| 1. |
- Girma Kebede, Betlehem, et al.
(författare)
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Communicative challenges among physicians, patients, and family caregivers in cancer care: An exploratory qualitative study in Ethiopia
- 2020
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cancer is a growing concern in Ethiopia. Though communication is essential for the treatment process, few studies have looked at communication in Ethiopian cancer care. Due to the large number of patients and scarcity of resources, it is vital to understand how to manage consultations in order to effectively help as many patients as possible in this challenging work environment. Thus, research is needed to analyze and understand the communicative challenges experienced by physicians, patients, and family caregivers, in order to successfully handle patient care in practice. Objective We explore communication in Ethiopian cancer care and present the main challenges faced by physicians, patients, and family caregivers. Methods This explorative qualitative study was conducted at the Oncology Department of the Tikur Anbessa (Black Lion) Specialized Teaching Hospital (TASH) in Addis Ababa, Ethiopia. A triangulation of data collection methods was used: 91 audio-recorded, semi-structured interviews and 21 video-recordings of authentic interactions during hospital rounds. The aim was to obtain as complete a picture as possible of communication from the perspectives of physicians, patients, and family caregivers. The interviews were analyzed using thematic content analysis and the identified themes were supported by excerpts from the transcribed recordings. Results Eight themes emerged from the data. Workload and time pressure, in combination with restricted space for privacy, limited the possibilities for physicians to deliver detailed information and provide emotional support. Furthermore, patient literacy levels, in combination with no or little cancer awareness, financial problems, reliance on traditional and religious treatments, the stigma of cancer, and a fatalistic attitude, resulted in delays in patients seeking care and participating in positive health behaviors, and, subsequently, often resulted in an unwillingness to openly discuss problems with physicians and adhere to treatment. The study also illustrates the paramount role of family in physician-patient communication in Ethiopia. Though family caregivers provide a valuable interpreting support when patients have limited language skills, they can also prevent patients from sharing information with physicians. Another important finding is that family caregivers were often responsible for making decisions about treatment and avoided telling patients about a poor prognosis, believing that conveying bad news may upset them. All of these themes have important implications for the role of ethically acceptable communication in patient-centered care. Conclusions This study has identified a number of serious challenges for successful and ethically acceptable health communication in Ethiopian cancer care. The study contributes to our understanding of the complexity around the role of family, combined with patients’ dependency on family members for communication, support, and access to care, which creates particular ethical dilemmas for the medical staff. The questions raised by this study concern how to organize consultations to achieve patient-centered health communication, while maintaining a constructive alliance with the family and not jeopardizing the patient’s continued access to care. The integration of communication training for medical students in Ethiopia, with a focus on ethical guidelines for family-centered patient consultation suitable for these circumstances, would be an essential step.
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| 2. |
- Munthe, Christian, 1962, et al.
(författare)
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Sustainability principle for the ethics of healthcare resource allocation
- 2021
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Ingår i: Journal of Medical Ethics. - : BMJ. - 0306-6800 .- 1473-4257. ; 47:2, s. 90-97
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Tidskriftsartikel (refereegranskat)abstract
- We propose a principle of sustainability to complement established principles used for justifying healthcare resource allocation. We argue that the application of established principles of equal treatment, need, prognosis and cost-effectiveness gives rise to what we call negative dynamics: a gradual depletion of the value possible to generate through healthcare. These principles should therefore be complemented by a sustainability principle, making the prospect of negative dynamics a further factor to consider, and possibly outweigh considerations highlighted by the other principles. We demonstrate how this principle may take different forms, and show that a commitment to sustainability is supported by considerations internal to the ethical principles already guiding healthcare resource allocation. We also consider two objections. The first of these, we argue, is either based on implausible assumptions or begs the question, whereas the second can be adequately accommodated by the principle we propose.
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| 3. |
- Munthe, Christian, 1962
(författare)
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Pragmatic Challenges in Practical Ethics
- 2023
-
Ingår i: In: Garcia, A., Gunnemyr, M. & Werkmäster, J. Value, Morality & Social Reality: Essays dedicated to Dan Egonsson, Björn Petersson & Toni Rønnow-Rasmussen.. - Lund : Department of Philosophy, Lund University. - 9789189415669 ; , s. 275-285
-
Bokkapitel (refereegranskat)abstract
- This brief essay traces a development of orthodox applied ethics into a present-day variant of practical ethics, where pragmatic reasons may upset ideal theoretically and empirically informed epistemically supported ethical prescriptions when these are to be implemented in a real context. This shift comes with a development where the applied ethicists of older days are nowadays aiming for much more specific and practically useful action-guidance, and for activist involvement to support feasible implementation of ethical prescriptions. This results in a strongly and moderately activist variant of practical ethics, both of which face specific challenges due to the necessity of considering pragmatic reasons. I argue that the radical variant has trouble managing these challenges. The moderate variant may manage them, but this may require substantial methodological development.
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| 4. |
- Berbyuk Lindström, Nataliya, 1978, et al.
(författare)
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Person- and Family-Centeredness in Ethiopian Cancer Care: Improving Communication, Ethics, Decision Making and Health
- 2020
-
Ingår i: JMIR Research Protocols. - : JMIR Publications Inc.. - 1929-0748. ; 9:5
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cancer is a major burden in Ethiopia. The Oncology Department of Tikur Anbessa (Black Lion) Specialized Hospital (TASH) in Addis Ababa is the country's sole specialist unit for cancer care. With only a handful of oncologists, a lack of resources, and a huge patient load, the work is challenging, especially in terms of achieving effective and ethical patient consultations. Patients, usually accompanied by family members, often wait for a long time to receive medical attention and frequently depart without treatment. Handling consultations effectively is essential in order to help patients as much as possible within such limitations. OBJECTIVE: The project addresses three main aims: (1) to enhance and expand the understanding of communicative and associated ethical challenges in Ethiopian cancer care; (2) to enhance and expand the understanding of the implications and use of person- and family-centered solutions to address such communicative challenges in practice, and (3) to plan and evaluate interventions in this area. METHODS: This project develops and consolidates a research collaboration to better understand and mitigate the communicative challenges in Ethiopian cancer care, with a focus on the handling and sharing of decision making, and ethical tensions between patients, staff, and family. Using theoretical models from linguistics, health communication, and health care ethics, multiple sources of data will be analyzed. Data sources currently include semi-structured interviews with the Ethiopian staff, patients, and family caregivers (91), survey data on cancer awareness (150) and attitudes to breaking bad news (450), and video-recordings of medical consultations (45). In addition, we will also develop clinical and methodological solutions to formulate educational interventions. RESULTS: The project was awarded funding by the Swedish Research Council in December 2017 for the period 2018-2021. The research ethics board in Sweden and in Ethiopia approved the conduct of the project in May 2018. The results from the studies will be published in 2020 and 2021. CONCLUSIONS: The project is a first step towards producing unique and seminal knowledge for the specific context of Ethiopia in the area of physician-patient communication research and ethics. It contributes to an understanding of the complexity around the role of family and ethical challenges in relation to patient involvement and decision making in Ethiopia. Improved knowledge in this area can provide a fundamental model for ways to improve cancer care in many other low resource settings in Africa and the Middle East, which share central cultural prerequisites (such as a strong patriarchal family structure, combined with strong and devout religiosity). The project will also serve to develop greater understanding about current challenges in Western health systems associated with greater family and patient participation in decision making. In addition, the project will also contribute to improving the education of Ethiopian health professionals working in cancer care by developing a training program to help them better understand and respond to identified challenges associated with communication.
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| 5. |
- Nijsingh, Niels, 1977, et al.
(författare)
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Justifying Antibiotic Resistance Interventions: Uncertainty, Precaution and Ethics
- 2020
-
Ingår i: Jamrozik E., Selgelid M.J. (eds) Ethics and Drug-Resistance: Collective Responsibility for Global Public Health. - Cham, Switzerland : Springer. - 2211-6680. - 9783030278731
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Bokkapitel (refereegranskat)abstract
- This chapter charts and critically analyses the ethical challenge of assessing how much (and what kind of) evidence is required for the justification of interventions in response antibiotic resistance (ABR), as well as other major public health threats. Our ambition here is to identify and briefly discuss main issues, and point to ways in which these need to be further advanced in future research. This will result in a tentative map of complications, underlying problems and possible challenges. This map illustrates that the ethical challenges in this area are much more complex and profound than is usually acknowledged, leaving no tentatively plausible intervention package free of downsides. This creates potentially overwhelming theoretical conundrums when trying to justify what to do. We therefore end by pointing out two general features of the complexity we find to be of particular importance, and a tentative suggestion for how to create a theoretical basis for further analysis.
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| 6. |
- Herlitz, Anders, 1981, et al.
(författare)
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‘Green’ bioethics widens the scope of eligible values and overrides patient demand: comment on Parker
- 2023
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Ingår i: Journal of Medical Ethics. - : BMJ. - 0306-6800 .- 1473-4257. ; 49:2, s. 100-101
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- It is welcome to have concrete attempts to analyse the implications of environmental sustainability in clinical ethics. We discuss two interrelated weaknesses of Parker's article. These relate to the need in "green" bioethics to see beyond the normal healthcare ethical focus on health-related values related to individual patients, and to primarily adopt institutional ways of framing central decision problems.
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| 7. |
-
Coloniality and Decolonisation in the Nordic region
- 2023
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Samlingsverk (redaktörskap) (övrigt vetenskapligt/konstnärligt)abstract
- This book advances critical discussions about what coloniality, decoloniality and decolonization mean and imply in the Nordic region. It brings together analysis of complex realities from the perspectives of the Nordic peoples, a region that are often overlooked in current research, and explores the processes of decolonization that are taking place in this region. The book offers a variety of perspectives that engage with issues such as Islamic feminism and the progressive left; racialization and agency among Muslim youths; indigenizing distance language education for Sami; extractivism and resistance among the Sami; the Nordic international development endeavour through education; Swedish TV-reporting on Venezuela; creolizing subjectivities across Roma and non-Roma worlds and hierarchies; and the whitewashing and sanitization of decoloniality in the Nordic region. As such, this book extends much of the productive dialogue that has recently occurred internationally in decolonial thinking but also in the areas of critical race theory, whiteness studies, and postcolonial studies to concrete and critical problems in the Nordic region. This should make the book of considerable interest to scholars of history of ideas, anthropology, sociology, cultural studies, postcolonial studies, international development studies, legal sociology and (intercultural) philosophy with an interest in coloniality and decolonial social change.
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| 8. |
- Malmqvist, Erik, et al.
(författare)
-
Pharmaceutical Pollution from Human use and the Polluter Pays Principle
- 2023
-
Ingår i: Public Health Ethics. - 1754-9973 .- 1754-9981. ; 16:2, s. 152-164
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Tidskriftsartikel (refereegranskat)abstract
- Human consumption of pharmaceuticals often leads to environmental release of residues via urine and faeces, creating environmental and public health risks. Policy responses must consider the normative question how responsibilities for managing such risks, and costs and burdens associated with that management, should be distributed between actors. Recently, the Polluter Pays Principle (PPP) has been advanced as rationale for such distribution. While recognizing some advantages of PPP, we highlight important ethical and practical limitations with applying it in this context: PPP gives ambiguous and arbitrary guidance due to difficulties in identifying the salient polluter. Moreover, when PPP does identify responsible actors, these may be unable to avoid or mitigate their contribution to the pollution, only able to avoid/mitigate it at excessive cost to themselves or others, or excusably ignorant of contributing. These limitations motivate a hybrid framework where PPP, which emphasizes holding those causing large-scale problems accountable, is balanced by the Ability to Pay Principle (APP), which emphasizes efficiently managing such problems. In this framework, improving wastewater treatment and distributing associated financial costs across water consumers or taxpayers stand out as promising responses to pharmaceutical pollution from human use. However, sound policy depends on empirical considerations requiring further study.
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| 9. |
- Ranisch, Robert, et al.
(författare)
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Ethics of digital contact tracing apps for the Covid-19 pandemic response
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- There is a growing interest in contact tracing apps (CT apps) for pandemic man- agement. These apps raise significant moral concerns. It is therefore crucial to consider ethical requirements before and while implementing such apps. Public trust is of major importance for population uptake of contact tracing apps. Hasty, ill-prepared or badly communicated implementations of CT apps will likely under- mine public trust, and as such, risk impeding general effectiveness. In response to these demands, to meet ethical requirements and find a basis for justified trust, this background introduces an ethical framework for a responsible design and implementation of CT apps. However, even prudently chosen measures of digital contact tracing carry moral costs, which makes it necessary address different trade-offs. This background paper aims to inform developers, researchers and decision-makers be- fore and throughout the process of implementing contact tracing apps.
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| 10. |
- Ranisch, Robert, et al.
(författare)
-
Digital contact tracing and exposure notification: ethical guidance for trustworthy pandemic management
- 2021
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Ingår i: Ethics and Information Technology. - : Springer Science and Business Media LLC. - 1388-1957 .- 1572-8439. ; 23, s. 285-294
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Tidskriftsartikel (refereegranskat)abstract
- There is growing interest in contact tracing apps (CT apps) for pandemic management. It is crucial to consider ethical requirements before, while, and after implementing such apps. In this paper, we illustrate the complexity and multiplicity of the ethical considerations by presenting an ethical framework for a responsible design and implementation of CT apps. Using this framework as a starting point, we briefly highlight the interconnection of social and political contexts, available measures of pandemic management, and a multi-layer assessment of CT apps. We will discuss some trade-offs that arise from this perspective. We then suggest that public trust is of major importance for population uptake of contact tracing apps. Hasty, ill-prepared or badly communicated implementations of CT apps will likely undermine public trust, and as such, risk impeding general effectiveness.
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| 11. |
- Wild, Verina, et al.
(författare)
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Covid-19: Eine Ad hoc Public-Health-Ethikberatung : Covid-19: An ad hoc public health ethics consultation
- 2020
-
Ingår i: Das Gesundheitswesen. - : Georg Thieme Verlag KG. - 0941-3790 .- 1439-4421. ; 82:6, s. 507-513
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Tidskriftsartikel (refereegranskat)abstract
- In diesem Dokument beschreiben wir den Prozess und den Inhalt einer ad hoc Public-Health-Ethikberatung vom 22. März 2020 für eine regionale Gesundheitsbehörde (Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit) zu Entscheidungen im Zusammenhang mit Covid-19. In this paper we describe the process and content of our ad hoc public health ethics consultation for a Bavarian health authority in relation to Covid-19.
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| 12. |
- Munthe, Christian, 1962
(författare)
-
The place of political values in pandemic policy
- 2022
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Ingår i: Seminar series "Ethics @ Lunch", University of Augsburg, May 13, 2022. - Augsburg : University of Augsburg.
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Invited seminar presentation at the University of Augsburg's "Ethics @ Lunch" series.
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| 13. |
- Heilinger, Jan-Christoph, et al.
(författare)
-
Public Health Ethics and Covid-19: The ethical dimensions of public health decision-making during a pandemic
- 2020
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The Covid-19 pandemic forces policy makers and public health authorities to make ethically challenging decisions, often under conditions of uncertainty and under time pressure. In times of pandemics, ethical accountability is more important, not less. Understanding and handling of ethical problems require grounding in ethical theory and decision models, in combination with relevant facts from medicine, public health, law, economics, politics, etc. The perspective of public health ethics includes considerations from all ethical domains of relevance in a pandemic situation. This foundational policy brief provides an overview of the fundamental ethical dimensions of public health decision-making in the face of the Covid-19 pandemic. It references important existing ethical frameworks, some of which are based on extensive stakeholder vetting and public consultation. Its goal is to support decision-making that is justified and communicated as required by basic democratic principles and in the light of diverse values and norms present in democratic societies. These, however, may conflict with one another, making difficult trade-offs inevitable. Further policy briefs on specific topics will be consecutively developed by this ethics working group, including on ethical decision-making in policy and practice under conditions of uncertainty, ethics of vaccination, ethics of Covid-19-related contract-tracing apps, ethics of Covid-19 and age, ethics of experimental treatment, refugee health ethics and Covid-19.
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| 14. |
- Munthe, Christian, 1962, et al.
(författare)
-
Ethical aspects of pandemic public policy-making under uncertainty
- 2021
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Pandemic public policy-making requires far-reaching decisions in the context of severe and dynamic lack of information. This policy brief breaks down the ethical challenge of pandemic public policy-making under conditions of uncertainty into understandable parts, and elaborates how these may be approached in practice. A pandemic usually implies uncertainty about the spread of the infection, about its impacts for people and society, and the effects of policy measures undertaken in response to the pandemic. A precautionary approach is required, but precautionary reasoning must consider practicality, non-arbitrariness, proportionality and justification. Pandemic public policy making under uncertainty should avoid paralysis by limiting the space for precautionary reasoning; balance both uncertain harms and uncertain benefits; avoid false certainty bias; decrease uncertainty, while minding the price of precaution; take into consideration legitimacy but also public opinion and feelings; set, disclose and communicate underlying ethical values and principles; monitor and re-evaluate decisions and consequences. This paper is intended for those making and advising public policy decisions, including ethicists.
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| 15. |
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| 16. |
- Nijsingh, Niels, 1977, et al.
(författare)
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Screening for multi-drug-resistant Gram-negative bacteria: what is effective and justifiable?
- 2020
-
Ingår i: Monash Bioethics Review. - : Springer Science and Business Media LLC. - 1321-2753 .- 1836-6716. ; 38:supplement 1
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Tidskriftsartikel (refereegranskat)abstract
- Effectiveness is a key criterion in assessing the justification of antibiotic resistance interventions. Depending on an intervention’s effectiveness, burdens and costs will be more or less justified, which is especially important for large scale population-level interventions with high running costs and pronounced risks to individuals in terms of wellbeing, integrity and autonomy. In this paper, we assess the case of routine hospital screening for multi-drug-resistant Gram-negative bacteria (MDRGN) from this perspective. Utilizing a comparison to screening programs for Methicillin-Resistant Staphylococcus aureus (MRSA) we argue that current screening programmes for MDRGN in low endemic settings should be reconsidered, as its effectiveness is in doubt, while general downsides to screening programs remain. To accomplish justifiable antibiotic stewardship, MDRGN screening should not be viewed as a separate measure, but rather as part of a comprehensive approach. The program should be redesigned to focus on those at risk of developing symptomatic infections with MDRGN rather than merely detecting those colonised.
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| 17. |
- Moll, Jonas, 1982-, et al.
(författare)
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Experiences of Patients With Mental Health Issues Having Web-Based Access to Their Records : National Patient Survey
- 2024
-
Ingår i: JMIR Mental Health. - : JMIR Publications. - 2368-7959. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Sharing mental health notes through patient accessible electronic health records (PAEHRs) is controversial. Many psychiatric organizations and regions in Sweden have resisted the implementation, as clinicians worry about possible harms when patients are reading their notes. Despite the documented benefits of PAEHRs, there is still a lack of knowledge regarding whether patients with mental health issues could reap similar benefits of reading their notes as other patient groups. Objective: The aim of the study is to examine the use, attitudes, and experiences of patients with mental health issues by reading their notes in the PAEHR and, moreover, whether their experiences differ from other patient groups, and if so, how. Methods: A national patient survey was conducted with answers from 2587 patients from different patient groups. In total, 504 respondents (19.5%) indicated that they experienced a mental health disease. Answers from this patient group were compared to the answers from all other respondents. Survey questions related to attitudes, information usage, and effects on contacts with care were selected for analysis. Mann-Whitney U tests were used to detect groupwise differences. Results: Patients with mental health issues use PAEHRs for checking that they have received the right care (mean_mental health 2.83, SD_mental health 1.39; mean_others 2.62, SD_others 1.37; P=.002) or suspected inaccuracies (mean_mental health 2.55, SD_mental health 1.34; mean_others 2.31, SD_others 1.30; P=.001), blocking access for professionals in other specialties (mean_mental health 3.43, SD_mental health 1.46; mean_others 3.04, SD_others 1.42; P<.001), and checking which care professionals have accessed their record (mean_mental health 4.28, SD_mental health 1.14; mean_others 4.05, SD_others 1.25; P<.001) to a significantly higher degree than other patients. On the other hand, the results show that a significantly lower proportion of patients with mental health issues (mean_mental health 3.38, SD_mental health 1.21; mean_others 3.52, SD_others 1.18; P=.02) believe that PAEHRs help them in shared decision-making compared to other patient groups. Conclusions: Patients with mental health issues who took part in the survey, as a group, express some minor differences in both the use of the PAEHR and their experiences regarding its usefulness, as compared to other patients, as a group. This patient group shows a slightly higher interest in 2 types of use: checking for accuracy of care in the record and blocking access to mental health notes for professionals from other parts of the health care system. Compared to other patient groups, these patients are less likely to experience that the PAEHR is a support in shared decision-making. The study indicates that the benefits of PAEHR on a general level are the same for this patient group as for other patients. The study does not support clinicians’ worry about possible harm to this patient group. Further research is however needed.
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| 18. |
- Munthe, Christian, 1962, et al.
(författare)
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Balancing health and environmental impact in antibiotic resistance policy
- 2022
-
Ingår i: 16th World Congress of Bioethics, University of Basel, July 20-22, 2022.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- There is an increase of suggestions that healthcare policies should pay more attention to environmental impact. However, this raises a question of how to analyze and manage conflicts between environmental considerations and immediate health considerations. E.g., if drugs are prioritized not only on the basis of need, effect and cost-effectiveness, but also on the environmental impact pattern of its production and/or consumption, single patients may be denied effective therapies due to overarching structural concerns which are difficult to trace back to effects on these or any other single patient. At the same time, the overall environmental health impact of pharmaceutical pollution is recognized to be a major global public health threat, for instance, via its contribution to antibiotic resistance (ABR). While background philosophical theories may in theory answer how to balance these concerns, to produce an actual answer is challenging due to their level of abstraction. At the same time, standard ideas in operational healthcare ethics and public health ethics seem inadequate by themselves, as they capture only parts of the problem but are also problematic to combine, as they are based on conflicting perspectives and ethoses. This makes it difficult to produce an ethical analyses that could facilitate a solution to the problem of how to balance individual health and structural environmental concerns. This paper will use ABR as a case in point to describe this challenge in more detail, and present three rivalling ways forward.
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| 19. |
- Munthe, Christian, 1962
(författare)
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Djurhållning och antibiotika: en gyllene triangel!
- 2023
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Ingår i: Tidskriften Alba. - 1403-5448. ; :2023-10-24
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- För ett par veckor sedan var jag i Amsterdam och talade om etiska dilemman och utmaningar i arbetet med antibiotikaresistens i djurhållning och veterinärmedicin på en konferens. ”Från fabrik till gödselstack” var devisen för mitt bidrag, för att framhålla att djurhållningens användning av antibiotika – precis som sjukvårdens – är en del av en större helhet, där även produktionssystemen för läkemedel och mat (och friska djur och människor), och naturmiljön ingår. Varje del både bidrar till utmaningen med resistens – att vår användning och hantering av dessa viktiga mediciner gör dem obrukbara – och utgör löften för att sätta in åtgärder som kan mildra problemet. Alla sådana åtgärder kommer samtidigt ha nackdelar och kostnader – därav behovet att analysera etiken. På konferensen fick jag också chans att förkovra mig i olika slags forskning om hur jordbruk och annan djurhållning kan hantera antibiotikaresistensen bättre. Jag lärde mig då att området utgör en riktig gyllene triangel – på gott och ont.
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| 20. |
- Munthe, Christian, 1962, et al.
(författare)
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Healthcare must stop ignoring future patients!
- 2020
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Ingår i: Journal of Medical Ethics Blog. - London : BMJ. ; :2020-11-11
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Most countries with publicly funded healthcare systems have ethically informed priority setting schemes to decide how to allocate scarce resources. Established principles in such schemes recognise patients’ need of care, the effects of interventions, and background requirements of equal consideration and cost-effectiveness. However, the typical use of such schemes is alarmingly short-sighted, systematically allowing the future resource base of healthcare to be undermined. In short: our way of helping current patients is systematically exposing future patients to serious harm and risk.
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| 21. |
- Hagström, Josefin, et al.
(författare)
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Adolescents' and Young Adults' Experiences of Offense from Reading Their Health Records Online
- 2024
-
Ingår i: Studies in Health Technology and Informatics. - : IOS Press. - 0926-9630 .- 1879-8365. ; 310, s. 1422-1423
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Tidskriftsartikel (refereegranskat)abstract
- Patients feeling offended by reading records online is a concern among healthcare professionals, however previously published work has focused on adult patients. Here, a survey was used to explore and compare experiences of offense among adolescents (15-19 years old) and young adults (20-24 years old). Findings indicated that while the ratio of those offended did not differ between adolescents and young adults, reasons for feeling offended did.
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| 22. |
- Malmqvist, Erik, et al.
(författare)
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What High-Income States Should Do to Address Industrial Antibiotic Pollution
- 2020
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Ingår i: Public Health Ethics. - : Oxford University Press (OUP). - 1754-9973 .- 1754-9981. ; 13:3, s. 275-287
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Tidskriftsartikel (refereegranskat)abstract
- Antibiotic resistance is widely recognized as a major threat to public health and healthcare systems worldwide. Recent research suggests that pollution from antibiotics manufacturing is an important driver of resistance development. Using Sweden as an example, this article considers how industrial antibiotic pollution might be addressed by public actors who are in a position to influence the distribution and use of antibiotics in high-income countries with publicly funded health systems. We identify a number of opportunities for these actors to incentivize industry to increase sustainability in antibiotics production. However, we also show that each alternative would create tensions with other significant policy goals, necessitating trade-offs. Since justifiable trade-offs require ethical consideration, we identify and explore the main underlying normative issues, namely, the weighing of local versus global health interests, the weighing of present versus future health interests, and the role of individualistic constraints on the pursuit of collective goals. Based on this analysis, we conclude that the actors have weighty principled reasons for prioritizing the goal of addressing pollution, but that translating this stance into concrete policy requires accommodating significant pragmatic challenges.
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| 23. |
- Pasquini, Mirko, 1991
(författare)
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Like ticking time bombs. Improvising structural competency to ‘Defuse’ the exploding of violence against emergency care workers in Italy
- 2023
-
Ingår i: Global Public Health. - : Informa UK Limited. - 1744-1692 .- 1744-1706. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- While violence against health care workers is being progressively recognised as a serious problem in the healthcare industry, it remains an under-studied area of enquiry in global public health. Anthropologists have long observed that violence toward patients is tied to institutional care practises in multiple ways, including repression, misrecognition and silencing. But research on health care staff’s experience of violence is still lacking. This article aims to address this literature gap by providing research on the daily experience of vulnerability to violence that health care providers face during their work. To do so, the paper ethnographically explores the effects and perception of violence against health care workers in an emergency department (ED) in northern Italy, a place with a dramatic escalation of violent incidents. The article illustrates how the ED staff attended to the experience of suffering of potentially violent patients. In so doing, ED professionals shifted the responsibility of violence against them from violent individuals to violent structures shaping health inequities. The paper thus argues that ED professionals display a structural competence perspective when dealing with violence.
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| 24. |
- El-Alti, Leila, 1986, et al.
(författare)
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Caregiver perspectives on patient capacities and institutional pathways to person centered forensic psychiatric care
- 2022
-
Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 17:9
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Tidskriftsartikel (refereegranskat)abstract
- The ethical discourse surrounding patients’ agential capacities, vis-à-vis their active participation in shared decision-making (SDM) in forensic psychiatric (FP) contexts, is an unexplored area of inquiry. The aim of this paper is to explore caregivers’ perceptions of patient agential capacities and institutional pathways and barriers to person centered care (PCC) in the context of FP. Following an exploratory qualitative design, we conducted eight semi-structured interviews with hands-on caregivers at an in-patient FP facility in Sweden. A deductive framework method of analysis was employed, and four themes emerged: “Fundamental Variability in Patient Capacity”, “Patient Participation: Narration or Compliance?”, “Antagonism Rooted in Power Struggles”, and “System Structure Thwarts Patient Release”. While the results generally paint a bleak picture for the possibility of a person-centered FP care, we describe a constrained version of PCC with high-level SDM dynamics which promotes a certain degree of patient empowerment while allowing care strategies, within set restrictions, to promote patient adherence and treatment progress.
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| 25. |
- Groglopo, Adrián, 1967, et al.
(författare)
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Coloniality and decolonisation in the Nordic region: An introduction
- 2023
-
Ingår i: Groglopo, Adrián & Julia Suárez-Krabbe (2023).Coloniality and Decolonisation in the Nordic Region. Routledge: New York.. - New York : Routledge - Taylor & Francis Group. - 9781032274867 ; , s. 1-21
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- This chapter aims to further fruitful conversations about the meaning and implications of coloniality, decoloniality and decolonization in the Nordic region. Such a collective endeavour cannot bypass the perspectives and historical experience of people in the Nordic region who are produced as non-belonging, absent, criminal and/or barbaric in general, including ‘non-Western’ migrants and refugees, Afro-Nordics and Muslim communities, as well as the Romani and the indigenous communities of the region such as the Sami and Inuit. However, much of the decolonial scholarship in the Nordic region approaches coloniality through a poststructuralist and postcolonial lens and reproduces the coloniality of knowledge by ignoring and depoliticizing the radical political concepts and projects emanating the abovementioned peoples in the Nordic region and the colonized regions of the world, resulting in undertheoretization. On this basis, the chapter argues for the need of reclaiming the political, which involves theorizing the materiality of colonial politics in contemporary Nordic societies, including its imperial investments and political economy.
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| 26. |
- Cafaro, Philip, et al.
(författare)
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Fewer people would help preserve biodiversity: A response to Hughes et al. (2023)
- 2023
-
Ingår i: Biological Conservation. - 0006-3207. ; 282
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Tidskriftsartikel (refereegranskat)abstract
- “Smaller human populations are neither a necessary nor sufficient condition for biodiversity conservation,” according to Alice Hughes and colleagues. We agree that reducing human numbers is not sufficient for preserving biodiversity; whether it’s necessary depends on how high we set the bar for successful conservation. If we hope to preserve robust populations of most of the world’s remaining wild species and their habitats, the evidence suggests human populations will have to be considerably reduced.
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| 27. |
- Robinson, Yohan, 1977, et al.
(författare)
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AI och framtidens försvarsmedicin
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Medicinskt legitimerad personal är, och kommer med stor sannolikhet fortsattatt vara, en knapp resurs inom Försvarsmaktens sjukvårdsorganisation. I denna rapport ges en översikt över pågående och planerade ansatser baserade påartificiell intelligens (AI) inom akutsjukvård med särskild tonvikt på omhändertagandet av traumapatienter, där lösningarna skulle kunna bidra till att Försvarsmakten kan bibehålla sin sjukvårdskapacitet i kritiska lägen. Rapporten är ett resultat av samarbetet mellan FM, FOI, FMV, FHS och KI, och vänder sig i första hand till Försvarsmaktens strategiska ledning.Användningen av AI-teknik i framtida beslutsstöd kan skapa nya möjligheter till avlastning av personal och resurseffektivisering. Tekniken ger möjligheter att i realtid samla in, bearbeta och analysera stora mängder blandadinformation om förbands hälsoläge och fysiska stridsvärde. Bedömning av skadade kan t.ex. göras av triagedrönare och den efterföljande evakueringen kanunderlättas av intelligenta autonoma plattformar. Införandet av AI-system ställer dock vårdgivaren inför svåra etiska och medikolegala överväganden.Försvarsmedicin har en central roll i Försvarsmaktens krigföringsförmåga och för samhällets uthållighet. För att nyttja hela AI-teknikens framfart till Försvarsmaktens nytta måste dess innebörd och konsekvens för försvarsmedicinen förstås. Därför rekommenderar denna studie att Försvarsmaktens framtida satsningar inom AI och autonomi inkluderar den försvarsmedicinska teknikutveckling som är beskriven i denna rapport.
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| 28. |
- Stavrakakis, Ioannis, et al.
(författare)
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The teaching of computer ethics on computer science and related degree programmes. a European survey
- 2021
-
Ingår i: INTERNATIONAL JOURNAL OF ETHICS EDUCATION. - : Springer Science and Business Media LLC. - 2364-0006 .- 2363-9997. ; In Press
-
Tidskriftsartikel (refereegranskat)abstract
- Within the Computer Science community, many ethical issues have emerged as significant and critical concerns. Computer ethics is an academic field in its own right and there are unique ethical issues associated with information technology. It encompasses a range of issues and concerns including privacy and agency around personal information, Artificial Intelligence and pervasive technology, the Internet of Things and surveillance applications. As computing technology impacts society at an ever growing pace, there are growing calls for more computer ethics content to be included in Computer Science curricula. In this paper we present the results of a survey that polled faculty from Computer Science and related disciplines about teaching practices for computer ethics at their institutions. The survey was completed by respondents from 61 universities across 23 European countries. Participants were surveyed on whether or not computer ethics is taught to Computer Science students at each institution, the reasons why computer ethics is or is not taught, how computer ethics is taught, the background of staff who teach computer ethics and the scope of computer ethics curricula. This paper presents and discusses the results of the survey.
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| 29. |
- Wiszmeg, Andréa, et al.
(författare)
-
Transforming trash to treasure Cultural ambiguity in foetal cell research
- 2021
-
Ingår i: Philosophy Ethics and Humanities in Medicine. - : Springer Science and Business Media LLC. - 1747-5341. ; 16:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background Rich in different kind of potent cells, embryos are used in modern regenerative medicine and research. Neurobiologists today are pushing the boundaries for what can be done with embryos existing in the transitory margins of medicine. Therefore, there is a growing need to develop conceptual frameworks for interpreting the transformative cultural, biological and technical processes involving these aborted, donated and marginal embryos. This article is a contribution to this development of frameworks. Methods This article examines different emotional, cognitive and discursive strategies used by neurobiologists in a foetal cell transplantation trial in Parkinson's disease research, using cells harvested from aborted embryos. Two interviews were analysed in the light of former observations in the processing laboratories, using the anthropologist Mary Douglas's concept of pollution behaviour and the linguist, philosopher, psychoanalyst and feminist Julia Kristeva's concept of the abjective to explain and make sense of the findings. Results The findings indicate that the labour performed by the researchers in the trial work involves transforming the foetal material practically, as well as culturally, from trash to treasure. The transformation process contains different phases, and in the interview material we observed that the foetal material or cells were considered objects, subjects or rejected as abject by the researchers handling them, depending on what phase of process or practice they referred to or had experience of. As demonstrated in the analysis, it is the human origin of the cell that makes it abjective and activates pollution discourse, when the researchers talk of their practice. Conclusions The marginal and ambiguous status of the embryo that emerges in the accounts turns the scientists handling foetal cells into liminal characters in modern medicine. Focusing on how practical as well as emotional and cultural strategies and rationalizations of the researchers emerge in interview accounts, this study adds insights on the rationale of practically procuring, transforming and utilizing the foetal material to the already existing studies focused on the donations. We also discuss why the use and refinement of a tissue, around which there is practical consensus but cultural ambiguity, deserves further investigation.
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| 30. |
- Munthe, Christian, 1962
(författare)
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The role of pragmatics in practical ethics
- 2022
-
Ingår i: Filosofidagarna: Swedish Congress of Philosophy, Lund University, June 10th-June 12th, 2022. - Lund.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 31. |
- Shannon, Michelle M, et al.
(författare)
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Application of Theory in Studies of Healthcare Built Environment Research
- 2020
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Ingår i: Health Environments Research & Design Journal. - : SAGE Publications. - 1937-5867 .- 2167-5112. ; 13:3, s. 154-170
-
Tidskriftsartikel (refereegranskat)abstract
- We aimed to examine the nature and extent of theory application in studies of built environment attributes and impact on adults in healthcare facilities. Many varied theories are described when providing the rationale for research into built environments in healthcare. Uncertainty exists around the right theory to frame a research question, alignment with measurement tools, and whether healthcare setting makes a difference. This poses challenges to researchers seeking to build the evidence base for built environment design that benefits patients and staff. Our multidisciplinary review team scoped the literature to determine how theories are used to inform research investigating the impact of the built environment of healthcare on adults. When researchers recorded theory at development of the study question, in data collection, and in data analysis/interpretation, we called this explicitly theory-based application. Synthesis occurred using a narrative approach. Overall, we found 17 diverse theories named in studies. Explicitly theory-based use occurred with eight theories, comprising 47% of all theories used. Five theories were named more frequently in studies out of all theories identified. In 20% of studies, theory was not used explicitly during the research inquiry. We argue that researchers must continue to strive toward explicit use of theories, similar to development of other health interventions that employ multifactorial components.
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| 32. |
- Pepic, I., et al.
(författare)
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Early detection of sepsis using artificial intelligence : a scoping review protocol
- 2021
-
Ingår i: Systematic Reviews. - : Springer Nature. - 2046-4053. ; 10:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. To decrease the high case fatality rates and morbidity for sepsis and septic shock, there is a need to increase the accuracy of early detection of suspected sepsis in prehospital and emergency department settings. This may be achieved by developing risk prediction decision support systems based on artificial intelligence.Methods: The overall aim of this scoping review is to summarize the literature on existing methods for early detection of sepsis using artificial intelligence. The review will be performed using the framework formulated by Arksey and O’Malley and further developed by Levac and colleagues. To identify primary studies and reviews that are suitable to answer our research questions, a comprehensive literature collection will be compiled by searching several sources. Constrictions regarding time and language will have to be implemented. Therefore, only studies published between 1 January 1990 and 31 December 2020 will be taken into consideration, and foreign language publications will not be considered, i.e., only papers with full text in English will be included. Databases/web search engines that will be used are PubMed, Web of Science Platform, Scopus, IEEE Xplore, Google Scholar, Cochrane Library, and ACM Digital Library. Furthermore, clinical studies that have completed patient recruitment and reported results found in the database ClinicalTrials.gov will be considered. The term artificial intelligence is viewed broadly, and a wide range of machine learning and mathematical models suitable as base for decision support will be evaluated. Two members of the team will test the framework on a sample of included studies to ensure that the coding framework is suitable and can be consistently applied. Analysis of collected data will provide a descriptive summary and thematic analysis. The reported results will convey knowledge about the state of current research and innovation for using artificial intelligence to detect sepsis in early phases of the medical care chain.Ethics and dissemination: The methodology used here is based on the use of publicly available information and does not need ethical approval. It aims at aiding further research towards digital solutions for disease detection and health innovation. Results will be extracted into a review report for submission to a peer-reviewed scientific journal. Results will be shared with relevant local and national authorities and disseminated in additional appropriate formats such as conferences, lectures, and press releases.
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| 33. |
- Falkenström, Erica, 1966-
(författare)
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Svensk pandemiberedskap i organisationsetisk belysning : Empirisk analys och åtgärdsförslag för framtida pandemier
- 2021
-
Rapport (refereegranskat)abstract
- The purpose of this report is to contribute knowledge about organizational ethical aspects of the Swedish pandemic preparedness. More specifically, 12 key policy documents aimed at guiding health care practice – before a pandemic and during the Covid-19 pandemic – has been analyzed regarding the purpose of the policy documents, their ethical content, and the attention given to value conflicts and the recipient organizations' ability to comply with fundamental ethical requirements. Based on the results, concrete proposals are given to strengthen the health care system’s preparedness and capacity for ethical responsibility in relation to the goal of the Swedish pandemic preparedness – and thus reduced vulnerability – for future pandemics.The analysis shows that purposes and essential ethical values prescribed by law, such as the principle of human dignity, tended to be reduced and even drained of their ethical content in the policy documents. Fundamental aspects of organizational ethics in health care (including an ethics of care) were also missing. For instance, overall, the purpose of health care has not been properly indicated in the policy documents, and no attention was given to the receivers’ prerequisites to take ethical responsibility for conflicts of interest that occur and to apply the policy documents during the pandemic. Moreover, by presenting new national principles for priorities during the ongoing pandemic, which in addition deviated from the Health Care Act, The National Board of Health and Welfare may have misled priority decisions and increased the moral stress among healthcare staff rather than reduced it. Thus, during the Covid-19 pandemic health care providers may have had insufficient organizational conditions, political guidance, and administrative support to act ethically in relation to the goal of the Swedish preparedness for crisis and pandemics.In order to maintain the ethical value system that the Swedish constitution and the Health Care Act are ultimately based on – and to promote social trust and a long-term sustainable and robust welfare system – ethics needs to be taken more seriously and given legitimacy by being organized into the every-day practices in the healthcare system.
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| 34. |
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| 35. |
- Jemberie, Wossenseged Birhane, 1985-, et al.
(författare)
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Substance Use Disorders and COVID-19 : Multi-Faceted Problems Which Require Multi-Pronged Solutions
- 2020
-
Ingår i: Frontiers in Psychiatry. - : Frontiers Media S.A.. - 1664-0640. ; 11
-
Tidskriftsartikel (refereegranskat)abstract
- COVID-19 shocked health and economic systems leaving millions of people without employment and safety nets. The pandemic disproportionately affects people with substance use disorders (SUDs) due to the collision between SUDs and COVID-19. Comorbidities and risk environments for SUDs are likely risk factors for COVID-19. The pandemic, in turn, diminishes resources that people with SUD need for their recovery and well-being. This article presents an interdisciplinary and international perspective on how COVID-19 and the related systemic shock impact on individuals with SUDs directly and indirectly. We highlight a need to understand SUDs as biopsychosocial disorders and use evidence-based policies to destigmatize SUDs. We recommend a suite of multi-sectorial actions and strategies to strengthen, modernize and complement addiction care systems which will become resilient and responsive to future systemic shocks similar to the COVID-19 pandemic.
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| 36. |
- Almered Olsson, Gunilla, 1951, et al.
(författare)
-
Agenda 2030. För oss och kommande generationers skull.
- 2022
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Skriften ger en kortfattad genomgång av de 17 globala hållbarhetsmålen med målet att uppnå en socialt, miljömässigt och ekonomiskt hållbar värld till år 2030. Åtgärder på nationell och regional nivå beskrivs kortfattat. Varje mål illustreras med verksamheter på lokal nivå. Skriftens huvudsyfte är att belysa den lokala nivån och peka på civilsamhällets stora roll i hållbarhetsarbetet.
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| 37. |
- Petersson, Jesper, 1974, et al.
(författare)
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Patient-accessible online health records: Reconfigurations of clinical rhythms and doctors’ front- and backstage spaces
- 2022
-
Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536. ; 292
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Tidskriftsartikel (refereegranskat)abstract
- With patients’ increasing online access to medical information traditionally contained within healthcare in-stitutions, researchers have argued that the spaces of medicine are increasingly becoming blurred, allowing patients to sidestep their doctors and challenge their prior information dominance. In this context, Sweden has recently been spotlighted as it allows its inhabitants to continually access medical record content online. Based on an interview study on Swedish doctors’ clinical experiences of the patient-accessible online health record, this paper expands on the theme of emergent medical information spaces accessible to laypersons online by arguing that this not only may challenge the traditional spaces of medicine but can impose on its temporal orders too. We detail doctors’ attitudes toward the patient-accessible online health record, patients as continually updated re-cord readers, and how this may transform clinical work rhythms and affect doctors’ perceptions of the boundary between front- and backstage spaces. We moreover show how doctors can avoid “inappropriate intrusion” into the record by delaying patient access, but also that doctors can experience patients opposing to adapt to doctors’ preferred pace and instead attempting to control the clinical rhythm. By intertwining clinical rhythms with doctors’ front- and backstage, this paper contributes with an extended analysis of the emergent spaces of online medical information, adding a temporal layer. The paper furthermore enlarges the existing sociological body on historical developments of medical records and adds a piece to the so-far piecemeal social science literature on how online records may affect the medical profession.
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| 38. |
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| 39. |
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| 40. |
- Inge, Elin
(författare)
-
Patient and public involvement with forced migrants : Exploring communication, ethics and public contributor experiences
- 2024
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The topic of this thesis is patient and public involvement (PPI) in health research. Here, PPI is defined as the active involvement in key research decisions of people whose lives are at the centre of the research. Currently, there is an increased interest in and development of participatory methods. In Sweden, PPI has acquired growing attention in health research. However, the use of PPI in Sweden, as well as the structures supporting researchers and public contributors, are not yet established. The PPI field has been criticised for lacking diversity and fair representation of the researched groups. One group rarely involved as public contributors in PPI is forced migrants. Doing research with rather than about forced migrants, has the potential to alleviate asymmetries of power and knowledge, and reduce health inequities – if conducted in a meaningful way. The overall aim was to explore patient and public involvement with forced migrants in health research. Four studies were conducted. The study designs built on and complemented each other in terms of data, analysis methods and level of detail. Study I used a longitudinal qualitative approach to track the experiences of refugee parents during their involvement in a three-year child mental health trial. In Study II, enablers and barriers to PPI meetings with forced migrant public contributors were identified using a mixed methods approach. Study III evaluated the communication strategies in a research project with refugee youth coresearchers, with a focus on epistemic injustice. In Study IV, ethical issues in PPI with forced migrants were empirically investigated and analysed using relational ethics.The findings show similar patterns from different perspectives. PPI with forced migrants required considerations around inclusive communication, relationship-building and trust, as well as considerations around where and how decisions were made. For these processes to develop, time and a focus on relationships is required. Using relational ethics and a reflexive approach can help researchers navigate ethical PPI with forced migrants. In the Swedish setting, PPI needs to be acknowledged on an institutional level, to create conditions to work with PPI in meaningful and ethical ways.
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| 41. |
- Van den Bulcke, Bo, et al.
(författare)
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Ethical climate and intention to leave among critical care clinicians: an observational study in 68 intensive care units across Europe and the United States.
- 2020
-
Ingår i: Intensive care medicine. - 1432-1238. ; 46:1, s. 46-56
-
Tidskriftsartikel (refereegranskat)abstract
- Apart from organizational issues, quality of inter-professional collaboration during ethical decision-making may affect the intention to leave one's job. To determine whether ethical climate is associated with the intention to leave after adjustment for country, ICU and clinicians characteristics.Perceptions of the ethical climate among clinicians working in 68 adult ICUs in 12 European countries and the US were measured using a self-assessment questionnaire, together with job characteristics and intent to leave as a sub-analysis of the Dispropricus study. The validated ethical decision-making climate questionnaire included seven factors: not avoiding decision-making at end-of-life (EOL), mutual respect within the interdisciplinary team, open interdisciplinary reflection, ethical awareness, self-reflective physician leadership, active decision-making at end-of-life by physicians, and involvement of nurses in EOL. Hierarchical mixed effect models were used to assess associations between these factors, and the intent to leave in clinicians within ICUs, within the different countries.Of 3610 nurses and 1137 physicians providing ICU bedside care, 63.1% and 62.9% participated, respectively. Of 2992 participating clinicians, 782 (26.1%) had intent to leave, of which 27% nurses, 24% junior and 22.7% senior physicians. After adjustment for country, ICU and clinicians characteristics, mutual respect OR 0.77 (95% CI 0.66- 0.90), open interdisciplinary reflection (OR 0.73 [95% CI 0.62-0.86]) and not avoiding EOL decisions (OR 0.87 [95% CI 0.77-0.98]) were all associated with a lower intent to leave.This is the first large multicenter study showing an independent association between clinicians' intent to leave and the quality of the ethical climate in the ICU. Interventions to reduce intent to leave may be most effective when they focus on improving mutual respect, interdisciplinary reflection and active decision-making at EOL.
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| 42. |
- Lerner, Henrik, 1975-
(författare)
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Health in Non-human Organisms
- 2020. - 1 uppl
-
Ingår i: Explaining Health Across the Sciences. - Cham : Springer Nature. - 9783030526627 - 9783030526634 ; , s. 333-346
-
Bokkapitel (refereegranskat)abstract
- This chapter analyses attempts made to define health for non-human organisms. This could be done either as a bottom-up approach finding a common denominator that all organisms share, or as a top-down approach which starts with a certain valuable criterion that those organisms share. Through this chapter I will discuss both approaches. I will briefly discuss the concept of organism and why I only choose to discuss biological organisms. This chapter will also further develop a categorization of health definitions that acknowledges the variety of the different kinds of definitions. This is done as a two-level categorization consisting of categories and versions of these categories. I will go through relevant categories and versions in order to be able to say which could be fruitful to use as well as where science needs to be heading.
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| 43. |
- Munthe, Christian, 1962
(författare)
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The ethics of resource allocation in translational genomic medicine
- 2022
-
Ingår i: Journal of Community Genetics. - : Springer Science and Business Media LLC. - 1868-310X .- 1868-6001. ; 13:5, s. 539-545
-
Tidskriftsartikel (refereegranskat)abstract
- Two basic models of the rationale of translational genomic medicine (TGM)—the “Lab Assisting Clinic” (LAC) and the “Clinic Assisting Lab” (CAL) models—are distinguished, in order to address the ethics of allocating resources for TGM. The basic challenge of justifying such allocation is for TGM to demonstrate sufficient benefits to justify the opportunity cost of lost benefits in other areas of medicine or research. While suggested ethics frameworks for translational medicine build on clearly distinguishing these models, actual TGM typically blurs them. Due to lack of and difficulty in collecting evidence, prospects for justifying the LAC model currently seem poor, but this difficulty might be overcome by more research that tests the very concept of TGM. The CAL model aims to thus advance science, but is ridden by ethical hazard, undermining attempts at justification. This leaves the notion of running bona fide controlled trials of entire TGM concepts that have been justified from the perspective of clinical and research ethics (and approved by IRBs). It remains, however, an open question if the outcomes of such trials will demonstrate benefits that can justify the investment in TGM. To advance the prospect of such justification further, charting of the cost-benefit profile of TGM compared to alternative health investments would be helpful.
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| 44. |
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| 45. |
- Andersson, Thomas, 1970-, et al.
(författare)
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Clinicians' psychological empowerment to engage in management as part of their daily work
- 2022
-
Ingår i: Journal of Health Organization & Management. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 36:9, s. 272-287
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of the article is to analyze how physicians and nurses, as the two major health care professions, experience psychological empowerment for managerial work. Design/methodology/approach: The study was designed as a qualitative interview study at four primary care centers (PCCs) in Sweden. In total, 47 interviews were conducted, mainly with physicians and nurses. The first inductive analysis led us to the concept of psychological empowerment, which was used in the next deductive step of the analysis. Findings: The study showed that both professions experienced self-determination for managerial work, but that nurses were more dependent on structural empowerment. Nurses experienced that they had competence for managerial work, whereas physicians were more ignorant of such competence. Nurses used managerial work to create impact on the conditions for their clinical work, whereas physicians experienced impact independently. Both nurses and physicians experienced managerial work as meaningful, but less meaningful than nurses and physicians' clinical work. Practical implications: For an effective health care system, structural changes in terms of positions, roles, and responsibilities can be an important route for especially nurses' psychological empowerment. Originality/value: The qualitative method provided a complementary understanding of psychological empowerment on how psychological empowerment interacted with other factors. One such aspect was nurses' higher dependence on structural empowerment, but the most important aspect was that both physicians and nurses experienced that managerial work was less meaningful than clinical work. This implies that psychological empowerment for managerial work may only make a difference if psychological empowerment does not compete with physicians' and nurses' clinical work.
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| 46. |
- Munthe, Christian, 1962
(författare)
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Fem kärnfrågor som Coronakommissionen måste ta upp : Five core questions for the Corona Commission
- 2020
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Ingår i: Göteborgsposten. - 1103-9345. ; :20201005
-
Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Även om den första fasen nu är förbi i Sverige fortsätter pandemin och framtiden förblir osäker. Valda och föreslagna åtgärder väcker debatt. Men uppskruvat tonläge, fokus på avsändaren och ensidig analys står ofta i vägen för konstruktiva slutsatser. Därför vill jag lyfta fem kärnfrågor som den utlovade ”Coronakommissionen” behöver behandla, skriver Christian Munthe, professor i praktisk filosofi vid Göteborgs universitet.
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| 47. |
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| 48. |
- Munthe, Christian, 1962
(författare)
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Om krishantering i offentlig verksamhet
- 2022
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Ingår i: Tidskriften Alba. - 1403-5448. ; :2022-08-25
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- På bara några år har samhällets beredskap att mota undan, mildra och hantera allvarliga hot och påfrestningar seglat upp som ett huvudtema i svensk samhällsdebatt. Det gäller förstås den högaktuella situationen föranledd av den drastiska upptrappningen av Rysslands krig mot Ukraina. Men det gäller i lika hög grad pandemin, förorsakad av sjukdomen Covid-19. Sedan tidigare har ljus riktats mot samhällets svårigheter att hantera stora flyktingströmmar (som de kommande decennierna kan förväntas bli mångdubbelt större i klimatförändringarnas spår) och systemfel i styrning och finansiering av rättsväsende, skola och sjukvård. Pågående och växande strukturella hot som antibiotikaresistens, klimatförändringar, svårbekämpad organiserad brottslighet och bristfällig försörjning av material, infrastruktur och kompetens för samhällets centrala funktioner har uppmärksammats gång på gång. Men den svenska offentliga samhällsdiskursen fortsätter att vara dålig på att artikulera beredskapsfrågan som ett övergripande perspektiv på politik och samhälle, så även de politiska partierna. Man förlorar sig i än den ena, än den andra specifika detaljfrågan och politiken är mestadels reaktiv snarare än preventiv. Men debattklimatet håller på att förskjutas och i den här krönikan vill jag bidra till den utvecklingen utifrån min utsiktspunkt som forskare om moral- och samhällsfilosofi, beslutsfattande under osäkerhet, folkhälsoarbete, leveranssäkerhet och antibiotikaresistens. Min poäng är att olika beredskapstankar och -diskussioner hakar i varandra på väsentliga sätt. Detta beror på att de vilar på en gemensam grund av etiska normer och värderingar som handlar om moraliskt och politiskt ansvar och – förstås – olika synsätt på vilka dessa normer och värderingar är. Om dessa görs tydligare ökar förutsättningarna att sambandet mellan en rad skilda beredskapsdebatter tydliggörs. Därmed kan också en grund skönjas för ett sammanhållet synsätt på hur samhällets värdering av beredskap bör se ut och hur de kostnader som beredskapen ofrånkomligen kräver – samhällsekonomiskt, politiskt och etiskt – kan berättigas.
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| 49. |
- Munthe, Christian, 1962, et al.
(författare)
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Sustainable healthcare resource allocation, grounding theories and operational principles: response to our commentators
- 2022
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Ingår i: Journal of Medical Ethics. - : BMJ. - 0306-6800 .- 1473-4257. ; 47:1
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- We proposed adding a sustainability principle to the operational ethical principles guiding public healthcare resources allocation decisions. All our commentators acknowledge our core message: healthcare needs to pay (much better) attention to the future. They also strengthen our proposal by offering additional support by luck egalitarian and Rawlsian arguments, and helpfully point out ambiguities and gaps requiring attention in the further development of the proposal, and its practical implementation. We here consider some more substantial objections, and conclude that our proposal stands strong in light of these.
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- Wild, Verina, et al.
(författare)
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Responding to the SARS-CoV-2 pandemic: Experiences of an ad hoc public health ethics consultation
- 2020
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Ingår i: Journal of Medical Ethics. - 0306-6800. ; :20200401
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Public health authorities in many places of the world are now struggling with ethically complex decisions regarding their response to the SARS-CoV-2 pandemic. Surely, they are also reaching out to ethicists, asking for advice. We share our experience here so as to promote exchange with other public health ethicists who are actively consulting authorities at the moment. We are interested in knowing what questions are being asked; what answers are being produced; and what processes colleagues are using to respond to these consultation requests.
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