liu.seSearch for publications in DiVA
Change search
Link to record
Permanent link

Direct link
BETA
Alternative names
Publications (10 of 23) Show all publications
Gustavsson, E. & Sandman, L. (2018). Etisk analys av pre-expositionsprofylax (PrEP) för hiv. Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Etisk analys av pre-expositionsprofylax (PrEP) för hiv
2018 (Swedish)Report (Other academic)
Abstract [sv]

Föreliggande etiska analys rör pre- expositionsprofylax (PrEP) mot hiv som en hivnegativ person kan ta för att minska risken för att drabbas av en hivinfektion. Om PrEP tas som ordinerat ger det en ungefärlig skyddsgrad mot hiv på 85 % jämfört med en kontrollgrupp. Eftersom PrEP inte ger 100 % skydd och inte heller skyddar mot andra sexuellt överförbara sjukdomar så är rekommendationen att det tas i kombination med praktiserandet av säkert sex.

Den här etiska analysen har gjorts på uppdrag av NT-rådet och behandlar följande två frågeställningar: 1) finns det etiska skäl som talar emot förskrivning av PrEP; (2) hur bör PrEP prioriteras i relation till den etiska plattformen med ett särskilt fokus på huruvida PrEP bör egenfinanseras. Det finns starka skäl att minska smittspridningen av hiv utifrån såväl ett individ- som ett samhällsperspektiv vilket talar för förskrivning av PrEP. I diskussionen kring PrEP har det dock framförts att PrEP skiljer sig från annan preventiv behandling för att minska smittspridning på ett sätt som talar emot att PrEP förskrivs. Den etiska analysen diskuterar ett antal sådana argument: att friska personer utan medicinskt behov behandlas, att det handlar om ett socialt riskbeteende, att individer själva bör ta ansvar för smittspridning genom att ändra sitt beteende, samt risken för resistensproblematik. Slutsatsen är att inte något av dessa motargument är tillräckligt starkt för att tala emot förskrivningen av PrEP.

När det gäller prioritering av PrEP i relation till den etiska plattformen dras slutsatsen att PrEP hamnar i den lägre delen av prioriteringsskalan baserat på svårighetsgraden hos tillståndet som PrEP riktar sig emot. Det innebär att PrEP skulle kunna vara en kandidat för egenfinansiering.

Eftersom den etiska plattformen säger mycket lite om vilka åtgärder som bör egenfinaiseras så har analysen utgått från två ramverk presenterade i den internationella literaturen. Trots att flera aspekter av dessa ramverk talar för att PrEP skulle vara passande för egenfinansiering så väger aspekten av minskad smittspridning tungt. Dessa positiva externa effekter tillsammans med svårigheten att bedöma huruvida patientpopulationen skulle kunna egenfinansiera PrEP bidrar till bedömningen att PrEP bör finansieras inom ramen för det offentliga åtagandet.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2018. p. 16
Series
PrioC Access ; 2018:1
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-153865 (URN)
Available from: 2019-01-15 Created: 2019-01-15 Last updated: 2019-06-27Bibliographically approved
Broqvist, M., Sandman, L., Garpenby, P. & Krevers, B. (2018). The meaning of severity - do citizenś views correspond to a severity framework based on ethical principles for priority setting?. Health Policy, 122(6), 630-637, Article ID S0168-8510(18)30081-2.
Open this publication in new window or tab >>The meaning of severity - do citizenś views correspond to a severity framework based on ethical principles for priority setting?
2018 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 122, no 6, p. 630-637, article id S0168-8510(18)30081-2Article in journal (Refereed) Published
Abstract [en]

The importance for governments of establishing ethical principles and criteria for priority setting in line with social values, has been emphasised. The risk of such criteria not being operationalised and instead replaced by de-contextualised priority-setting tools, has been noted. The aim of this article was to compare whether citizenś views are in line with how a criterion derived from parliamentary-decided ethical principles have been interpreted into a framework for evaluating severity levels, in resource allocation situations in Sweden. Interviews were conducted with 15 citizens and analysed by directed content analysis. The results showed that the multi-factorial aspects that participants considered as relevant for evaluating severity, were similar to those used by professionals in the Severity Framework, but added some refinements on what to consider when taking these aspects into account. Findings of similarities, such as in our study, could have the potential to strengthen the internal legitimacy among professionals, to use such a priority-setting tool, and enable politicians to communicate the justifiability of how severity is decided. The study also disclosed new aspects regarding severity, of which some are ethically disputed, implying that our results also reveal the need for ongoing ethical discussions in publicly-funded healthcare systems.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Citizens views, Directed content analysis, Ethical principles, Priority setting, Severity of ill health, Sweden
National Category
Medical Ethics
Identifiers
urn:nbn:se:liu:diva-147772 (URN)10.1016/j.healthpol.2018.04.005 (DOI)000438479000010 ()29728287 (PubMedID)
Available from: 2018-05-14 Created: 2018-05-14 Last updated: 2019-06-27
Sandman, L. & Gustavsson, E. (2016). Beyond the Black Box Approach to Ethics! Comment on "Expanded HTA: Enhancing Fairness and Legitimacy".. International Journal of Health Policy and Management, 5(6), 393-394
Open this publication in new window or tab >>Beyond the Black Box Approach to Ethics! Comment on "Expanded HTA: Enhancing Fairness and Legitimacy".
2016 (English)In: International Journal of Health Policy and Management, ISSN 2322-5939, E-ISSN 2322-5939, Vol. 5, no 6, p. 393-394Article in journal, Editorial material (Refereed) Published
Abstract [en]

In the editorial published in this journal, Daniels and colleagues argue that his and Sabin's accountability for reasonableness (A4R) framework should be used to handle ethical issues in the health technology assessment (HTA)-process, especially concerning fairness. In contrast to this suggestion, it is argued that such an approach risks suffering from the irrrelevance or insufficiency they warn against. This is for a number of reasons: lack of comprehensiveness, lack of guidance for how to assess ethical issues within the "black box" of A4R as to issues covered, competence and legitimate arguments and finally seemingly accepting consensus as the final verdict on ethical issues. We argue that the HTA community is already in a position to move beyond this black box approach.

Keywords
Accountability for Reasonableness (A4R); Ethical Analysis; Ethical Competence; Ethics; Health Technology Assessment (HTA)
National Category
Medical Ethics
Identifiers
urn:nbn:se:liu:diva-130499 (URN)10.15171/ijhpm.2016.43 (DOI)27285520 (PubMedID)
Available from: 2016-08-11 Created: 2016-08-11 Last updated: 2019-06-27
Munthe, C., Broström, L., Brülde, B., Cutas, D., Eriksson, S., Helgeson, G., . . . Johansson, M. (2016). Efter skandalen: ”Gråzoner sätt att blanda bort korten”. Svenska Dagbladet
Open this publication in new window or tab >>Efter skandalen: ”Gråzoner sätt att blanda bort korten”
Show others...
2016 (Swedish)In: Svenska Dagbladet, ISSN 1101-2412Article in journal, News item (Other (popular science, discussion, etc.)) Published
Abstract [sv]

Efter skandalen kring kirurgen på Karolinska Institutet som gjorde experimentella operationer, talas det om gråzoner i lagen. Men detta stämmer inte, utan är ett sätt att blanda bort korten, skriver en rad professorer från sex olika universitet gemensamt.

Keywords
research ethics, grey zone, macciarini, forskningsetik, gråzon, macchiarini
National Category
Ethics Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-127132 (URN)
Available from: 2016-04-14 Created: 2016-04-14 Last updated: 2019-06-27
Sjostrand, M., Karlsson, P., Sandman, L., Helgesson, G., Eriksson, S. & Juth, N. (2015). Conceptions of decision-making capacity in psychiatry: interviews with Swedish psychiatrists. BMC Medical Ethics, 16(34)
Open this publication in new window or tab >>Conceptions of decision-making capacity in psychiatry: interviews with Swedish psychiatrists
Show others...
2015 (English)In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 16, no 34Article in journal (Refereed) Published
Abstract [en]

Background: Decision-making capacity is a key concept in contemporary healthcare ethics. Previous research has mainly focused on philosophical, conceptual issues or on evaluation of different tools for assessing patients capacity. The aim of the present study is to investigate how the concept and its normative role are understood in Swedish psychiatric care. Of special interest for present purposes are the relationships between decisional capacity and psychiatric disorders and between health law and practical ethics. Methods: Eight in-depth interviews were conducted with Swedish psychiatrists. The interviews were analysed according to descriptive qualitative content analysis in which categories and sub-categories were distilled from the material. Results: Decision-making capacity was seen as dependent on understanding, insight, evaluation, reasoning, and abilities related to making and communicating a choice. However, also the actual content of the decision was held as relevant. There was an ambivalence regarding the relationship between psychiatric disorders and capacity and a tendency to regard psychiatric patients who made unwise treatment decisions as decisionally incapable. However, in cases relating to patients with somatic illnesses, the assumption was rather that patients who made unwise decisions were imprudent but yet decisionally capable. Conclusions: The respondents conceptions of decision-making capacity were mainly in line with standard theories. However, the idea that capacity also includes aspects relating to the content of the decision clearly deviates from the standard view. The tendency to regard imprudent choices by psychiatric patients as betokening lack of decision-making capacity differs from the view taken of such choices in somatic care. This difference merits further investigations.

Place, publisher, year, edition, pages
BioMed Central, 2015
Keywords
Psychiatry; Bioethics; Mental capacity; Personal autonomy; Paternalism; Involuntary commitment
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-121148 (URN)10.1186/s12910-015-0026-8 (DOI)000359415200001 ()25990948 (PubMedID)
Note

Funding Agencies|Swedish Research Council [437-2014-299]; Swedish Research Council for Health, Working Life and Welfare [2014-4024]; Swedish Society of Medicine

Available from: 2015-09-08 Created: 2015-09-08 Last updated: 2019-06-27
Carlsson, P. & Sandman, L. (2015). "Dags att utveckla den etiska plattformen för prioriteringar". Dagens Medicin
Open this publication in new window or tab >>"Dags att utveckla den etiska plattformen för prioriteringar"
2015 (Swedish)In: Dagens Medicin, ISSN 1104-7488Article in journal, News item (Other (popular science, discussion, etc.)) Epub ahead of print
Abstract [sv]

Hälso- och sjukvården har under senare år ställts inför en rad utmaningar när det gäller användningen av de begränsade resurserna. Exempelvis har nya effektiva men mycket dyra läke­medel som Zytiga, Soliris eller läkemedel mot hepatit C lett till prioriteringsbeslut som har kritiserats men också blottlagt brister i den etiska plattform som ska vägleda beslutsfattare. Därför menar vi att plattformen behöver en parlamentarisk översyn.

Keywords
etiska plattformen för prioriteringar
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-130725 (URN)
Available from: 2016-08-22 Created: 2016-08-22 Last updated: 2019-06-27
Sjostrand, M., Sandman, L., Karlsson, P., Helgesson, G., Eriksson, S. & Juth, N. (2015). Ethical deliberations about involuntary treatment: interviews with Swedish psychiatrists. BMC Medical Ethics, 16(37)
Open this publication in new window or tab >>Ethical deliberations about involuntary treatment: interviews with Swedish psychiatrists
Show others...
2015 (English)In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 16, no 37Article in journal (Refereed) Published
Abstract [en]

Background: Involuntary treatment is a key issue in healthcare ethics. In this study, ethical issues relating to involuntary psychiatric treatment are investigated through interviews with Swedish psychiatrists. Methods: In-depth interviews were conducted with eight Swedish psychiatrists, focusing on their experiences of and views on compulsory treatment. In relation to this, issues about patient autonomy were also discussed. The interviews were analysed using a descriptive qualitative approach. Results: The answers focus on two main aspects of compulsory treatment. Firstly, deliberations about when and why it was justifiable to make a decision on involuntary treatment in a specific case. Here the cons and pros of ordering compulsory treatment were discussed, with particular emphasis on the consequences of providing treatment vs. refraining from ordering treatment. Secondly, a number of issues relating to background factors affecting decisions for or against involuntary treatment were also discussed. These included issues about the Swedish Mental Care Act, healthcare organisation and the care environment. Conclusions: Involuntary treatment was generally seen as an unwanted exception to standard care. The respondents judgments about involuntary treatment were typically in line with Swedish law on the subject. However, it was also argued that the law leaves room for individual judgments when making decisions about involuntary treatment. Much of the reasoning focused on the consequences of ordering involuntary treatment, where risk of harm to the therapeutic alliance was weighed against the assumed good consequences of ensuring that patients received needed treatment. Cases concerning suicidal patients and psychotic patients who did not realise their need for care were typically held as paradigmatic examples of justified involuntary care. However, there was an ambivalence regarding the issue of suicide as it was also argued that risk of suicide in itself might not be sufficient for justified involuntary care. It was moreover argued that organisational factors sometimes led to decisions about compulsory treatment that could have been avoided, given a more patient-oriented healthcare organisation.

Place, publisher, year, edition, pages
BioMed Central, 2015
Keywords
Psychiatry; Bioethics; Personal autonomy; Paternalism; Coercion; Involuntary commitment
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-121146 (URN)10.1186/s12910-015-0029-5 (DOI)000359415500002 ()26016885 (PubMedID)
Note

Funding Agencies|Swedish Research Council [437-2014-299]; Swedish Research Council; Swedish Research Council for Health, Working Life and Welfare [2014-4024]; Swedish Society of Medicine

Available from: 2015-09-08 Created: 2015-09-08 Last updated: 2019-06-27
Gustavsson, E., Juth, N., Munthe, C. & Sandman, L. (2015). Etiska och praktiska utmaningar med ökat patientinflytande. Läkartidningen, 112, Article ID DD3X.
Open this publication in new window or tab >>Etiska och praktiska utmaningar med ökat patientinflytande
2015 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, article id DD3XArticle in journal (Other academic) Published
Abstract [sv]

Det finns ett ökat intresse för patientinflytande i vården. Ett sådant fokus kan dock komma i konflikt med ett antal värden/praktiker inom vården. I denna artikel identifierar vi att följande värden/praktiker kan påverkas: 

Idén om patientens vårdbehov förefaller tappa sin moraliska och politiska ställning. 

Prioriteringar på gruppnivå kan bli svårare att tillämpa på individnivå. 

Det kan bli svårare att bedöma nyttan med behandlingar. 

Det kan bli svårare att få fram evidens för behandlingar. 

Det tycks komplicera idén om den följsamme patienten. 

Det kan innebära vissa implikationer för resursanvändning. 

Det kan ge ett nytt perspektiv på idén om att prioritera efter en ansvarsprincip.

Place, publisher, year, edition, pages
Stockholm: , 2015
National Category
Medical Ethics
Identifiers
urn:nbn:se:liu:diva-130504 (URN)
Available from: 2016-08-11 Created: 2016-08-11 Last updated: 2019-06-27
Heintz, E., Lintamo, L., Hultcrantz, M., Jacobson, S., Levi, R., Munthe, C., . . . Sandman, L. (2015). FRAMEWORK FOR SYSTEMATIC IDENTIFICATION OF ETHICAL ASPECTS OF HEALTHCARE TECHNOLOGIES: THE SBU APPROACH. International Journal of Technology Assessment in Health Care, 31(3), 124-130
Open this publication in new window or tab >>FRAMEWORK FOR SYSTEMATIC IDENTIFICATION OF ETHICAL ASPECTS OF HEALTHCARE TECHNOLOGIES: THE SBU APPROACH
Show others...
2015 (English)In: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 31, no 3, p. 124-130Article in journal (Refereed) Published
Abstract [en]

Objectives: Assessment of ethical aspects of a technology is an important component of health technology assessment (HTA). Nevertheless, how the implementation of ethical assessment in HTA is to be organized and adapted to specific regulatory and organizational settings remains unclear. The objective of this study is to present a framework for systematic identification of ethical aspects of health technologies. Furthermore, the process of developing and adapting the framework to a specific setting is described. Methods: The framework was developed based on an inventory of existing approaches to identification and assessment of ethical aspects in HTA. In addition, the framework was adapted to the Swedish legal and organizational healthcare context, to the role of the HTA agency and to the use of non-ethicists. The framework was reviewed by a group of ethicists working in the field as well as by a wider set of interested parties including industry, interest groups, and other potential users. Results: The framework consists of twelve items with sub-questions, short explanations, and a concluding overall summary. The items are organized into four different themes: the effects of the intervention on health, its compatibility with ethical norms, structural factors with ethical implications, and long term ethical consequences of using the intervention. Conclusions: In this study, a framework for identifying ethical aspects of health technologies is proposed. The general considerations and methodological approach to this venture will hopefully inspire and present important insights to organizations in other national contexts interested in making similar adaptations.

Place, publisher, year, edition, pages
Cambridge University Press (CUP): HSS Journals, 2015
Keywords
Ethics; Guideline; Framework; Procedure; Health technology assessment
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-120666 (URN)10.1017/S0266462315000264 (DOI)000358218800003 ()26134927 (PubMedID)
Available from: 2015-08-20 Created: 2015-08-20 Last updated: 2019-06-27
Gustavsson, E. & Sandman, L. (2015). Health-care needs and shared decision-making in priority-setting. Medicine, Health care and Philosophy, 18(1), 13-22
Open this publication in new window or tab >>Health-care needs and shared decision-making in priority-setting
2015 (English)In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 18, no 1, p. 13-22Article in journal (Refereed) Published
Abstract [en]

In this paper we explore the relation between health-care needs and patients desires within shared decision-making (SDM) in a context of priority setting in health care. We begin by outlining some general characteristics of the concept of health-care need as well as the notions of SDM and desire. Secondly we will discuss how to distinguish between needs and desires for health care. Thirdly we present three cases which all aim to bring out and discuss a number of queries which seem to arise due to the double focus on a patients need and what that patient desires. These queries regard the following themes: the objectivity and moral force of needs, the prediction about what kind of patients which will appear on a micro level, implications for ranking in priority setting, difficulties regarding assessing and comparing benefits, and implications for evidence-based medicine.

Place, publisher, year, edition, pages
Springer Verlag (Germany), 2015
Keywords
Needs; Health-care needs; Shared decision-making; Desires; Priority setting; Rationing
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-114234 (URN)10.1007/s11019-014-9568-7 (DOI)000347699000003 ()24807745 (PubMedID)
Available from: 2015-02-16 Created: 2015-02-16 Last updated: 2019-06-27Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-0987-7653

Search in DiVA

Show all publications