body and mind.
|
|
| 33. |
- Nordgren, Anders, 1953-
(författare)
-
Privacy by design in personal health monitoring
- 2015
-
Ingår i: Health Care Analysis. - : Springer-Verlag New York. - 1065-3058 .- 1573-3394. ; 23:2, s. 148-164
-
Tidskriftsartikel (refereegranskat)abstract
- The concept of privacy by design is becoming increasingly popular among regulators of information and communications technologies. This paper aims at analysing and discussing the ethical implications of this concept for personal health monitoring. I assume a privacy theory of restricted access and limited control. On the basis of this theory, I suggest a version of the concept of privacy by design that constitutes a middle road between what I call broad privacy by design and narrow privacy by design. The key feature of this approach is that it attempts to balance automated privacy protection and autonomously chosen privacy protection in a way that is context-sensitive. In personal health monitoring, this approach implies that in some contexts like medication assistance and monitoring of specific health parameters one single automatic option is legitimate, while in some other contexts, for example monitoring in which relatives are receivers of health-relevant information rather than health care professionals, a multi-choice approach stressing autonomy is warranted.
|
|
| 34. |
- Nordgren, Anders, 1953-
(författare)
-
Remote monitoring or close encounters? : Ethical considerations in priority setting regarding telecare
- 2014
-
Ingår i: Health Care Analysis. - : Springer. - 1065-3058 .- 1573-3394. ; 22:4, s. 325-339
-
Tidskriftsartikel (refereegranskat)abstract
- The proportion of elderly in society is growing rapidly, leading to increasing health care costs. New remote monitoring technologies are expected to lower these costs by reducing the number of close encounters with health care professionals, for example the number of visits to health care centres. In this paper, I discuss issues of priority setting raised by this expectation. As a starting-point, I analyse the recent debate on principles for priority setting in Sweden. The Swedish debate illustrates that developing an approach to priority setting is an ongoing process. On the basis of this analysis, I conclude that several different ethical principles, and specifications of these principles, can be appealed to for giving priority—over close encounters—to a large-scale introduction of remote monitoring technologies in health care services to elderly people, but also that many specifications can be appealed to against giving such priority. I propose that given the different views on principles, it is necessary to develop fair procedures of deliberation on these principles and their application, in particular in order to reach agreement on exactly how much resources should be allocated to remote monitoring and how much to close encounters. I also present a few points to consider in a large-scale introduction of remote monitoring.
|
|
| 35. |
- Nordgren, Anders, 1953-
(författare)
-
The Web-Rhetoric of Companies Offering Home-Based Personal Health Monitoring
- 2012
-
Ingår i: Health Care Analysis. - : Springer. - 1065-3058 .- 1573-3394. ; 20:2, s. 103-118
-
Tidskriftsartikel (refereegranskat)abstract
- In this paper I investigate the web-rhetoric of companies offering homebasedpersonal health monitoring to patients and elderly people. Two main rhetoricalmethods are found, namely a reference to practical benefits and a use ofprestige words like ‘‘quality of life’’ and ‘‘independence’’. I interpret the practicalbenefits in terms of instrumental values and the prestige words in terms of finalvalues. I also reconstruct the arguments on the websites in terms of six differenttypes of argument. Finally, I articulate a general critique of the arguments, namelythat the websites neglect the context of use of personal health monitoring technologies.Whether or not a technology is good depends on the use of the technologyby a particular individual in a particular context. The technology is not good–orbad–in itself. I support this critique with a number of more specific arguments suchas the risk for reduced personal contact. For some elderly people social contact withcare providers is more valuable than the independent living made possible byremote monitoring, for others independence is more important.
|
|
| 36. |
- Omar, Faisal, et al.
(författare)
-
Compensated living kidney donation : a plea for pragmatism
- 2010
-
Ingår i: Health Care Analysis. - : Springer Science and Business Media LLC. - 1065-3058 .- 1573-3394. ; 18:1, s. 85-101
-
Tidskriftsartikel (refereegranskat)abstract
- Kidney transplantation is the most efficacious and cost-effective treatment for end-stage renal disease. However, the treatment's accessibility is limited by a chronic shortage of transplantable kidneys, resulting in the death of numerous patients worldwide as they wait for a kidney to become available. Despite the implementation of various measures the disparity between supply and needs continues to grow. This paper begins with a look at the current treatment options, including various sources of transplantable kidneys, for end-stage renal disease. We propose, in accordance with others, the introduction of compensated kidney donation as a means of addressing the current shortage. We briefly outline some of the advantages of this proposal, and then turn to examine several of the ethical arguments usually marshaled against it in a bid to demonstrate that this proposal indeed passes the ethics test. Using available data of public opinions on compensated donation, we illustrate that public support for such a program would be adequate enough that we can realistically eliminate the transplant waiting list if compensation is introduced. We urge a pragmatic approach going forward; altruism in living kidney donation is important, but altruism only is an unsuccessful doctrine.
|
|
| 37. |
- Palm, Elin, 1973-
(författare)
-
A Declaration of Healthy Dependence : The case of home care
- 2014
-
Ingår i: Health Care Analysis. - : Springer. - 1065-3058 .- 1573-3394. ; 22:4, s. 385-404
-
Tidskriftsartikel (refereegranskat)abstract
- Aging populations have become a major concern in the developed world and are expected to require novel care strategies. Public policies, health-care regimes and technology developers alike stress the need for a more individualized care to meet the increased demand for care services in response to demographic change. Increasingly, care services are offered to individuals with diseases and or disabilities in their homes by means of Personalized Health-Monitoring (PHM) technologies. PHM-based home care is typically portrayed as the key to a cost-effective future care that better can accommodate the needs of an aging population and promote care recipients’ independence. In light of the emerging technology-based home care, this article sets forth to investigate the significance and implications of a strong emphasis on independence in relation to this novel care form. Notions of independence as used by care planners, care providers and technology developers are examined in relation to ICT-based home care and the reasonableness of independence as an aim for future health-care is critically discussed. In conclusion, the need for a shift from a strong emphasis on independence to a right to healthy dependence is advocated.
|
|
| 38. |
- Palm, Elin, 1973-
(författare)
-
Who cares? : Moral obligations in formal and informal care provision in the light of ICT-based home care
- 2013
-
Ingår i: Health Care Analysis. - : Springer Science and Business Media LLC. - 1065-3058 .- 1573-3394. ; 21:2, s. 171-188
-
Tidskriftsartikel (refereegranskat)abstract
- An aging population is often taken to require a profound reorganization of the prevailing health care system. In particular, a more cost-effective care system is warranted and ICT-based home care is often considered a promising alternative. Modern health care devices admit a transfer of patients with rather complex care needs from institutions to the home care setting. With care recipients set up with health monitoring technologies at home, spouses and children are likely to become involved in the caring process and informal caregivers may have to assist kin-persons with advanced care needs by means of sophisticated technology. This paper investigates some of the ethical implications of a near-future shift from institutional care to technology-assisted home care and the subsequent impact on the care recipient and formal- and informal care providers.
|
|
| 39. |
- Persson, Anders, 1958-, et al.
(författare)
-
Profitable exchanges for scientists: The case of Swedish human embryonic stem cell research
- 2007
-
Ingår i: Health Care Analysis. - : Springer Science and Business Media LLC. - 1065-3058 .- 1573-3394. ; 15, s. 291-304
-
Tidskriftsartikel (refereegranskat)abstract
- In this article two inter-related issues concerning the ongoing commercialisation of biomedical research are analyzed. One aim is to explain how scientists and clinicians at Swedish public institutions can make profits, bot commercially and scientifically, by controlling rare human biological material, like embryos and embryonic stem cell lines. This control in no way presupposes legal ownership or other property rights as initial condition. We show how ethically sensitive material (embryos and stem cell lines) have been used in Sweden as a foundation for a commercial stem cell enterprise-despite all official Swedish strictures agaisnt commercilaisation in this area. We also show how political decisions may amplify the value of controlling this kind of biological material. Another aim of the article is to analyze and discuss the meaning of this kind of academic commercial enterprise in a wider context of research funding strategies. A conclusion that is drawn is that the academic turn to commercial funding sources is dependent on the decline of public funding.
|
|
| 40. |
- Persson, Karl
(författare)
-
Why Bariatric Surgery Should be Given High Priority: An Argument from Law and Morality
- 2014
-
Ingår i: Health Care Analysis. - : Springer Science and Business Media LLC. - 1065-3058 .- 1573-3394. ; 22:4, s. 305-324
-
Tidskriftsartikel (refereegranskat)abstract
- In recent years, bariatric surgery has become an increasingly popular treatment of obesity. The amount of resources spent on this kind of surgery has led to a heated debate among health care professionals and the general public, as each procedure costs at minimum $14,500 and thousands of patients undergo surgery every year. So far, no substantial argument for or against giving this treatment a high priority has, however, been presented. In this article, I argue that regardless which moral perspective we consider-greatest need, utility or personal responsibility-the conclusion is that we should give bariatric surgery a high priority when allocating scarce resources in health care.
|
|
| 41. |
- Sandman, Lars, et al.
(författare)
-
Shared Decision Making, Paternalism and Patient Choice
- 2010
-
Ingår i: Health Care Analysis. - : Springer Science and Business Media LLC. - 1065-3058 .- 1573-3394. ; 18:1, s. 60-84
-
Tidskriftsartikel (refereegranskat)abstract
- In patient centred care, shared decision making is a central feature and widely referred to as a norm for patient centred medical consultation. However, it is far from clear how to distinguish SDM from standard models and ideals for medical decision making, such as paternalism and patient choice, and e.g., whether paternalism and patient choice can involve a greater degree of the sort of sharing involved in SDM and still retain their essential features. In the article, different versions of SDM are explored, versions compatible with paternalism and patient choice as well as versions that go beyond these traditional decision making models. Whenever SDM is discussed or introduced it is of importance to be clear over which of these different versions are being pursued, since they connect to basic values and ideals of health care in different ways. It is further argued that we have reason to pursue versions of SDM involving, what is called, a high level dynamics in medical decision-making. This leaves four alternative models to choose between depending on how we balance between the values of patient best interest, patient autonomy, and an effective decision in terms of patient compliance or adherence: Shared Rational Deliberative Patient Choice, Shared Rational Deliberative Paternalism, Shared Rational Deliberative Joint Decision, and Professionally Driven Best Interest Compromise. In relation to these models it is argued that we ideally should use the Shared Rational Deliberative Joint Decision model. However, when the patient and professional fail to reach consensus we will have reason to pursue the Professionally Driven Best Interest Compromise model since this will best harmonise between the different values at stake: patient best interest, patient autonomy, patient adherence and a continued care relationship.
|
|
| 42. |
- Sandman, Lars
(författare)
-
Should people die a natural death?
- 2005
-
Ingår i: Health Care Analysis. - : Springer New York LLC. - 1065-3058 .- 1573-3394. ; 13:4, s. 275-287
-
Tidskriftsartikel (refereegranskat)abstract
- In the article the concept of natural death as used in end-of-life decision contexts is explored. Reviewing some recent empirical studies on end-of-life decisionmaking, it is argued that the concept of natural death should not be used as an action-guiding concept in end-of-life decisions both for being too imprecise and descriptively open in its current use but mainly since it appears to be superfluous to the kind of considerations that are really at stake in these situations. Considerations in terms of the quality of life cost of the intervention in relation to the quality and length of life benefits of the same intervention. In referring to the concept of natural death we risk to blur these considerations and end up in difficult distinctions between what is a natural and non- or un-natural death, a distinction which it is argued is of no real moral interest.
|
|
| 43. |
- Sandman, Lars, 1965-, et al.
(författare)
-
Should Severity Assessments in Healthcare Priority Setting be Risk- and Time-Sensitive?
- 2023
-
Ingår i: Health Care Analysis. - : Springer. - 1065-3058 .- 1573-3394. ; 31:3-4, s. 169-185
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Severity plays an essential role in healthcare priority setting. Still, severity is an under-theorised concept. One controversy concerns whether severity should be risk- and/or time-sensitive. The aim of this article is to provide a normative analysis of this question. Methods: A reflective equilibrium approach is used, where judgements and arguments concerning severity in preventive situations are related to overall normative judgements and background theories in priority-setting, aiming for consistency. Analysis, discussion, and conclusions: There is an argument for taking the risk of developing a condition into account, and we do this when we consider the risk of dying in the severity assessment. If severity is discounted according to risk, this will dilute severity, depending on how well we are able to delineate the population, which is dependent on the current level of knowledge. This will potentially have a more far-reaching effect when considering primary prevention, potentially the de-prioritisation of effective preventive treatments in relation to acute, less-effective treatments. The risk arguments are dependent on which population is being assessed. If we focus on the whole population at risk, with T-0 as the relevant population, this supports the risk argument. If we instead focus on the population of as-yet (at T-0) unidentified individuals who will develop the condition at T-1, risk will become irrelevant, and severity will not be risk sensitive. The strongest argument for time-sensitive severity (or for discounting future severity) is the future development of technology. On a short timescale, this will differ between different diagnoses, supporting individualised discounting. On a large timescale, a more general discounting might be acceptable. However, we need to also consider the systemic effects of allowing severity to be risk- and time-sensitive.
|
|
| 44. |
|
|
| 45. |
- Sandman, Lars, et al.
(författare)
-
The (Ir)relevance of Group Size in Health Care Priority Setting: A Reply to Juth
- 2017
-
Ingår i: Health Care Analysis. - : SPRINGER. - 1065-3058 .- 1573-3394. ; 25:1, s. 21-33
-
Tidskriftsartikel (refereegranskat)abstract
- How to handle orphan drugs for rare diseases is a pressing problem in current health-care. Due to the group size of patients affecting the cost of treatment, they risk being disadvantaged in relation to existing cost-effectiveness thresholds. In an article by Niklas Juth it has been argued that it is irrelevant to take indirectly operative factors like group size into account since such a compensation would risk discounting the use of cost, a relevant factor, altogether. In this article we analyze Juths argument and observe that we already do compensate for indirectly operative factors, both outside and within cost-effectiveness evaluations, for formal equality reasons. Based on this we argue that we have reason to set cost-effectiveness thresholds to integrate equity concerns also including formal equality considerations. We find no reason not to compensate for group size to the extent we already compensate for other factors. Moreover, groups size implying a systematic disadvantage also on a global scale, i.e. taking different aspects of the health condition of patients suffering from rare diseases into account, will provide strong reason for why group size is indeed relevant to compensate for (if anything).
|
|
| 46. |
- Sandman, Lars, et al.
(författare)
-
Why We Dont Need "Unmet Needs"! On the Concepts of Unmet Need and Severity in Health-Care Priority Setting
- 2019
-
Ingår i: Health Care Analysis. - : SPRINGER. - 1065-3058 .- 1573-3394. ; 27:1, s. 26-44
-
Tidskriftsartikel (refereegranskat)abstract
- In health care priority setting different criteria are used to reflect the relevant values that should guide decision-making. During recent years there has been a development of value frameworks implying the use of multiple criteria, a development that has not been accompanied by a structured conceptual and normative analysis of how different criteria relate to each other and to underlying normative considerations. Examples of such criteria are unmet need and severity. In this article these crucial criteria are conceptually clarified and analyzed in relation to each other. We argue that disease-severity and condition-severity should be distinguished and we find the latter concept better reflects underlying normative values. We further argue that unmet need does not fulfil an independent and relevant role in relation to condition-severity except for in some limited situations when having to distinguish between conditions of equal severity (and where other features also equals each other).
|
|
| 47. |
- Segerdahl, Pär, 1962-
(författare)
-
The Invisible Patient : Concerns about Donor Exploitation in Stem Cell Research
- 2022
-
Ingår i: Health Care Analysis. - : Springer. - 1065-3058 .- 1573-3394. ; 20:3-4, s. 240-253
-
Tidskriftsartikel (refereegranskat)abstract
- As embryonic stem cell research is commercialized, the stem cell debate may shift focus from concerns about embryo destruction to concerns about exploitation of the women who donate eggs and embryos for research. Uncomfortable with the polarization of the embryo debate, this paper proposes a more “contemplative” approach than intellectual debate to concerns about exploitation. After examining pitfalls of rigid intellectual positions on exploitation, the paper investigates the possibility of a broader understanding of donation for research where patients are seen as the intended beneficiaries of the donation. Together with other actors, research is perceived as mediating altruistic gift relationships that extend from donors to patients. The paper explores how this broader perspective on “donation for research” can open up new possibilities of understanding donation and addressing risks of exploitation.
|
|
| 48. |
- Shutzberg, Mani
(författare)
-
The Doctor as Parent, Partner, Provider… or Comrade? Distribution of Power in Past and Present Models of the Doctor-Patient Relationship
- 2021
-
Ingår i: Health Care Analysis. - : Springer. - 1065-3058 .- 1573-3394. ; 29, s. 231-248
-
Tidskriftsartikel (refereegranskat)abstract
- The commonly occurring metaphors and models of the doctor-patient relationship can be divided into three clusters, depending on what distribution of power they represent: in the paternalist cluster, power resides with the physician; in the consumer model, power resides with the patient; in the partnership model, power is distributed equally between doctor and patient. Often, this tripartite division is accepted as an exhaustive typology of doctor-patient relationships. The main objective of this paper is to challenge this idea by introducing a fourth possibility and distribution of power, namely, the distribution in which power resides with neither doctor nor patient. This equality in powerlessness-the hallmark of "the age of bureaucratic parsimony"-is the point of departure for a qualitatively new doctor-patient relationship, which is best described in terms of solidarity between comrades. This paper specifies the characteristics of this specific type of solidarity and illustrates it with a case study of how Swedish doctors and patients interrelate in the sickness certification practice.
|
|
| 49. |
- Smajdor, Anna, et al.
(författare)
-
Will Artificial Gametes End Infertility?
- 2015
-
Ingår i: Health Care Analysis. - : Springer Science and Business Media LLC. - 1065-3058 .- 1573-3394. ; 23:2, s. 134-147
-
Tidskriftsartikel (refereegranskat)abstract
- In this paper we will look at the various ways in which infertility can be understood and at how need for reproductive therapies can be construed. We will do this against the background of research with artificial gametes (AGs). Having explored these questions we will attempt to establish the degree to which technologies such as AGs could expand the array of choices that people have to reproduce and/or become parents. Finally, we will examine whether and in what ways the most promising developments of such technologies are likely to bring about the “end of infertility”.
|
|
| 50. |
- Tengland, Per-Anders
(författare)
-
Behavior Change Or Empowerment : On the Ethics of Health Promotion Goals
- 2016
-
Ingår i: Health Care Analysis. - : Springer. - 1065-3058 .- 1573-3394. ; 24:1, s. 24-46
-
Tidskriftsartikel (refereegranskat)abstract
- One important ethical issue for health promotion and public health work is to determine what the goals for these practices should be. This paper will try to clarify what some of these goals are thought to be, and what they ought to be. It will specifically discuss two different approaches to health promotion, such as, behavior change and empowerment. The general aim of this paper is, thus, to compare the behavior-change approach and the empowerment approach, concerning their immediate (instrumental) goals or aims, and to morally evaluate the strengths and weaknesses of these two goal models, in relation to the ultimate goal of health promotion. The investigation shows that the behavior-change approach has several moral problems. First of all, it is overly paternalistic and often disregards the individual’s or group’s own perception of what is important—something that also increases the risk of failed interventions. Furthermore, it risks leading to ‘victim blaming’ and stigmatization, and to increased inequalities in health, and it puts focus on the ‘wrong’ problems, i.e., behavior instead of the ‘causes of the causes’. It is thereafter shown that the empowerment approach does not have any of these problems. Finally, some specific problems for the empowerment approach are discussed and resolved, such as, the idea that empowering some groups might lead to power over others, the objection that the focus is not primarily on health (which it should be), and the fact that empowered people might choose to live lives that risk reducing their health.
|
|
