| 1. |
- Furberg, Elisabeth, 1979-
(författare)
-
Advance Directives and Personal Identity
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Advance directives are instructions given by patients – or potential patients – specifying what actions ought to be taken for their health in the event that they are no longer capable to make decisions due to illness or incapacity. Over the last decades, there has been a rising tide in favour of advance directives: not only is the use of such directives recommended by most medical and advisory bodies, they are also gaining increasing legal recognition in many parts of the world.This book, however, takes as its point of departure one of the most commonly discussed medical-ethical arguments against granting advance directives moral force: the Objection from Personal Identity. The adherers of this objection basically asserts that when there is lacking psychological continuity between the person who formulated the advance directive and the later patient to whom it supposedly applies, this seriously threatens the directive’s moral authority. And, further, that this is so because lacking sufficient psychological continuity implies that the author of the advance directive is numerically distinct from the later patient.Although this argument has some initial appeal, most philosophers in the advance directives debate maintain that the Objection from Personal Identity fails, but suggest different reasons as to why. Whereas some argue that the objection has no force because it rests on faulty beliefs about personal identity, others argue that we ought to grant advance directives moral authority even if the author and the later patient are numerically distinct beings. This book investigates some of the most influential of these arguments and reaches the conclusion that the Objection from Personal Identity has more to it than is usually recognized in the medical-ethical debate. Lacking sufficient psychological continuity between author and later patient, it is concluded, does threaten the moral authority of the advance directive.
|
|
| 2. |
|
|
| 3. |
- Juth, Niklas, et al.
(författare)
-
Honour-related threats and human rights : A qualitative study of Swedish healthcare providers’ attitudes towards young women requesting a virginity certificate or hymen reconstruction
- 2013
-
Ingår i: European journal of contraception & reproductive health care. - : Informa UK Limited. - 1362-5187 .- 1473-0782. ; 18:6, s. 451-459
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives To investigate the preferred actions of healthcare staff, as well as their reasoning and attitudes about young females’ requests for a virginity certificate or hymen restoration.Method A qualitative study, consisting of semi-structured interviews of healthcare providers from different parts of Sweden and from different medical specialties and professions, who had experience of women who asked for a virginity certificate or a hymen repair.Results Using content analysis, ten themes emerged regarding healthcare personnel's attitudes and reasoning about young female patients and their requests for demonstration of virginity. The themes logically were categorised as values, beliefs, and cultural affiliation.Conclusions Responders had a more pragmatic and permissive view than the restrictive, official Swedish policy opposing hymenoplasties within the public healthcare system. There were degrees of willingness to accommodate such requests, due, for example, to different moral beliefs and medical concerns. Responders expressed frustration over the difficulty of following up patients, a situation likely due to the restrictive policy. The patient-centred approach adopted by a Dutch team of health professionals would probably better enable quality assurance.
|
|
| 4. |
- Juth, Niklas, 1973, et al.
(författare)
-
The Ethics of Screening in Health Care and Medicine: Serving Society or Serving the Patient?
- 2012
-
Bok (övrigt vetenskapligt/konstnärligt)abstract
- Medical or health-oriented screening programs are amongst the most debated aspects of health care and public health practices in health care and public health ethics, as well as health policy discussions. In spite of this, most treatments of screening in the research literature restrict themselves to isolated scientific aspects, sometimes complemented by economic analyses or loose speculations regarding policy aspects. At the same time, recent advances in medical genetics and technology, as well as a rapidly growing societal focus on public health concerns, inspires an increase in suggested or recently started screening programs. This book involves an in-depth analysis of the ethical, political and philosophical issues related to health-oriented screening programs. It explores the considerations that arise when heath care interacts with other societal institutions on a large scale, as is the case with screening: What values may be promoted or compromised by screening programs? What conflicts of values do typically arise – both internally and in relation to the goals of health care, on the one hand, and the goals of public health and the general society, on the other? What aspects of screening are relevant for determining whether it should be undertaken or not and how it should be organised in order to remain defensible? What implications does the ethics of screening have for health care ethics as a whole? These questions are addressed by applying philosophical methods of conceptual analysis, as well as models and theories from moral and political philosophy, medical ethics, and public health ethics, to a large number of ongoing and proposed screening programs which makes this book the first comprehensive work on the ethics of screening. Analyses and suggestions are made that are of potential interest to health care staff, medical researchers, policy makers and the general public.
|
|
| 5. |
- Juth, Niklas, 1973
(författare)
-
The Right Not to Know and the Duty to Tell: The Case of Relatives
- 2014
-
Ingår i: Journal of Law, Medicine and Ethics. - : Cambridge University Press (CUP). - 1073-1105 .- 1748-720X. ; 42, s. 38-52
-
Tidskriftsartikel (refereegranskat)abstract
- © 2014 American Society of Law, Medicine & Ethics, Inc. Obtaining and sharing genetic information when there is a potential conflict of interest between patients and their relatives give rise to two questions. Do we have a duty to find out our genetic predispositions for disease for the sake of our relatives, or do we have a right to remain ignorant? Do we have a duty to disclose our known genetic predispositions for disease to our relatives? I argue that the answer to both questions is yes, but to a lesser extent than sometimes claimed.
|
|
| 6. |
- Lilja Andersson, Petra, et al.
(författare)
-
Ethical aspects of undergoing a predictive genetic testing for Huntington’s disease
- 2013
-
Ingår i: Nursing Ethics. - 0969-7330 .- 1477-0989. ; 20:2, s. 189-199
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe the experiences of undergoing a presymptomatic genetic test for the hereditary and fatal Huntington’s disease, using a case study approach. The study was based on 18 interviews with a young woman and her husband from the decision to undergo the test, to receiving the results and trying to adapt to them, which were analysed using a life history approach. The findings show that the process of undergoing a presymptomatic test involves several closely connected ethical and medical questions, such as the reason for the test, the consequences of the test results and how health-care services can be developed to support people in this situation.
|
|
| 7. |
- Lynöe, Niels, et al.
(författare)
-
Duelling with doctors, restoring honour and avoiding shame? : A cross-sectional study of sick-listed patients' experiences of negative healthcare encounters with special reference to feeling wronged and shame
- 2013
-
Ingår i: Journal of Medical Ethics. - : BMJ. - 0306-6800 .- 1473-4257. ; 39:10, s. 654-657
-
Tidskriftsartikel (refereegranskat)abstract
- Aims: The aim of this study was to examine if it is plausible to interpret the appearance of shame in a Swedish healthcare setting as a reaction to having one's honour wronged.Methods: Using a questionnaire, we studied answers from a sample of long-term sick-listed patients who had experienced negative encounters (n=1628) and of these 64% also felt wronged. We used feeling wronged to examine emotional reactions such as feeling ashamed and made the assumption that feeling shame could be associated with having one's honour wronged. In statistical analyses relative risks (RRs) were computed, adjusting for age, sex, disease-labelling, educational levels, as well as their 95% CI.Results: Approximately half of those who had been wronged stated that they also felt shame and of those who felt shame, 93% (CI 91 to 95) felt that they had been wronged. The RR was 4.5 (CI 3.0 to 6.8) for shame when wronged. This can be compared with the other emotional reactions where the RRs were between 1.1 (CI 0.9 to 1.3)-1.4 (CI 1.2 to 1.7). We found no association between country of birth and feeling shame after having experienced negative encounters.Conclusions: We found that the RR of feeling shame when wronged was significantly higher compared with other feelings. Along with theoretical considerations, and the specific types of negative encounters associated with shame, the results indicate that our research hypothesis might be plausible. We think that the results deserve to be used as point of departure for future research.
|
|
| 8. |
- Malmqvist, Erik, 1980-, et al.
(författare)
-
Early stopping of clinical trials : Charting the ethical terrain
- 2011
-
Ingår i: Kennedy Institute of Ethics journal (Print). - : Johns Hopkins University Press. - 1054-6863 .- 1086-3249. ; 21:1, s. 57-78
-
Tidskriftsartikel (refereegranskat)abstract
- The decision to terminate a clinical trial earlier than planned isoften described as ethically problematic, but it is rarely systematically analyzedas an ethical issue in its own right. This paper provides an overview of the mainethical considerations at stake in such decisions and of the main tensions betweenthese considerations. Arguments about informed consent and the impact of earlystopping on research and society are explored. We devote particular attentionto a familiar conflict that arises with special urgency when early data suggestthat the experimental treatment is superior. Should the trial be stopped so thatparticipants in the control group will not be allocated a seemingly inferior treatment,or should it continue in pursuit of evidence conclusive enough to improvethe care of future patients? We scrutinize three ways to address this problem.Rather than dissolving the tension, they represent different trade-offs betweenthe respective welfare interests of subjects and future patients.
|
|
| 9. |
- Melas, Philippe A, et al.
(författare)
-
Information related to prenatal genetic counseling : interpretation by adolescents, effects on risk perception and ethical implications
- 2012
-
Ingår i: Journal of Genetic Counseling. - : Wiley. - 1059-7700 .- 1573-3599. ; 21:4, s. 536-46
-
Tidskriftsartikel (refereegranskat)abstract
- Being raised in the genomic era may not only increase knowledge of available genetic testing but may also have an impact on how genetic information is perceived. However, little is known about how current adolescents react to the language commonly used by health care professionals providing prenatal counseling. In addition, as risk communication is related to numbers and figures, having different educational backgrounds may be associated with variability in risk perceptions. In order to investigate these issues, a previously developed questionnaire studying different ways of being told about hypothetical anomalies in a baby and corresponding risks (Abramsky and Fletcher Prenatal Diagnosis 22(13):1188-1194, 2002) was administered to high-school students in Sweden. A total of 344 questionnaires were completed by students belonging to a natural science or a social science program. The data show that teenage participants found technical jargon and words such as rare and abnormal more worrying than the presented comparison terms. Negative framing effects and perception differences related to numeric risk formats were also present. Additionally, participants' gender and educational program did not seem to have an effect on risk assessment. In addition to reporting the questionnaire results, we discuss the ethical implications of the data based on the norm of non-directiveness and make some recommendations for practice. In general, genetic counselors should be aware that the language used within clinical services can be influential on this group of upcoming counselees.
|
|
| 10. |
|
|
| 11. |
- Nordström, Karin, et al.
(författare)
-
Values at stake : autonomy, responsibility, and trustworthiness in relation to genetic testing and personalized nutrition advice
- 2013
-
Ingår i: Genes & Nutrition. - : Springer. - 1555-8932 .- 1865-3499. ; 8:4, s. 365-372
-
Tidskriftsartikel (refereegranskat)abstract
- Personalized nutrition has the potential to enhance individual health control. It could be seen as a means to strengthen people’s autonomy as they learn more about their personal health risks, and receive dietary advice accordingly. We examine in what sense personalized nutrition strengthens or weakens individual autonomy. The impact of personalized nutrition on autonomy is analyzed in relation to responsibility and trustworthiness. On a societal level, individualization of health promotion may be accompanied by the attribution of extended individual responsibility for one’s health. This constitutes a dilemma of individualization, caused by a conflict between the right to individual freedom and societal interests. The extent to which personalized nutrition strengthens autonomy is consequently influenced by how responsibility for health is allocated to individuals. Ethically adequate allocation of responsibility should focus on prospective responsibility and be differentiated with regard to individual differences concerning the capacity of adults to take responsibility. The impact of personalized nutrition on autonomy also depends on its methodological design. Owing to the complexity of information received, personalized nutrition through genetic testing (PNTGT) is open to misinterpretation and may not facilitate informed choices and autonomy. As new technologies, personalized nutrition and PNTGT are subject to issues of trust. To strengthen autonomy, trust should be approached in terms of trustworthiness. Trustworthiness implies that an organization that develops or introduces personalized nutrition can show that it is competent to deal with both the technical and moral dimensions at stake and that its decisions are motivated by the interests and expectations of the truster.
|
|
| 12. |
- Rydvall, Anders, et al.
(författare)
-
Are physicians' estimations of future events value-impregnated? : Cross-sectional study of double intentions when providing treatment that shortens a dying patient's life
- 2014
-
Ingår i: Medicine, Health care and Philosophy. - : Springer Netherlands. - 1386-7423 .- 1572-8633. ; 17:3, s. 397-402
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to corroborate or undermine a previously presented conjecture that physicians' estimations of others' opinions are influenced by their own opinions. We used questionnaire based cross-sectional design and described a situation where an imminently dying patient was provided with alleviating drugs which also shortened life and, additionally, were intended to do so. We asked what would happen to physicians' own trust if they took the action described, and also what the physician estimated would happen to the general publics' trust in health services. Decrease of trust was used as surrogate for an undesirable action. The results are presented as proportions with a 95 % Confidence Interval (CI). Statistical analysis was based on inter-rater agreement (Weighted Kappa)-test as well as chi (2) test and Odds Ratio with 95 % CI. We found a moderate inter-rater agreement (Kappa = 0.552) between what would happen with the physicians' own trust in healthcare and their estimations of what would happen with the general population's trust. We identified a significant difference between being pro et contra the treatment with double intentions and the estimation of the general population's trust (chi(2) = 72, df = 2 and p < 0.001). Focusing on either decreasing or increasing own trust and being pro or contra the action we identified a strong association [OR 79 (CI 25-253)]. Although the inter-rater agreement in the present study was somewhat weaker compared to a study about the explicit use of the term 'physicians assisted suicide' we found that our hypothesis-physicians' estimations of others' opinions are influenced by their own opinions-was corroborated. This might have implications in research as well as in clinical decision-making. We suggest that Merton's ideal of disinterestedness should be highlighted.
|
|
| 13. |
- Rydvall, Anders, et al.
(författare)
-
To treat or not to treat a newborn child with severe brain damage? : A cross-sectional study of physicians' and the general population's perceptions of intentions
- 2014
-
Ingår i: Medicine, Health care and Philosophy. - : Springer Science and Business Media LLC. - 1386-7423 .- 1572-8633. ; 17:1, s. 81-88
-
Tidskriftsartikel (refereegranskat)abstract
- Ethical dilemmas are common in the neonatal intensive care setting. The aim of the present study was to investigate the opinions of Swedish physicians and the general public on treatment decisions regarding a newborn with severe brain damage. We used a vignette-based questionnaire which was sent to a random sample of physicians (n = 628) and the general population (n = 585). Respondents were asked to provide answers as to whether it is acceptable to discontinue ventilator treatment, and when it actually is discontinued whether or not it was acceptable to use drugs which hasten death unintentionally or intentionally. The response rate was 67 % of physicians and 46 % of the general population. A majority of both physicians [56 % (CI 50-62)] and the general population [53 % (CI 49-58)] supported arguments for withdrawing ventilator treatment. A large majority in both groups supported arguments for alleviating the patient's symptoms even if the treatment hastened death, but the two groups display significantly different views on whether or not to provide drugs with the additional intention of hastening death, although the difference disappeared when we compared subgroups of those who were for or against euthanasia-like actions. The study indicated that physicians and the general population have similar opinions regarding discontinuing life-sustaining treatment and providing effective drugs which might unintentionally hasten death but seem to have different views on intentions. The results might be helpful to physicians wanting to examine their own intentions when providing adequate treatment at the end of life.
|
|
| 14. |
- Sandberg, Joakim, 1979, et al.
(författare)
-
Ethics and Intuitions: A Reply to Singer
- 2011
-
Ingår i: The Journal of Ethics. - 1382-4554. ; 15:3, s. 209-226
-
Tidskriftsartikel (refereegranskat)abstract
- In a recent paper, Peter Singer suggests that some interesting new findings in experimental moral psychology support what he has contended all along—namely that intuitions should play little or no role in adequate justifications of normative ethical positions. Not only this but, according to Singer, these findings point to a central flaw in the method (or epistemological theory) of /reflective equilibrium/ used by many contemporary moral philosophers. In this paper, we try to defend reflective equilibrium from Singer’s attack and, in part, we do this by discussing Singer’s own favoured moral methodology as outlined in his /Practical Ethics/. Although basing ethics solely on (certain kinds of) intuitions certainly is problematic, we argue, basing it solely on ‘reason’ gives rise to similar problems. The best solution would arguably be one which could strike a balance between the two—but, we suggest, this is precisely what reflective equilibrium is all about.
|
|
| 15. |
- Sjostrand, Manne, et al.
(författare)
-
Paternalism in the Name of Autonomy
- 2013
-
Ingår i: Journal of Medicine and Philosophy. - : Oxford University Press (OUP). - 0360-5310 .- 1744-5019. ; 38:6, s. 710-724
-
Tidskriftsartikel (refereegranskat)abstract
- Different ideas of the normative relevance of autonomy can give rise to profoundly different action-guiding principles in healthcare. If autonomy is seen as a value rather than as a right, it can be argued that patients decisions should sometimes be overruled in order to protect or promote their own autonomy. We refer to this as paternalism in the name of autonomy. In this paper, we discuss different elements of autonomy (decision-making capacity, efficiency, and authenticity) and arguments in favor of paternalism for the sake of autonomy that have been proposed in the bioethical debate. We argue that if autonomy is valuable, then paternalism for the sake of autonomy may be justified. However, policies allowing paternalism in the name of autonomy may be self-defeating.
|
|
| 16. |
- Sjöstrand, Manne, et al.
(författare)
-
Autonomy-based arguments against physician-assisted suicide and euthanasia : A critique
- 2013
-
Ingår i: Medicine, Health care and Philosophy. - : Springer Science and Business Media LLC. - 1386-7423 .- 1572-8633. ; 16:2, s. 225-230
-
Tidskriftsartikel (refereegranskat)abstract
- Respect for autonomy is typically considered a key reason for allowing physician assisted suicide and euthanasia. However, several recent papers have claimed this to be grounded in a misconception of the normative relevance of autonomy. It has been argued that autonomy is properly conceived of as a value, and that this makes assisted suicide as well as euthanasia wrong, since they destroy the autonomy of the patient. This paper evaluates this line of reasoning by investigating the conception of valuable autonomy. Starting off from the current debate in end-of-lifecare, two different interpretations of how autonomy is valuable is discussed. According to one interpretation, autonomy is a personal prudential value, which may provide a reason why euthanasia and assisted suicide might be against a patient’s best interests. According to a second interpretation, inspired by Kantian ethics, being autonomous is unconditionally valuable, which may imply a duty to preserve autonomy. We argue that both lines of reasoning have limitations when it comes to situations relevant for end of life care. It is concluded that neither way of reasoning can be used to show that assisted suicide or euthanasia always is impermissible.
|
|
