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| 2. |
- Helgesson, Gert, et al.
(författare)
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Reasoning about physician-assisted suicide : analysis of comments by physicians and the Swedish general public
- 2009
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Ingår i: Clinical Ethics. - : Sage Publications. - 1477-7509 .- 1758-101X. ; 4:1, s. 19-25
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Tidskriftsartikel (refereegranskat)abstract
- Two questionnaires directed to Swedish physicians and a sample of the Swedish population investigated attitudes towards physician-assisted suicide (PAS). The aim of the present work was to analyse qualitative data from these questionnaires in order to explore how respondents reason about PAS. Data were analysed in two steps. First, we categorized different kinds of responses and identified pro and con arguments. Second, we identified general conclusions from the responses. The data reflect the differences in attitudes towards PAS among the public and physicians, with the former mainly in favour of PAS and the latter mainly against. There was, however, considerable agreement about what requirements must be met before PAS could be considered ethical. Many arguments against PAS concerned the professional role of physicians, which indicates that it may not be assisted suicide as such that many PAS opponents disagree with, but rather that it is handled by physicians in the regular health-care system.
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| 3. |
- Hoeyer, Klaus, et al.
(författare)
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Motivating donors to genetic research? Anthropological reasons to rethink the role of informed consent.
- 2006
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Ingår i: Medicine, Health care and Philosophy. - : Springer Science and Business Media LLC. - 1386-7423 .- 1572-8633. ; 9:1, s. 13-23
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Tidskriftsartikel (refereegranskat)abstract
- In this article we explore the contribution from social anthropology to the medical ethical debates about the use of informed consent in research, based on blood samples and other forms of tissue. The article springs from a project exploring donors' motivation for providing blood and healthcare data for genetic research to be executed by a Swedish start-up genomics company. This article is not confined to empirical findings, however, as we suggest that anthropology provides reason to reassess the theoretical understanding of autonomy as generally defined by Beauchamp and Childress. Careful consideration of the trust expressed by donors through the act of donation, furthermore, suggests that there is reason to redirect the ethical scrutiny from informed consent to issues concerning institutional arrangements and social responsibility. In particular, we suggest that an anthropological approach could facilitate a reconsideration of the political implications of using informed consent as a regulatory practice in tissue-based research.
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| 4. |
- Hoeyer, Klaus, et al.
(författare)
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The ethics of research using biobanks : reason to question the importance attributed to informed consent.
- 2005
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Ingår i: Archives of Internal Medicine. - : American Medical Association (AMA). - 0003-9926 .- 1538-3679. ; 165:1, s. 97-100
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: During the past decade, the use of stored tissue has become an object of increased ethical query. A Swedish biobank and a biotech company have been praised for solving the ethical problems with explicit informed consent procedures, and we decided to investigate donors' perceptions of the system. METHODS: A questionnaire was sent to a randomized sample of 1200 donors who had donated blood and signed informed consent forms. RESULTS: The response rate was 80.9%. Of the respondents, 64.5% were aware that they had consented to donate a blood sample, 55.4% thought that they had consented to donate phenotypic information, and 31.6% believed that they could withdraw their consent. Among respondents, 3.9% considered informing donors about the research objective as the most important ethical issue in relation to biobanks, and 5.6% were unsatisfied with the information they had been given. There was 85.9% acceptance of surrogate decision making by regional research ethics committees. CONCLUSIONS: Considering that the donors in this study were not always aware of their donation but generally were not unsatisfied with the information they had received, and that they did not rate being informed about the research objective as an important issue, informed consent seems to be an inadequate measure of public acceptance of biobank-based research.
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| 5. |
- Högberg, Ulf, et al.
(författare)
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Cesarean by choice? Empirical study of public attitudes.
- 2008
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 87:12, s. 1301-1308
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study examines public attitudes towards maternal requests for cesarean delivery and its association with health care and birth experiences. In addition, this study attempts to ascertain whether gender, age and residence influence these attitudes. DESIGN: Cross-sectional population survey with a postal questionnaire. SETTING: The counties of Stockholm and Vasterbotten in Sweden. POPULATION: Equal numbers of women and men between 20 and 80 years of age (n=2,000) by population size and gender distribution. METHODS: Descriptive statistics and content analysis. RESULTS: Of the 1,066 women (53%) who responded, two-thirds stated that a cesarean should be decided on for medical reasons and by a doctor. One-third considered that a woman, without persuasion, should decide herself about mode of delivery and should be free to choose a cesarean. These respondents used arguments such as women's rights, bodily integrity and childbirth fear. The results were associated with low trust in health care, women being young or middle aged, urban living and having no children. Low trust in health care was associated with experiences of insecurity, vulnerability and perceived maltreatment. CONCLUSION: Public norms towards women's own decision making on mode of delivery are associated with younger age, lower trust in health care and urban living. Antenatal care will encounter more parents asking for a cesarean and demanding that health professionals provide an ethically appropriate informed consent process. Considering the risk of violating young women's trust if not respecting her wish, it seems reasonable that making decisions whether or not to perform a cesarean is part of shared decision making.
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| 6. |
- Lynöe, Niels, et al.
(författare)
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Enkätstudie om medicinsk etik i läkarutbildningen: Goda förebilder och tid för reflektion saknas
- 2007
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Ingår i: Läkartidningen. ; 9:104, s. 676-678
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Tidskriftsartikel (refereegranskat)abstract
- Cirka tre fjärdedelar av läkarstuderande har varit i kontakt med goda förebilder, och drygt hälften har varit i kontakt med dåliga.En tiondel av läkarstuderande har enbart varit i kontakt med dåliga förebilder.Mindre än 40 procent har varit med om att läkare/lärare lyft fram etiska problem, och fler har erfarenhet av att läkare/ lärare enbart ger sin egen bedömning utan att ge utrymme för diskussion.Det förefaller vara riskabelt att enbart förlita sig på att läkare/lärare fungerar som goda förebilder och att etikdiskussionen är integrerad i den kliniska undervisningen.För att utveckla ett etiskt förhållningssätt bör undervisningen i medicinsk etik kompletteras med kunskaper i den etiska grammatiken.
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| 7. |
- Lynöe, Niels, et al.
(författare)
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Från läkarpaternalism till patientautonomi
- 2009
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 106:52, s. 3500-3502
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Tidskriftsartikel (refereegranskat)abstract
- Patientens ställning har stärkts, och ett paternalistiskt bemötande är inte längre gångbart.Att respektera en patients autonomi innebär att både respektera patients beslut och stärka och bevara patientens beslutsförmåga.Läkare förväntas i dag respektera en beslutskapabel patients autonomi beträffande rätten att tacka nej till erbjuden utredning och behandling.På samma sätt som läkare bör respektera patienters autonomi bör patienter respektera läkares professionella autonomi, som baseras på vetenskap och beprövad erfarenhet.Vetenskap och beprövad erfarenhet inbegriper både fakta- och värderingsaspekter, och i en etisk analys bör man förtydliga båda aspekterna.
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| 8. |
- Lynöe, Niels, et al.
(författare)
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Goda förebilder och tid för reflektion saknas : enkätstudie om medicinsk etik i läkarutbildningen
- 2007
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Ingår i: Läkartidningen. - Stockholm : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. ; 104:9, s. 676-678
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Tidskriftsartikel (refereegranskat)abstract
- Cirka tre fjärdedelar av läkarstuderande har varit i kontakt med goda förebilder, och drygt hälften har varit i kontakt med dåliga. En tiondel av läkarstuderande har enbart varit i kontakt med dåliga förebilder. Mindre än 40 procent har varit med om att läkare/lärare lyft fram etiska problem, och fler har erfarenhet av att läkare/lärare enbart ger sin egen bedömning utan att ge utrymme för diskussion. Det förefaller vara riskabelt att enbart förlita sig på att läkare/lärare fungerar som goda förebilder och att etikdiskussionen är integrerad i den kliniska undervisningen. För att utveckla ett etiskt förhållningssätt bör undervisningen i medicinsk etik kompletteras med kunskaper i den etiska grammatiken.
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| 9. |
- Lynöe, Niels, et al.
(författare)
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[Patient participation in clinical training of medical students. Interviews with teachers, patients and students]
- 2008
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Ingår i: Lakartidningen. - 0023-7205. ; 105:38, s. 2568-71
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- SAMMANFATTATNiels Lynöe, Solvig Ekblad, Göran ElinderE-MAIL niels.lynoe@ki.sePatienter ställer gärna upp i den kliniska undervisningen men vill informeras i förväg och föredrar att bara en student deltar. Om patienten känner sig exploaterad är han/hon mindre benägen att ställa upp nästa gång han/hon tillfrågas.Läkarstudenter letar efter goda förebilder och känner sig obekväma om läraren behandlar patienten respektlöst – de är sig enbart att "så ska jag aldrig själv göra". Läkare bör vara uppmärksamma på att den kliniska undervisningen kan bli kontroproduktiv om man inte visar respekt för patientens självbestämmande. Vid undervisning i undersökningsteknik och diagnostik förmedlas indirekt undervisning i medicinsk etik genom det goda eller dåliga etiska förhållningssätt som läraren visar.
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| 10. |
- Rydvall, Anders, et al.
(författare)
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Decision making in a life-threatening cerebral condition : a comparative study of the ethical reasoning of intensive care unit physicians and neurosurgeons
- 2007
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 51:10, s. 1338-1343
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Severe traumatic brain injury (TBI) is one of the major causes of death in younger age groups. In Umea, Sweden, an intracranial pressure (ICP) targeted therapy protocol, the Lund concept, has been used in treatment of severe TBI since 1994. Decompressive craniectomy is used as a protocol-guided treatment step. The primary aim of the investigation was to study the effect of craniectomy on ICP changes over time in patients with severe TBI treated by an ICP-targeted protocol. In this retrospective study, all patients treated for severe TBI during 1998-2001 who fulfilled the following inclusion criteria were studied: GCS 10 mm Hg, arrival within 24 h of trauma, and need of intensive care for >72 h. Craniectomy was performed when the ICP could not be controlled by evacuation of hematomas, sedation, ventriculostomy, or low-dose pentothal infusion. Ninety-three patients met the inclusion criteria. Mean age was 37.6 years. Twenty-one patients underwent craniectomy as a treatment step. We found a significant reduction of the ICP directly after craniectomy, from 36.4 mm Hg (range, 18-80 mm Hg) to 12.6 mm Hg (range, 2-51 mm Hg). During the following 72 h, we observed an increase in ICP during the first 8-12 h after craniectomy, reaching approximately 20 mm Hg, and later levelling out at approximately 25 mm Hg. The reduction of ICP was statistically significant during the 72 h. The outcome as measured by Glasgow Outcome Scale (GOS) did not significantly differ between the craniectomized group (DC) and the non-craniectomized group (NDC). The outcome was favorable (GOS 5-4) in 71% in the craniectomized group, and in 61% in the non-craniectomized group. Craniectomy is a useful tool in achieving a significant reduction of ICP overtime in TBI patients with progressive intracranial hypertension refractory to medical therapy. The procedure seems to have a satisfactory effect on the outcome, as demonstrated by a high rate of favorable outcome and low mortality in the craniectomized group, which did not significantly differ compared with the non-craniectomized group.
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