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Medium-Range Narratives as a Complementary Tool to Principle-Based Prioritization in Sweden: Test Case "ADHD"
Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
Region Östergötland. Institute for Ethics, History and Philosophy of Medicine, University of Muenster, Muenster, Germany.
2019 (English)In: Journal of Bioethical Inquiry, ISSN 1176-7529, E-ISSN 1872-4353, Vol. 16, no 1, p. 113-125Article in journal (Refereed) Published
Abstract [en]

In this paper, for the benefit of reflection processes in clinical and in local, regional, and national priority-setting, we aim to develop an ethical theoretical framework that includes both ethical principles and medium-range narratives. We present our suggestion in the particular case of having to choose between treatment interventions for attention deficit hyperactivity disorder (ADHD) and treatment interventions for other conditions or diseases, under circumstances of scarcity. In order to arrive at our model, we compare two distinct ethical approaches: a generalist (principles) approach and a particularist (narratives) approach. Our focus is on Sweden, because in Sweden prioritization in healthcare is uniquely governmentally regulated by the “ethics platform.” We will present a (fictional) scenario to analyse the strengths and weaknesses of the generalist principled perspective of the ethics platform and the particularist perspective of narrative ethics. We will suggest an alternative (moderately particularist) approach to prioritization, which we dub a “principles plus medium-range narratives” approach. Notwithstanding the undeniably central role of principles in distributive justice, we claim that medium-range narratives concerning individuals or groups who stand to benefit or lose from ADHD prioritization practices should also be read or listened to and taken into account at all levels of priority-setting. These narratives are expected to ethically optimize clinical priority-setting, as well as that undertaken at local, regional, and national levels.

Place, publisher, year, edition, pages
Springer Netherlands, 2019. Vol. 16, no 1, p. 113-125
Keywords [en]
ADHD, Ethical framework, Medium-range narratives, Prioritization, Swedish healthcare system
National Category
Philosophy, Ethics and Religion
Identifiers
URN: urn:nbn:se:liu:diva-153250DOI: 10.1007/s11673-018-9884-3ISI: 000467739900011PubMedID: 30519994OAI: oai:DiVA.org:liu-153250DiVA, id: diva2:1268491
Available from: 2018-12-06 Created: 2018-12-06 Last updated: 2019-06-14Bibliographically approved

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Jaarsma, PierGelhaus, Petra

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Division of Health Care AnalysisFaculty of Medicine and Health SciencesRegion Östergötland
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