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  • 1.
    Aamodt, Ina Thon
    et al.
    Oslo Univ Hosp, Norway; Univ Oslo, Norway; Lovisenberg Diaconal Univ Coll, Norway.
    Strömberg, Anna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Kardiologiska kliniken US.
    Helleso, Ragnhild
    Univ Oslo, Norway.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten.
    Lie, Irene
    Oslo Univ Hosp, Norway.
    Tools to Support Self-Care Monitoring at Home: Perspectives of Patients with Heart Failure2020Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, nr 23, artikel-id 8916Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Self-care monitoring at home can be a challenge for patients with heart failure (HF). Tools that leverage information and communication technology (ICT), comprise medical devices, or have written material may support their efforts at home. The aim of this study was to describe HF patients experiences and their prioritization of tools that support, or could support, self-care monitoring at home. A descriptive qualitative design employing semi-structured interviews was used with HF patients living at home and attending an HF outpatient clinic in Norway. We used a deductive analysis approach, using the concept of self-care monitoring with ICT tools, paper-based tools, medical devices, and tools to consult with healthcare professionals (HCPs) as the categorization matrix. Nineteen HF patients with a mean age of 64 years participated. ICT tools are used by individual participants to identify changes in their HF symptoms, but are not available by healthcare services. Paper-based tools, medical devices, and face-to-face consultation with healthcare professionals are traditional tools that are available and used by individual participants. HF patients use traditional and ICT tools to support recognizing, identifying, and responding to HF symptoms at home, suggesting that they could be used if they are available and supplemented by in-person consultation with HCPs.

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  • 2.
    Barra, Mathias
    et al.
    Akershus Univ Hosp, Norway.
    Broqvist, Mari
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Gustavsson, Erik
    Linköpings universitet, Institutionen för kultur och samhälle, Avdelningen för filosofi, historia, konst och religion. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Henriksson, Martin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Juth, Niklas
    Karolinska Inst, Sweden.
    Sandman, Lars
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Solberg, Carl Tollef
    Akershus Univ Hosp, Norway; Univ Bergen, Norway.
    Severity as a Priority Setting Criterion: Setting a Challenging Research Agenda2020Ingår i: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 28, nr 1, s. 25-44Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to todays severity criteria in Norway and Sweden. The Scandinavian perspective on severity might be conducive to the international discussion, given its long-standing use as a priority setting criterion, despite having reached rather different conclusions so far. We then argue that severity can be viewed as a multidimensional concept, drawing on accounts of need, urgency, fairness, duty to save lives, and human dignity. Such concerns will often be relative to local mores, and the weighting placed on the various dimensions cannot be expected to be fixed. Thirdly, we present what we think are the most pertinent questions to answer about severity in order to facilitate decision making in the coming years of increased scarcity, and to further the understanding of underlying assumptions and values that go into these decisions. We conclude that severity is poorly understood, and that the topic needs substantial further inquiry; thus we hope this article may set a challenging and important research agenda.

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  • 3.
    Bea, Sara
    Science Technology and Innovation Studies, The University of Edinburgh, UK.
    No Heroics, Please: Mapping Deceased Donation Practices in a Catalan Hospital2017Doktorsavhandling, monografi (Övrigt vetenskapligt)
    Abstract [en]

    This thesis presents an in-depth ethnographic mapping of deceased donation in a Catalan hospital. A unique site in terms of leading edge technoscientific practices, high rates of donation and its consolidated specialised team of transplant coordinators (TCs). The thesis situates donation as an embedded medical practice and traces the practicalities and specificities of making donation a possibility at the hospital. The empirical accounts offer a distinctive contribution that complements and challenges existing social sciences literature about donation. The latter have predominantly focused on donation as a controversial practice through highlighting the emotional experiences of donors’ families and individual medical practitioners involved. This empirical investigation mobilises, and further develops, STS material semiotics tools to provide an account of donation enacted as both procurement and healthcare. Ethnographic insights illustrate the shifting processes of mutual inclusion and exclusion that underpin the trajectory of integrating donation as a routinized hospital practice, along the recurring set of enduring tensions. This is achieved by following the work of TCs along the stages of donor detection, evaluation, maintenance, consent request and organ extraction. Crucially, the analytical focus decenters the individual actors’ perspectives, broadening the scope of the inquiry and making visible the complex sociomaterial arrangements that take place, inside and outside the hospital, which are rendered as a gradual process of assembling donations. Families’ consent to donation is essential but it is decentered, it is neither that which starts a donation process nor the only factor that contributes to the assembling of a donation process. Unlike available anthropological and sociological studies of donation this work is not about documenting the reductionist transition from patient to donor, whole to parts, person to thing and denouncing the fall from subject to object reified in donation practices. The emphasis here is on tracing the overlap between donors as patients, thus the analysis shows the shifting enactments of the embedded donor/patient configuration, which includes the donor/body, donor/person and donor/corpse figures simultaneously along the donation process. The intervention of bodies as active entities is examined through a speculative and pragmatic elucidation on the situated and relational enactments of responsive bodies and organs. This thesis contributes to contemporary re/articulations of materiality and agency through the lens of distributed joint action and entangled actors from a nonanthropomorphic stance. The research also contributes to current policy debates in the UK, and in Scotland in particular, that propose to tackle the national problem of low donation rates with a legislative move to an opt-out system for donation. It offers robust empirical evidence to contest the dominant organ shortage problematisation that is reduced to the legal polarity of either opting in or out of donation. I suggest that questions about increasing donation rates cannot be restricted to the domain of individual choice as this excludes the situated medical practices that enable the choice of donation in the first place.

  • 4. Beställ onlineKöp publikationen >>
    Broqvist, Mari
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Asking the public: Citizens´ views on priority setting and resource allocation in democratically governed healthcare2018Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Resource allocation in publicly funded healthcare systems is inevitably linked with priority setting between different patient groups and between different service areas, so-called meso level priorities. Behind every priority-setting decision (investments, reallocating or rationing), are values affecting both the content of the decisions and how the decisions are made. The importance for priority-setting to reflect social values, has been emphasised for the legitimacy of the healthcare systems and the decision makers. Also important, if supposed to provide enough guidance in practice, is that content values, expressed in ethical principles and criteria, are further operationalised. Few studies exist where Swedish citizens have been asked about priority setting and rationing at meso level, and findings from other countries cannot automatically be transferred to the Swedish context.

    The overall aim of this thesis is to extend and deepen the knowledge of the Swedish citizens´ views on acceptance of rationing in healthcare, on appropriate decision makers for rationing, and on the severity criterion for priority setting. Two qualitative and one mixmethod study were conducted, where citizens were interviewed. Citizens´ views on severity were also compared, both with a Severity Framework, derived from parliamentary-decided ethical principles and used for resource allocation, and with health professionals´ and politicians´ ranking of different aspects of severity in a quantitative, survey study.

    Study I shows that citizen participants perceived that acceptance of rationing at meso level is built on the awareness of priority-setting dilemmas between patient groups. No such spontaneous awareness was found. Depending on reactions of self-interest or solidarity, acceptance was also perceived to be built on acceptable principles for rationing and/or access to alternatives to public care. Study II shows that awareness of the meso level forms the basis for awareness of different risks of unfairness, linked with potential decision makers (even health professionals). Collaborative arrangements were promoted in order to control for such risks, especially the risk of self-interest. Politicians, in contrast to previous studies, were favoured as final decision makers for rationing healthcare. In study III, citizen participants identified the same severity aspects as health professionals and experts had done in the Severity Framework. They contributed with some possible refinements, but also promoted aspects not in line with established ethical criteria for priority setting in Sweden. Study IV shows that citizen respondents differ to a larger proportion compared to politicians´ ranking of severity aspects, than with that of health professionals´. The greatest number of significant differences was found between politicians and health professionals.

    This thesis has several implications. Politicians ought to strive for greater public awareness of the priority-setting dilemma at the meso level in healthcare, both according to the process and the content values behind the decisions. Social values not in accordance to the parliamentary decision indicate a need to facilitate an ongoing dialogue, reason-giving activities and promotion of content values of solidarity. To capture social values on priority setting and rationing, ambitious public deliberation is not the only way. Methodologically stringent research, with a variety of study designs, could contribute in many important ways.

    Delarbeten
    1. To accept, or not to accept, that is the question: citizen reactions to rationing
    Öppna denna publikation i ny flik eller fönster >>To accept, or not to accept, that is the question: citizen reactions to rationing
    2014 (Engelska)Ingår i: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 17, nr 1, s. 82-92Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background  The publicly financed health service in Sweden has come under increasing pressure, forcing policy makers to consider restrictions. Objective  To describe different perceptions of rationing, in particular, what citizens themselves believe influences their acceptance of having to stand aside for others in a public health service. Design  Qualitative interviews, analysed by phenomenography, describing perceptions by different categories. Setting and participants  Purposeful sample of 14 Swedish citizens, based on demographic criteria and attitudes towards allocation in health care. Results  Participants expressed high awareness of limitations in public resources and the necessity of rationing. Acceptance of rationing could increase or decrease, depending on one's (i) awareness that healthcare resources are limited, (ii) endorsement of universal health care, (iii) knowledge and acceptance of the principles guiding rationing and (iv) knowledge about alternatives to public health services. Conclusions  This study suggests that decision makers should be more explicit in describing the dilemma of resource limitations in a publicly funded healthcare system. Openness enables citizens to gain the insight to make informed decisions, i.e. to use public services or to 'opt out' of the public sector solution if they consider rationing decisions unacceptable.

    Ort, förlag, år, upplaga, sidor
    John Wiley & Sons, 2014
    Nyckelord
    citizen perspective, phenomenography, priority setting, rationing, Sweden
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-104308 (URN)10.1111/j.1369-7625.2011.00734.x (DOI)000330647300010 ()22032636 (PubMedID)
    Tillgänglig från: 2014-02-14 Skapad: 2014-02-14 Senast uppdaterad: 2018-04-03
    2. It takes a giraffe to see the big picture - Citizens' view on decision makers in health care rationing
    Öppna denna publikation i ny flik eller fönster >>It takes a giraffe to see the big picture - Citizens' view on decision makers in health care rationing
    2015 (Engelska)Ingår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 128, s. 301-308Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Previous studies show that citizens usually prefer physicians as decision makers for rationing in health care, while politicians are downgraded. The findings are far from clear-cut due to methodological differences, and as the results are context sensitive they cannot easily be transferred between countries. Drawing on methodological experiences from previous research, this paper aims to identify and describe different ways Swedish citizens understand and experience decision makers for rationing in health care, exclusively on the programme level. We intend to address several challenges that arise when studying citizens' views on rationing by (a) using a method that allows for reflection, (b) using the respondents' nomination of decision makers, and (c) clearly identifying the rationing level. We used phenomenography, a qualitative method for studying variations and changes in perceiving phenomena. Open-ended interviews were conducted with 14 Swedish citizens selected by standard criteria (e.g. age) and by their attitude towards rationing. The main finding was that respondents viewed politicians as more legitimate decision makers in contrast to the results in most other studies. Interestingly, physicians, politicians, and citizens were all associated with some kind of risk related to self-interest in relation to rationing. A collaborative solution for decision making was preferred where the views of different actors were considered important. The fact that politicians were seen as appropriate decision makers could be explained by several factors: the respondents' new insights about necessary trade-offs at the programme level, awareness of the importance of an overview of different health care needs, awareness about self-interest among different categories of decision-makers, including physicians, and the national context of long-term political accountability for health care in Sweden. This study points to the importance of being aware of contextual and methodological issues in relation to research on how citizens experience arrangements for rationing in health care.

    Ort, förlag, år, upplaga, sidor
    Elsevier, 2015
    Nyckelord
    Sweden Health care Rationing Programme level Decision maker Citizens' view Interview Phenomenography
    Nationell ämneskategori
    Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi
    Identifikatorer
    urn:nbn:se:liu:diva-115129 (URN)10.1016/j.socscimed.2015.01.043 (DOI)000351323500037 ()25638017 (PubMedID)
    Anmärkning

    The authors gratefully acknowledge the contribution made by the participants in this study. This study was supported by the Swedish Federation of County Councils Research Program on Change Processes in Health Care and the Swedish National Centre for Priority Setting in Health Care.

    Tillgänglig från: 2015-03-09 Skapad: 2015-03-09 Senast uppdaterad: 2018-04-03
    3. The meaning of severity - do citizenś views correspond to a severity framework based on ethical principles for priority setting?
    Öppna denna publikation i ny flik eller fönster >>The meaning of severity - do citizenś views correspond to a severity framework based on ethical principles for priority setting?
    2018 (Engelska)Ingår i: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 122, nr 6, s. 630-637, artikel-id S0168-8510(18)30081-2Artikel i tidskrift (Refereegranskat) 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.

    Ort, förlag, år, upplaga, sidor
    Elsevier, 2018
    Nyckelord
    Citizens views, Directed content analysis, Ethical principles, Priority setting, Severity of ill health, Sweden
    Nationell ämneskategori
    Medicinsk etik
    Identifikatorer
    urn:nbn:se:liu:diva-147772 (URN)10.1016/j.healthpol.2018.04.005 (DOI)000438479000010 ()29728287 (PubMedID)
    Tillgänglig från: 2018-05-14 Skapad: 2018-05-14 Senast uppdaterad: 2020-01-29
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    Asking the public: Citizens´ views on priority setting and resource allocation in democratically governed healthcare
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  • 5.
    Broqvist, Mari
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Sandman, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Garpenby, Peter
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Krevers, Barbro
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    The meaning of severity - do citizenś views correspond to a severity framework based on ethical principles for priority setting?2018Ingår i: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 122, nr 6, s. 630-637, artikel-id S0168-8510(18)30081-2Artikel i tidskrift (Refereegranskat)
    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.

  • 6.
    Brüggemann, Jelmer
    et al.
    Linköpings universitet, Institutionen för tema, Tema teknik och social förändring. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Forsberg, Camilla
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och didaktik. Linköpings universitet, Utbildningsvetenskap. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Thornberg, Robert
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och didaktik. Linköpings universitet, Utbildningsvetenskap.
    Re-negotiating agency: patients using comics to reflect upon acting in situations of abuse in health care2019Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 19, nr 1, artikel-id 58Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    There is a growing body of international research that displays the prevalence and character of abuse in health care. Even though most of these studies are conducted from a patient perspective little is known about how patients conceptualize their agency in relation to such situations. This study aimed to explore how patients reason about their potential to act in abusive situations.

    Methods

    Qualitative interviews were conducted with thirteen patients in Sweden. Central in the interviews were three comics, inspired by Boal’s Forum Theatre and part of an earlier online intervention study in which the informants had participated. Each comic showed a situation in which a patient feels abused, and on the opposite side were suggestions for how the patient could act in response. Informants were asked to reflect about situations of abuse and in specific upon the comics. We used the methodology of constructivist grounded theory throughout the study, including the analysis.

    Results

    It appeared that the informants constantly re-negotiated their and other patients’ agency in relation to the specifics of the event, patients’ and staff’s responsibilities, and the patients’ needs and values. This process questions views of agency as fixed and self-evident, and can be understood as part of changing discourses about patients’ social role and possibilities to organize their care. Using a feminist theory of power we expected the informants to elicit instances of resistance to domination, which is central to the comics. While doing that, the informants also hinted at parallel stories of empowerment and less visible forms of agency in spite of domination.

    Conclusion

    The current analysis showed different ways in which the informants constantly re-negotiated their agency in potentially abusive situations. Not only did the informants engage in reflections about immediate responses to these untoward situations, they also engaged in thoughts about strategies that could protect them and counteract abuse in health care over the long-term. This opens up for future research into ways patients organize their care and identify threats and barriers to the care they need, which could be valuable knowledge for care quality improvement.

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    Re-negotiating agency – patients using comics to reflect upon acting in situations of abuse in health care
  • 7.
    Bäckryd, Emmanuel
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Nurturing the Virtues: Upholding Professionalism in the Midst of Busy Medical Practice2019Ingår i: Journal of Continuing Education in the Health Professions, ISSN 0894-1912, E-ISSN 1554-558X, Vol. 39, nr 1, s. 69-72Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Tom L. Beauchamp and James F. Childress (Bamp;C) book Principles of Biomedical Ethics is well known for its fourprinciple approach to biomedical ethics. However, the authors also emphasize the importance of the virtues of health care personnel. After a short overview of virtue ethics, the five "focal virtues" described by Bamp;C are discussed and applied to a chronic pain example. The question of how virtues are learned in the health care setting is addressed, and it is argued that virtues such as the ones defended by Bamp;C are acquired when health care personnel are socialized in an environment dedicated to the continuous upholding of practices that aim at the telos of medicine. Viewed from this perspective, professional isolation can be considered to be dangerous; the upholding of medical professionalism throughout a whole career largely presupposing the existence of a community where virtues relevant to the practice of medicine are embodied and kept alive. The concept of professional socialization is important in that respect. Finally, some potential general implications of this view for continuing professional development are proposed.

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  • 8.
    Bäckryd, Emmanuel
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin.
    "Professional Helper" or "Helping Professional?" The Patient-Physician Relationship in the Chronic Pain Setting, With Special Reference to the Current Opioid Debate2016Ingår i: Journal of Continuing Education in the Health Professions, ISSN 0894-1912, E-ISSN 1554-558X, Vol. 36, nr 2, s. 133-137Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There seems to be a strong cultural expectation among patients for effective pain relief. As a result, physicians often find themselves trying to bridge the gap between the chronic pain patients expectations and harsh biomedical reality. The typology of Emanuel and Emanuel of four models for the patient-physician relationship is used in this article as a conceptual tool to examine the possible roles of physicians in the context of chronic noncancer pain. Their typology is reconceptualized as a "pathway" along which the physician is able to walk more or less far, starting from the "information" end of the path. The other end of the pathway is "caring deliberation." I then propose that, in pain medicine today, consumerism is a powerful incentive for physicians to stay at the information end of the spectrum. Against this background, I discuss the current opioid epidemic in the United States and the need for what has been called a new medical professionalism. I conclude by challenging educators involved in pain medicine continuing professional development to not only design adequate biomedical-educational programs, but also consider issues like professionalism, personal development, critical self-reflection, and the ethics of engaging in caring deliberation with chronic pain patients.

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  • 9.
    Collste, Göran
    et al.
    Linköpings universitet, Institutionen för kultur och samhälle, Avdelningen för filosofi, historia, konst och religion. Linköpings universitet, Filosofiska fakulteten.
    Hermerén, Göran
    Lunds universitet.
    Sahlin, Nils-Eric
    Lunds universitet.
    Sandlund, Mikael
    Umeå universitet.
    Eriksson, Lotta
    Statens medicinsk-etiska råd (Smer).
    Etiska vägval vid en pandemi: Rapport från Statens medicinsk-etiska råd2020Rapport (Övrigt vetenskapligt)
  • 10.
    Dwyer, Lise-Lotte
    et al.
    Örebro University, Sweden, and Ersta Sköndal University College, Stockholm, Sweden.
    Andershed, Birgitta
    Örebro University, Sweden, and Ersta Sköndal University College, Stockholm, Sweden.
    Nordenfelt, Lennert
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Ternestedt, Britt-Marie
    Ersta Sköndal University College Stockholm, Sweden and Karolinska Institutet, Stockholm, Sweden.
    Dignity as experienced by nursing home staff2009Ingår i: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 4, nr 3, s. 185-193Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims and objectives.  To explore nursing home staff members’ experiences of what dignity in end of life care means to older people and to themselves.

    Background.  Dignity is a concept often used in end-of-life care, but its meaning is rarely clarified.

    Design.  Qualitative descriptive study.

    Methods.  Content analysis. This study is based on interviews with 21 staff members in four different nursing homes in Sweden.

    Findings.  The results show that staff members balanced between providing for the older person’s physical needs while wishing to be able to deliver a ‘deeper’ level of care. The older people’s dignity is presented in the main theme: Feeling trust – Showing respect. The staff members’ dignity is presented in the main theme: Maintaining self-respect – Being shown respect. Threats to dignity are presented in the main theme: conflicts between the ideal and the reality.

    Conclusions.  The results reveal that nursing home staff members deal with a moral conflict between what they are able to deliver and what they would like to provide in the care of older people.

    Relevance to clinical practice.  To promote older people’s dignity, there is a need to take account of staff members’ work situation. Supervision and continuous education could be one way of achieving this.

  • 11.
    Dwyer, Lise-Lotte
    et al.
    Örebro University, Sweden.
    Nordenfelt, Lennart
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Ternestedt, Britt-Marie
    Ersta Sköndal College and Ersta Hospital, Stockholm and Örebro University, Sweden.
    Three nursing home residents speak about meaning at the end of life2008Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 15, nr 1, s. 97-109Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This article provides a deeper understanding of how meaning can be created in everyday life at a nursing home. It is based on a primary study concerning dignity involving 12 older people living in two nursing homes in Sweden. A secondary analysis was carried out on data obtained from three of the primary participants interviewed over a period of time (18-24 months), with a total of 12 interviews carried out using an inductive hermeneutic approach. The study reveals that sources of meaning were created by having a sense of: physical capability, cognitive capability, being needed, and belonging. Meaning was created through inner dialogue, communication and relationships with others. A second finding is that the experience of meaning can sometimes be hard to realize. © 2008 SAGE Publications.

  • 12.
    Ekerstad, Niklas
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Etiskt tillstånd bör ges för forskning på svårt sjuka äldre2011Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, nr 42, s. 2072-2073Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 13.
    Eklund Saksberg, My
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten.
    Bielsten, Therese
    Jonkoping Univ, Sweden.
    Cahill, Suzanne
    Trinity Coll Dublin, Ireland.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten.
    Nedlund, Ann-Charlotte
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Sandman, Lars
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Jaarsma, Pier
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Nurses' priority-setting for older nursing home residents during COVID-192024Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Ethical principles behind prioritization in healthcare are continuously relevant. However, applying ethical principles during times of increased need, such as during the COVID-19 pandemic, is challenging. Also, little is known about nursing home nurses' prioritizations in their work to achieve well-being and health for nursing home residents.Aim The aim of this study was to explore nursing home nurses' priority-setting for older nursing home residents in Sweden during the COVID-19 pandemic.Research design, participants, and research context We conducted a qualitative interview study. Data were collected through in-depth interviews (retrospective self-reports) between February and May 2021 with 21 nursing home nurses. To help respondents to recall their memories, we used the critical incident technique (CIT). We analyzed data within the theoretical framework and the methodological orientation of content analysis.Ethical considerations Written and verbal consent was obtained before the interviews, and information was given to participants informing them that participation was entirely voluntary. The Swedish Ethical Review Agency gave an advisory opinion stating that there were no ethical objections to the research project (Dnr. 2020-05649).Findings We identified an overarching theme-nursing home nurses struggling on multiple fronts, "just do it"-and seven categories: striving for survival and caring about a dignified death; responding sensitively to relatives' expectations; ranking the urgency of needed care; responding to input from different actors; combating the spread of infection in unconventional ways; taking the lead and doing what is required; and following the ideals of person-centered nursing.Conclusions Nurses' priority-setting for older nursing homes residents during the COVID-19 pandemic meant strain and struggle. In some cases, nurses had taken responsibility for priorities falling outside their statutory powers. Different demands and interests affected nurses' priorities. Nursing home nurses need organizational and managerial support to prioritize.

  • 14.
    El-Alti, Leila
    et al.
    Univ Gothenburg, Sweden.
    Sandman, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Munthe, Christian
    Univ Gothenburg, Sweden.
    Person Centered Care and Personalized Medicine: Irreconcilable Opposites or Potential Companions?2019Ingår i: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 27, nr 1, s. 45-59Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In contrast to standardized guidelines, personalized medicine and person centered care are two notions that have recently developed and are aspiring for more individualized health care for each single patient. While having a similar drive toward individualized care, their sources are markedly different. While personalized medicine stems from a biomedical framework, person centered care originates from a caring perspective, and a wish for a more holistic view of patients. It is unclear to what extent these two concepts can be combined or if they conflict at fundamental or pragmatic levels. This paper reviews existing literature in both medicine and related philosophy to analyze closer the meaning of the two notions, and to explore the extent to which they overlap or oppose each other, in theory or in practice, in particular regarding ethical assumptions and their respective practical implications.

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  • 15.
    Eldh, Ann Catrine
    et al.
    Örebro University, Sweden.
    Ekman, Inger
    Göteborg University.
    Ehnfors, Margareta
    Örebro University.
    Conditions for Patient Participation and Non-Participation in Health Care2006Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, nr 5, s. 503-514Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study explored patients' experiences of participation and non-participation in their health care. A questionnaire-based survey method was used. Content analysis showed that conditions for patient participation occurred when information was provided not by using standard procedures but based on individual needs and accompanied by explanations, when the patient was regarded as an individual, when the patient's knowledge was recognized by staff, and when the patient made decisions based on knowledge and needs, or performed self-care. Thus, to provide conditions for true patient participation, professionals need to recognize each patient's unique knowledge and respect the individual's description of his or her situation rather than just inviting the person to participate in decision making.

  • 16.
    Foster, Mandie
    et al.
    Auckland Univ Technol, New Zealand; Edith Cowan Univ, Australia.
    Lisa Whitehead, L.
    Auckland Univ Technol, New Zealand; Edith Cowan Univ, Australia; Univ Otago, New Zealand.
    O'sullivan, Therese A.
    Edith Cowan Univ, Australia.
    HILL, Julie
    Edith Cowan Univ, Australia.
    Mörelius, Evalotte
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Edith Cowan Univ, Australia.
    Ethical considerations in undertaking research with children2023Ingår i: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 73, s. 13-14Artikel i tidskrift (Övrigt vetenskapligt)
    Publikationen är tillgänglig i fulltext från 2024-11-14 14:05
  • 17. Frank, Fabrice
    et al.
    Florens, Nans
    Univ Strasbourg, France.
    Meyerowitz-katz, Gideon
    Univ Wollongong, Australia.
    Barriere, Jerome
    Polyclin St Jean, France.
    Billy, Eric
    Independent researcher, Strasbourg, France.
    Saada, Veronique
    Gustave Roussy Anticanc Ctr, France.
    Samuel, Alexander
    Independent researcher, Nice, France.
    Robert, Jacques
    Univ Bordeaux, France.
    Besançon, Lonni
    Linköpings universitet, Institutionen för teknik och naturvetenskap, Medie- och Informationsteknik. Linköpings universitet, Tekniska fakulteten.
    Raising concerns on questionable ethics approvals - a case study of 456 trials from the Institut Hospitalo-Universitaire Mediterranee Infection2023Ingår i: RESEARCH INTEGRITY AND PEER REVIEW, ISSN 2058-8615, Vol. 8, nr 1, artikel-id 9Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background The practice of clinical research is strictly regulated by law. During submission and review processes, compliance of such research with the laws enforced in the country where it was conducted is not always correctly filled in by the authors or verified by the editors. Here, we report a case of a single institution for which one may find hundreds of publications with seemingly relevant ethical concerns, along with 10 months of follow-up through contacts with the editors of these articles. We thus argue for a stricter control of ethical authorization by scientific editors and we call on publishers to cooperate to this end. Methods We present an investigation of the ethics and legal aspects of 456 studies published by the IHU-MI (InstitutHospitalo-Universitaire Mediterranee Infection) in Marseille, France. Results We identified a wide range of issues with the stated research authorization and ethics of the published studies with respect to the Institutional Review Board and the approval presented. Among the studies investigated, 248 were conducted with the same ethics approval number, even though the subjects, samples, and countries of investigation were different. Thirty-nine (39) did not even contain a reference to the ethics approval number while they present research on human beings. We thus contacted the journals that published these articles and provide their responses to our concerns. It should be noted that, since our investigation and reporting to journals, PLOS has issued expressions of concerns for several publications we analyze here. Conclusion This case presents an investigation of the veracity of ethical approval,and more than 10 months of follow-up by independent researchers. We call forstricter control and cooperation in handling of these cases, including editorial requirement to upload ethical approval documents, guidelines from COPE to address such ethical concerns, and transparent editorial policies and timelines to answer such concerns. All supplementary materials are available.

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  • 18.
    Franklin, Lise-Lotte
    et al.
    Örebro University, Sweden.
    Ternestedt, B.-M.
    Örebro University and Ersta Sköndal College, Stockholm, Sweden.
    Nordenfelt, Lennart
    Linköpings universitet, Institutionen för hälsa och samhälle, Tema hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Views on dignity of elderly nursing home residents2006Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, nr 2, s. 130-146Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Discussion about a dignified death has almost exclusively been applied to palliative care and people dying of cancer. As populations are getting older in the western world and living with chronic illnesses affecting their everyday lives, it is relevant to broaden the definition of palliative care to include other groups of people. The aim of the study was to explore the views on dignity at the end of life of 12 elderly people living in two nursing homes in Sweden. A hermeneutic approach was used to interpret the material, which was gathered during semi-structured interviews. A total of 39 interviews were transcribed. The analysis revealed three themes: (1) the unrecognizable body, (2) fragility and dependency, and (3) inner strength and a sense of coherence. © 2006 Edward Arnold (Publishers) Ltd.

  • 19.
    Friedrichsen, Maria
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i östra Östergötland, LAH i Norrköping.
    Lythell, Caroline
    Region Östergötland, Närsjukvården i östra Östergötland, LAH i Norrköping. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten.
    Waldreus, Nana
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten.
    Ångström, Helene
    Region Östergötland, Närsjukvården i östra Östergötland, LAH i Norrköping.
    Milovanovic, Micha
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Karlsson, Marit
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Närvårdskliniken.
    Milberg, Anna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i östra Östergötland, LAH i Norrköping.
    Thulesius, Hans
    Linnaeus Univ, Sweden; Reg Kronoberg, Sweden.
    Hedman, Christel
    Karolinska Inst, Sweden; Stockholms Sjukhem Fdn, Sweden.
    Söderlund Schaller, Anne
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Jaarsma, Pier
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Ethical challenges around thirst in end-of-life care -experiences of palliative care physicians2023Ingår i: BMC Medical Ethics, E-ISSN 1472-6939, Vol. 24, nr 1, artikel-id 61Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundThirst and dry mouth are common symptoms in terminally ill patients. In their day-to-day practice, palliative care physicians regularly encounter ethical dilemmas, especially regarding artificial hydration. Few studies have focused on thirst and the ethical dilemmas palliative care physicians encounter in relation to this, leading to a knowledge gap in this area.AimThe aim of this study was to explore palliative care physicians experiences of ethical challenges in relation to thirst in terminally ill patients.MethodsA qualitative interview study with an inductive approach was conducted. Sixteen physicians working in four different specialised palliative care units and one geriatric care unit in different hospitals in Sweden were interviewed. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis.ResultsWhen presented with an ethical challenge relating to thirst, physicians attempted to balance benefits and harms while emphasizing respect for the patients autonomy. The ethical challenges in this study were: Starting, continuing or discontinuing drips; lack of evidence and traditions create doubt; and lack of interest and time may result in patient suffering.ConclusionsAll physicians in this study reported that "Starting, continuing or discontinuing drips" was the main ethical challenge they encountered, where some were so accustomed to the decision that they had a standard answer ready to offer patients and families. Physicians reported that drips were a symbol of thirst quenching, life and survival but were not necessary in end-of-life care. Others questioned the traditions regarding thirst and emphasised drips in particular.

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  • 20.
    Gawel, Danuta
    et al.
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa.
    Bojner Horwitz, Eva
    Klinisk neurovetenskap, Karolinska institutet, Stockholm, Sverige.
    Sysoev, Oleg
    Linköpings universitet, Institutionen för datavetenskap, Statistik och maskininlärning. Linköpings universitet, Filosofiska fakulteten.
    Jacobsson, Bo
    Avdelningen för obstetrik och gynekologi, Göteborgs universitet; kvinnokliniken, Sahlgrenska universitetssjukhuset, Göteborg, Sverige.
    Jönsson, Jan-Ingvar
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för molekylär medicin och virologi. Linköpings universitet, Medicinska fakulteten.
    Melén, Erik
    Institutionen för klinisk forskning och utbildning, Södersjukhuset, Karolinska institutet; Sachsska barn- och ungdomssjukhuset, Stockholm, Sverige.
    Ynnerman, Anders
    Linköpings universitet, Institutionen för teknik och naturvetenskap, Medie- och Informationsteknik. Linköpings universitet, Tekniska fakulteten.
    Benson, Mikael
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Region Östergötland, Barn- och kvinnocentrum, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus. Karolinska institutet, Stockholm, Sverige.
    Stor potential när genomikdatakan implementeras i klinisk rutin: [Clinical translation of genomic medicine]2021Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 118Artikel, forskningsöversikt (Refereegranskat)
    Abstract [sv]

    Ett av de största problemen för många patienter är attde inte förbättras av läkemedelsbehandling. Detta orsakar, förutom lidande, stora samhällskostnader. Viktigaorsaker är sjukdomars molekylära komplexitet samt sendiagnostik och behandling.

    Precisionsmedicin kan bidra till att lösa problem genom att karakterisera och tolka denna komplexitet. Ettexempel är att läkemedelsbehandling kan provas ut ochindividualiseras genom datorsimuleringar.

    Precisionsmedicin har potential att påtagligt förbättrabåde hälsa och ekonomi. Detta kräver en bred IT-strategi för att integrera genomik- och andra storskaligadatakällor, som inkluderar nationella superdator-,visualiserings- och AI-centrum.

  • 21.
    Grankvist, Hannah
    et al.
    Linköpings universitet, Institutionen för tema, Tema teknik och social förändring. Linköpings universitet, Filosofiska fakulteten.
    Kimmelman, Jonathan
    Studies for Translation, Research Ethics, and Medicine (STREAM), Biomedical Ethics Unit/Social Studies of Medicine, McGill University.
    How do researchers decide early clinical trials?2016Ingår i: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 19, nr 2, s. 191-198Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Launch of clinical investigation represents a substantial escalation in commitment to a particular clinical translation trajectory; it also exposes human subjects to poorly understood interventions. Despite these high stakes, there is little to guide decision-makers on the scientific and ethical evaluation of early phase trials. In this article, we review policies and consensus statements on human protections, drug regulation, and research design surrounding trial launch, and conclude that decision-making is largely left to the discretion of research teams and sponsors. We then review what is currently understood about how research teams exercise this discretion, and close by laying out a research agenda for characterizing the way investigators, sponsors, and reviewers approach decision-making in early phase research.

  • 22.
    Gunnarson, Martin
    et al.
    Linköpings universitet, Institutionen för tema, Tema teknik och social förändring. Linköpings universitet, Filosofiska fakulteten. Centre for Studies in Practical Knowledge, School of Culture and Learning, Södertörn University, Huddinge, Sweden.
    Kapeller, Alexandra
    Linköpings universitet, Institutionen för tema, Tema teknik och social förändring. Linköpings universitet, Filosofiska fakulteten.
    Zeiler, Kristin
    Linköpings universitet, Institutionen för tema, Tema teknik och social förändring. Linköpings universitet, Filosofiska fakulteten.
    Ethico-Political Aspects of Conceptualizing Screening: The Case of Dementia2021Ingår i: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 29, nr 4, s. 343-359Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    While the value of early detection of dementia is largely agreed upon, population-based screening as a means of early detection is controversial. This controversial status means that such screening is not recommended in most national dementia plans. Some current practices, however, resemble screening but are labelled “case-finding” or “detection of cognitive impairment”. Labelled as such, they may avoid the ethical scrutiny that population-based screening may be subject to. This article examines conceptualizations of screening and case-finding. It shows how the definitions and delimitations of the concepts (the what of screening) are drawn into the ethical, political, and practical dimensions that screening assessment criteria or principles are intended to clarify and control (the how of screening, how it is and how it should be performed). As a result, different conceptualizations of screening provide the opportunity to rethink what ethical assessments should take place: the conceptualizations have different ethico-political implications. The article argues that population-based systematic screening, population-based opportunistic screening, and case-finding should be clearly distinguished.

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  • 23.
    Gustavsson, Erik
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Patients with multiple needs for healthcare and priority to the worse off2019Ingår i: Bioethics, ISSN 0269-9702, E-ISSN 1467-8519, Vol. 33, nr 2, s. 261-266Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There is a growing body of literature which suggests that decisions about healthcare priority setting should take into account the extent to which patients are worse off. However, such decisions are often based on how badly off patients are with respect to the condition targeted by the treatment whose priority is under consideration (condition-specific severity). In this paper I argue that giving priority to the worse off in terms of condition-specific severity does not reflect the morally relevant sense of being worse off. I conclude that an account of giving priority to the worse off relevant for healthcare priority setting should take into account how badly off patients are when all of their conditions are considered (holistic severity).

  • 24.
    Gustavsson, Erik
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för kultur och samhälle, Avdelningen för filosofi, historia, konst och religion. Linköpings universitet, Filosofiska fakulteten.
    Galvis Rojas, Giovanni
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Juth, Niklas
    Karolinska Inst, Sweden.
    Genetic testing for breast cancer risk, fromBRCA1/2to a seven gene panel: an ethical analysis2020Ingår i: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 21, nr 1, artikel-id 102Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Genetic testing is moving from targeted investigations of monogenetic diseases to broader testing that may provide more information. For example, recent health economic studies of genetic testing for an increased risk of breast cancer suggest that it is associated with higher cost-effectiveness to screen for pathogenic variants in a seven gene panel rather than the usual two gene test for variants inBRCA1andBRCA2. However, irrespective of the extent to which the screening of the panel is cost-effective, there may be ethical reasons to not screen for pathogenic variants in a panel, or to revise the way in which testing and disclosing of results are carried out. Main text In this paper we discuss the ethical aspects of genetic testing for an increased risk of breast cancer with a special focus on the ethical differences between screening for pathogenic variants inBRCA1/2and a seven gene panel. The paper identifies that the panel increases the number of secondary findings as well as the number of variants of uncertain significance as two specific issues that call for ethical reflection. Conclusions We conclude that while the problem of handling secondary findings should not be overstated with regard to the panel, the fact that the panel also generate more variants of uncertain significance, give rise to a more complex set of problems that relate to the value of health as well as the value of autonomy. Therefore, it is insufficient to claim that the seven gene panel is preferable by only referring to the higher cost effectiveness of the panel.

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  • 25.
    Gustavsson, Erik
    et al.
    Linköpings universitet, Institutionen för kultur och samhälle, Avdelningen för filosofi och tillämpad etik. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa.
    Juth, Niklas
    Uppsala Univ, Sweden.
    Larfars, Gerd
    Reg Stockholm, Sweden.
    Raaschou, Pauline
    Karolinska Inst, Sweden.
    Sandman, Lars
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Should relational effects be considered in health care priority setting?2023Ingår i: Bioethics, ISSN 0269-9702, E-ISSN 1467-8519, Vol. 37, nr 7, s. 668-673Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    It is uncontroversial to claim that the extent to which health care interventions benefit patients is a relevant consideration for health care priority setting. However, when effects accrue to the individual patient, effects of a more indirect kind may accrue to other individuals as well, such as the patients children, friends, or partner. If, and if so how, such relational effects should be considered relevant in priority setting is contentious. In this paper, we illustrate this question by using disease-modifying drugs for Alzheimers disease as a case in point. The ethical analysis begins by sketching the so-called prima facie case for ascribing moral weight to relational effects and then moves on to consider a number of objections to it. We argue that, whereas one set of objections may be dismissed, there is another set of arguments that poses more serious challenges for including relational effects in priority setting.

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  • 26.
    Gustavsson, Erik
    et al.
    Linköpings universitet, Institutionen för kultur och kommunikation, Avdelningen för kulturvetenskaper, KVA. Linköpings universitet, Filosofiska fakulteten.
    Juth, Niklas
    Centre for healthcare ethics, Karolinska institutet, Solna, Sverige.
    Munthe, Christian
    Institutionen för filosofi, lingvistik och vetenskapsteori, Göteborgs universitet, Sverige.
    Sandman, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Institutionen för vårdvetenskap, Högskolan i Borås, Sverige.
    Etiska och praktiska utmaningar med ökat patientinflytande2015Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, artikel-id DD3XArtikel i tidskrift (Övrigt vetenskapligt)
    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.

  • 27.
    Gustavsson, Erik
    et al.
    Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för kultur och samhälle, Avdelningen för filosofi, historia, konst och religion.
    Juth, Niklas
    Raaschou, Pauline
    Bonnard, Alexandre
    Davidson, Thomas
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Lärfars, Gerd
    Sandman, Lars
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa.
    Sjukdomsmodifierande läkemedel mot Alzheimers sjukdom: etiska aspekter av prioriteringar och screening2020Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    I skrivande stund pågår det intensiv forskning för att få fram ett sjukdomsmodifierande läkemedel mot Alzheimers sjukdom (AD). Vid introduktion av sådana läkemedel kommer en rad etiskt svåra frågor kring screening och prioriteringar av vårdens resurser, att aktualiseras. Föreliggande rapport behandlar dessa frågor.

    Trots att de nya läkemedlens effekt sannolikt har en påverkan på närstående till personer med AD så är det vår bedömning att den svenska etiska plattformen inte lämnar något utrymme för sådan hänsyn. Det finns också skäl att vara särskilt uppmärksam på utsträckningen i vilken de surrogatmått som används i de kliniska studierna faktiskt är av klinisk relevans.

    När det gäller att väga samman patientnytta som tillfaller olika individer är det vår bedömning att plattformen inte tillåter aggregering av patientnytta på ett sådant sätt. Det innebär att det faktum att personer med AD utgör en stor patientgrupp utgör i sig inte ett skäl för högre prioritet då effekten skall bedömas med avseende på hur den tillfaller varje enskild individ. I ett scenario där budgetpåverkan blir så stor att man behöver prioritera inom gruppen så tycks det saknas för prioriteringar relevanta kriterier.

    Manifest AD är ett tillstånd med mycket stor svårighetsgrad. Men eftersom de nya läkemedlen siktar in sig på den prekliniska eller fasen i vilken patienter har en lindrig kognitiv störning så bör svårighetsgraden av tillståndet viktas ned med avseende på sannolikheten att faktiskt insjukna i AD. Tillståndets svårighetsgrad blir därmed olika för läkemedel som siktar på den prekliniska fasen, de som siktar på fasen med lindrig kognitiv störning och de som siktar på kliniska stadier av AD. Eftersom personer med AD kan ha sämre förutsättningar än andra patientgrupper att kommunicera sina behov bör de beaktas särskilt. Det innebär dock inte någon högre prioritet utan en markering att personer med AD har samma rätt till hälso- och sjukvård som andra grupper med liknande behov.

    Populationsscreening för AD är förknippat med flera problem. Det finns generella problem med screening ur exempelvis autonomisynpunkt. Men det finns också problem som relaterar till att nuvarande metoder för riskstratifiering är så opålitliga vilket i sin tur resulterar i falska negativa (med risk för underbehandling) och falska positiva (med risk för överbehandling). Screening i fasen då patienten har en lindrig kognitiv störning har (förutom de problem som kommer med populationsscreening) problem med ojämlikhet och godtycke. När den kliniska fasen inträder har poängen med screening gått förlorad: ju senare identifikation, desto mindre potentiella behandlingsfördelar jämfört med vanlig diagnostik som den går till idag.

    Det är vår sammantagna bedömning att de nya läkemedlen måste generera stora hälsovinster för personer som riskerar att insjukna i AD för att berättigas allmän finansiering och för att rättfärdiga de etiska kostnader som kommer med de nuvarande diagnostiska metoderna.

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  • 28.
    Gustavsson, Erik
    et al.
    Linköpings universitet, Institutionen för kultur och samhälle, Avdelningen för filosofi och tillämpad etik. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa.
    Lindblom, Lars
    Linköpings universitet, Institutionen för kultur och samhälle, Avdelningen för filosofi och tillämpad etik. Linköpings universitet, Filosofiska fakulteten.
    Justification of principles for healthcare priority setting: the relevance and roles of empirical studies exploring public values2023Ingår i: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    How should scarce healthcare resources be distributed? This is a contentious issue that became especially pressing during the pandemic. It is often emphasised that studies exploring public views about this question provide valuable input to the issue of healthcare priority setting. While there has been a vast number of such studies it is rarely articulated, more specifically, what the results from these studies would mean for the justification of principles for priority setting. On the one hand, it seems unreasonable that public values would straightforwardly decide the ethical question of how resources should be distributed. On the other hand, in a democratic society, it seems equally unreasonable that they would be considered irrelevant for this question. In this paper we draw on the notion of reflective equilibrium and discuss the relevance and roles that empirical studies may plausibly have for justification in priority setting ethics. We develop a framework for analysing how different kinds of empirical results may have different kinds of implications for justification.

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  • 29.
    Gustavsson, Erik
    et al.
    Linköpings universitet, Institutionen för kultur och samhälle, Avdelningen för filosofi, historia, konst och religion. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård. Linköpings universitet, Medicinska fakulteten.
    Raaschou, Pauline
    Clinical Pharmacology Unit, Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Larfars, Gerd
    Health and Medical Care Administration, Stockholm, Sweden.
    Sandman, Lars
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Juth, Niklas
    Stockholm Centre of Healthcare Ethics, LIME, Karolinska Institute, Stockholm, Sweden.
    Comments: The ethics of disease-modifying drugs targeting Alzheimer disease: response to our commentators (vol.47, issue 9, page :608–614)2022Ingår i: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 48, nr 3, artikel-id 108157Artikel i tidskrift (Övrigt vetenskapligt)
  • 30.
    Gustavsson, Erik
    et al.
    Linköpings universitet, Institutionen för kultur och samhälle, Avdelningen för filosofi, historia, konst och religion. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Sjödahl, Rune
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Theodorsson, Elvar
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk kemi. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi.
    The ethical dilemma ofgranulocyte transfusions2020Ingår i: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 15, nr 3, s. 156-161Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Granulocyte transfusions have been administered to patients with life-threatening infections for more than five decades. However, to what extent this should be the case is far from established. On the one hand, the clinical effects of these transfusions are difficult to prove in clinical studies, and the donors of granulocytes may be exposed to certain risks. On the other hand, clinical experience seems to support the idea that granulocyte transfusions do play an important role for severely ill patients, and the donors are primarily motivated by altruistic reasons. In this paper, we first discuss the ethical issues that arise from the fact that there is a conflict between clinical experience and the results from the attempts to perform randomized control trials, and second, the risk/benefit assessment that has to be made between two different parties, namely the recipient and the donor of granulocyte transfusions.

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  • 31.
    Heidenreich, Kaja
    et al.
    Univ Hlth Care Res Ctr, Sweden.
    Svantesson, Mia
    Univ Hlth Care Res Ctr, Sweden.
    Karlsson, Marit
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Närvårdskliniken.
    Bremer, Anders
    Linnaeus Univ, Sweden.
    Exploring what is reasonable: uncovering moral reasoning of vascular surgeons in daily2023Ingår i: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 24, nr 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Vascular surgery offers a range of treatments to relieve pain and ulcerations, and to prevent sudden death by rupture of blood vessels. The surgical procedures involve risk of injury and harm, which increases with age and frailty leading to complex decision-making processes that raise ethical questions. However, how vascular surgeons negotiate these questions is scarcely studied. The aim was therefore to explore vascular surgeons moral reasoning of what ought to be done for the patient.Methods Qualitative, semi-structured interviews were conducted with 19 vascular surgeons working at three Swedish university hospitals. Data were analysed according to systematic text condensation.Results The surgeons moral reasoning about what ought to be done comprised a quest to relieve suffering and avoid harm by exploring what is reasonable to do for the patient. Exploring reasonableness included to shift one & acute;s perspective from the vessels to the whole person, to balance patients conflicting needs and to place responsibility for right decision on one & acute;s shoulders. The shift from blood vessels to the whole person implied gaining holistic knowledge in pondering of what is best, struggling with ones authority for surgery through dialogue, and building relationship for mutual security. To balance patients conflicting needs implied weighing the patients independence and a sense of being whole against ease of suffering, respecting the patients will against protecting life and well-being, and weighing longer life against protecting the present well-being. Finally, to place responsibility on one & acute;s shoulders was conveyed as an urge to remind oneself of the risk of complications, withholding ones power of proficiency, and managing time during the illness course.Conclusions This study contributes to uncovering how moral reasoning is embodied in the vascular surgeons everyday clinical discourse as a tangible part of their patient care. The results underpin the significance of moral considerations in the assemblage of medical knowledge and technical skills to further understand vascular surgeons clinical practice. The clinical application of these results is the need of forums with sufficient possibilities for articulating these important moral considerations in everyday care.

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  • 32.
    Hellström, Ingrid
    et al.
    Ersta Sköndal University College, Stockholm, Sweden.
    Nolan, Mike
    University of Sheffield, UK .
    Nordenfelt, Lennart
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Lundh, Ulla
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier. Linköpings universitet, Hälsouniversitetet.
    Ethical and methodological issues in interviewing persons with dementia2007Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 14, nr 5, s. 608-619Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    People with dementia have previously not been active participants in research, with ethical difficulties often being cited as the reason for this. A wider inclusion of people with dementia in research raises several ethical and methodological challenges. This article adds to the emerging debate by reflecting on the ethical and methodological issues raised during an interview study involving people with dementia and their spouses. The study sought to explore the impact of living with dementia. We argue that there is support for the inclusion of people with dementia in research and that the benefits of participation usually far outweigh the risks, particularly when a ;safe context' has been created. The role of gatekeepers as potentially responsible for excluding people with dementia needs further consideration, with particular reference to the appropriateness of viewing consent as a primarily cognitive, universalistic and exclusionary event as opposed to a more particularistic, inclusive and context relevant process.

  • 33.
    Hjelmfors, Lisa
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten.
    Mårtensson, Jan
    Jönköping Univ, Sweden.
    Strömberg, Anna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Kardiologiska kliniken US.
    Sandgren, Anna
    Linnaeus Univ, Sweden.
    Friedrichsen, Maria
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Region Östergötland, Närsjukvården i östra Östergötland, LAH i Norrköping.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Jonkoping Univ, Sweden.
    Communication about Prognosis and End-of-Life in Heart Failure Care and Experiences Using a Heart Failure Question Prompt List2022Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, nr 8, artikel-id 4841Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: To further advance the use of a heart-failure-specific question prompt list (HF-QPL) for communication about prognosis and end-of-life care, knowledge about such communication and the perceptions and experiences of professionals is needed. Objectives: 1. to describe health care professionals perceptions of communication about prognosis and end-of-life in heart failure (HF) care, and 2. to describe their experiences of using a HF-QPL. Design: A qualitative design that analyzed material from written assignments of nurses and physicians who were using a HF-QPL while participating in a communication course. Methods: Fifteen health care professionals from different regions in the south of Sweden were included. The data were collected from course assignments on 1. their reflection on the suitable timepoint for talking about prognosis for the first time, 2. their reflection on the HF-QPL, and 3. their experiences of using the HF-QPL in clinical practice. Data were analyzed using thematic analysis. Results: Five overarching themes were identified. The first theme was awareness of professional role responsibilities that described the recognition of different responsibilities in these conversations within the HF team. The second theme described the importance of being optimally prepared, and the third that confidence and skills are required to use the HF-QPL. The fourth theme described the HF-QPL as a bridge in the communication between professionals, patients, and family members. The fifth theme identified challenges using the HF-QPL in HF care. Conclusions: Using a HF-QPL in HF care has the potential to start conversation and facilitate discussion about the HF trajectory.

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  • 34. Beställ onlineKöp publikationen >>
    Holm, Marie-Louise
    Linköpings universitet, Institutionen för tema, Tema Genus. Linköpings universitet, Filosofiska fakulteten.
    Fleshing out the self: Reimagining intersexed and trans embodied lives through (auto)biographical accounts of the past2017Doktorsavhandling, monografi (Övrigt vetenskapligt)
    Abstract [sv]

    Denna avhandling undersöker hur nuvarande sätt att föreställa sig möjligheter för intersexuella och transpersoners liv inom medicinska sammanhang kan informeras av och omföreställas genom historiska livserfarenheter hos intersexuella och transindivider, som de har artikulerats i självbiografiska berättelser.

    Postmoderna, queer, intersex- och transforskare och aktivister har kritiserat existerande normer för intersex- och transhälsovård för att begränsa möjligheterna för olika förkroppsligande liv genom att artikulera vissa former av förkroppsligande och subjektivitet som mer sannolikt att möjliggöra ett levbart liv än andra. Detta har ofta gjorts i ett medicinskt-juridiskt sammanhang genom att hänvisa till förflutna erfarenheter av levbarhet kring förkroppsligande och genusifierande situationer som skiljer sig från privilegierade positioner.

    Med utgångspunkt i denna kritik, återupptar denna avhandling frågor om hur intersexuella och transpersoner kan bli förkroppsligade och ha relationer till andra, genom att reflektera kring de första tre fjärdedelarna av nittonhundratalet när de nuvarande normerna för vård och diagnostiska kategorier uppstod, men ännu inte blivit etablerade. Med utgångspunkt i en unik uppsättning av historiskt källmaterial från Danska  Justitiedepartementet och Medicinsk-Etiska Rådets arkiv, återges intersexuella och transpersoners livshistorier från egna och medicinsk-etiska experters berättelser skrivna i relation till ansökningar av förändring av juridiskt kön och medicinsk transition. Genom denna process har livshistorier upprepande gånger blivit omartikulerade för att bli en användbar grund för diagnos och beslutsfattande. Samtidigt är dessa livshistorier uppöppnade än en gång i en omartikulation med fokus på deras komplexitet och mångfald.

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  • 35.
    Iversen, Clara
    et al.
    Uppsala Univ, Sweden.
    Broström, Anders
    Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US. School of Health and Welfare, Jönköping University, Jönköping, Sweden.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US.
    Traffic risk work with sleepy patients: from rationality to practice2018Ingår i: Health, Risk and Society, ISSN 1369-8575, E-ISSN 1469-8331, Vol. 20, nr 1-2, s. 23-42Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In this article, we aim to contribute to the emerging field of risk-work studies by examining the relationship between risk rationality and risk practices in nurses conversations with Obstructive Sleep Apnoea patients about traffic risks. Legislation in Sweden towards traffic risk involves clinicians making risk assessment of patients prone to falling asleep while driving. In contrast to an overall care rationale, this means that the health of the patient is not the only risk object in treatment consultations. However, guidelines on how to implement legislation are missing. To examine the practical reality of nurses traffic-risk work, we draw on an analysis of data from a Swedish study in 2015. This study included qualitative interviews with specialist nurses and video-recorded interactions between nurses and Obstructive Sleep Apnoea patients. We found that a lack of clarity in traffic-risk guidelines on how risk should be addressed was evident in both interview accounts and in observed practice. While nurses primarily accounted for risk work as treatment-relevant education, they practised risk work as interrogation. Patients also treated nurses inquiries as assessment - not education - by responding defensively. We conclude that while confusing risk work and treatment enables clinicians to treat patients as competent actors, it obscures the controlling aspects of traffic-risk questions for individual patients and downplays the implications of drowsy driving for general traffic safety.

  • 36.
    Jaarsma, Pier
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Gelhaus, Petra
    Linköpings universitet, Institutionen för hälsa, medicin och vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Psykiatricentrum, Psykiatriska kliniken i Linköping.
    Eklund Saksberg, My
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten.
    Two cases of nursing older nursing home residents during COVID-192023Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction Two ethical challenges of nursing home nurses during the COVID-19 pandemic in Sweden are discussed in this paper. Background Historically, the nurses primary concern is for the person who is ill, which is the core of nurses moral responsibility and identity. In Sweden, person-centered care is generally deemed important in nursing older nursing home residents. Objective To chart moral responsibilities of nursing home nurses in two cases involving older residents during the COVID-19 pandemic in Sweden. Methods We used Margaret Urban Walkers framework for moral responsibilities and the International Council of Nurses (ICN) code of ethics for nurses (2021) for our normative analysis. Ethical considerations Written and verbal consent was obtained before the interviews, and information was given that participation was entirely voluntary and possible to cancel at any time before the work was published. The Swedish Ethical Review Agency gave an advisory opinion stating that there were no ethical objections to this research project (Dnr. 2020-05649). Findings Case #1: a palliative older nursing home resident who was coercively tested for COVID-19, and case #2: a COVID-19-infected resident with dementia who was isolated using sedation. The decision that was finally made in the respective case was analyzed in the light of either consequentialist/utilitarian or non-consequentialist/deontological reasons. Discussion Empowerment of nurses as moral agents is required for the application of practical wisdom in the balancing of different care relationships (responsibilities), moral identities (professional virtues), and competing moral values. This requires resources and opens possibilities for profound ethical reflection in nursing education and at work. Conclusion During the COVID-19 pandemic, the moral and professional responsibility of nursing home nurses to deliver person-centered care was sometimes problematically abandoned in favor of a more utilitarian manner of ethical decision-making.

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  • 37.
    Johnson, Ericka
    Linköpings universitet, Institutionen för tema, Tema Genus. Linköpings universitet, Filosofiska fakulteten.
    Screening för prostatacancer: Att dela sårbarhet2022Ingår i: Screeningens mångsidighet: Dess möjligheter och utmaningar / [ed] Anette Wickström, Sofia Morberg Jämterud, Kristin Zeiler, Lund: Nordic Academic Press, 2022, s. 49-66Kapitel i bok, del av antologi (Övrigt vetenskapligt)
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  • 38.
    Jonasson, Lise-Lotte
    et al.
    Univ Boras, Sweden.
    Sandman, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Univ Boras, Sweden.
    Bremer, Anders
    Univ Boras, Sweden; Linnaeus Univ, Sweden.
    Managers experiences of ethical problems in municipal elderly care: a qualitative study of written reflections as part of leadership training2019Ingår i: Journal of Healthcare Leadership, E-ISSN 1179-3201, Vol. 11, s. 63-74Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Managers in elderly care have a complex ethical responsibility to address the needs and preferences of older persons while balancing the conflicting interests and requirements of relatives demands and nursing staffs work environment. In addition, managers must consider laws, guidelines, and organizational conditions that can cause ethical problems and dilemmas that need to be resolved. However, few studies have focused on the role of health care managers in the context of how they relate to and deal with ethical conflicts. Therefore, the aim of this study was to describe ethical problems experienced by managers in elderly care. Methods: We used a descriptive, interpretative design to analyze textual data from two examinations in leadership courses for managers in elderly care. A simple random selection of 100 out of 345 written exams was made to obtain a manageable amount of data. The data consisted of approximately 300 pages of single-spaced written text. Thematic analysis was used to evaluate the data. Results: The results show that managers perceive the central ethical conflicts relate to the older persons autonomy and values versus their needs and the values of the staff. Additionally, ethical dilemmas arise in relation to the relatives perspective of their loved ones needs and preferences. Legislations, guidelines, and a lack of resources create difficulties when managers perceive these factors as conflicting with the care needs of older persons. Conclusion: Managers in elderly care experience ethical conflicts that arise as unavoidable and perennial values conflicts, poorly substantiated values, and problematic organizational conditions. Structured approaches for identifying, reflecting on, and assessing ethical problems in the organization should therefore be implemented.

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  • 39.
    Lampic, Claudia
    et al.
    Karolinska Inst, Sweden; Uppsala Univ, Sweden.
    Svanberg, Agneta Skoog
    Uppsala Univ, Sweden.
    Sorjonen, Kimmo
    Karolinska Inst, Sweden.
    Sydsjö, Gunilla
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Understanding parents intention to disclose the donor conception to their child by application of the theory of planned behaviour2021Ingår i: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 36, nr 2, s. 395-404Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    STUDY QUESTION: Does the theory of planned behaviour (TPB) contribute to understanding parents intention to share information about genetic origin with their donor-conceived child? SUMMARY ANSWER: Parents intention to start disclosure was associated with beliefs that disclosure would have desired consequences and a desire to act in accordance to societal norms. WHAT IS KNOWN ALREADY: Despite a growing consensus on donor-conceived offsprings right to information about their genetic origin, disclosure to the child remains a challenge for many parents, particularly heterosexual couples. TPB has successfully been applied to many health-related contexts and may contribute to increase understanding of parents decision-making about disclosing the genetic origin to their children. STUDY DESIGN, SIZE, DURATION: A cross-sectional survey study of heterosexual couples with children aged 7-8 years following identity-release oocyte donation (OD, n = 83) or sperm donation (SD, n = 113). PARTICIPANTS/MATERIALS, SETTING, METHODS: The study is part of the prospective longitudinal Swedish Study on Gamete Donation. Couples accepted for oocyte or sperm donation treatment at seven fertility clinics were recruited in 2005-2008 and requested to complete four postal surveys in the following 10 years. The present study sample includes heterosexual couples with donor-conceived children aged 7-8 years. Data were collected with the study-specific TPB Disclosure Questionnaire and analysed with path analysis. MAIN RESULTS AND THE ROLE OF CHANCE: More than half of parents following OD or SD had already disclosed the donor conception to their child (OD 61%, SD 58%). Among parents who had not yet started the disclosure process, the belief that disclosure would have desired consequences (P < 0.05) and a desire to act in accordance to social norms favouring disclosure (P < 0.01) were positively associated with their intention to talk with their child about the donor conception during the upcoming year. In contrast, perceived confidence to talk with the child about his/her genetic origin was found to be negatively associated with the intention to start the disclosure process (P < 0.05). Type of treatment (OD/SD) and the existence or absence of a genetic link to the child were not directly associated with parents disclosure intentions. LIMITATIONS, REASONS FOR CAUTION: The study was performed with heterosexual couples within the context of the Swedish legislation on identity-release donation, which limits the generalizability to other populations. Also, attrition may have introduced selection bias to the study findings. Future studies using the TPB Disclosure Questionnaire (TPB-DQ) with larger samples are needed to validate this measure. WIDER IMPLICATIONS OF THE FINDINGS: Application of the theory of planned behaviour highlighted the importance of attitudes and social norms for parents intention to share information about the donor conception with their child. The present results add to the complexity of disclosure of donor conception, and may contribute to promote open communication and support family life following donor conception.

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  • 40.
    Lindström, Pål
    et al.
    Susano Rehab AB, Malmö, Sweden.
    Lemming, Dag
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Lantz Lenander, Eva
    Susano Rehab AB, Malmö, Sweden.
    Jönsson, Rolf
    Apport Rehab, Kristianstad, Sweden.
    Sverige behöver riktlinjer för oberoende medicinska utredningar [Sweden needs guidelines for independent medical evaluations]2015Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, artikel-id DHRZArtikel i tidskrift (Övrigt vetenskapligt)
    Abstract [sv]

    En oberoende medicinsk utredning kräver ett tydligt etiskt ställningstagande från utövaren, anser Pål Lindström och medförfattare. De föreslår tydliga etiska riktlinjer baserade på internationell standard, anpassade för svenska förhållanden.

  • 41.
    Lundberg, Kristina
    et al.
    Jonkoping Univ, Sweden; Univ Boras, Sweden.
    Kjellstrom, Sofia
    Jonkoping Univ, Sweden.
    Sandman, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Univ Boras, Sweden.
    Dual loyalties: Everyday ethical problems of registered nurses and physicians in combat zones2019Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 26, nr 2, s. 480-495Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: When healthcare personnel take part in military operations in combat zones, they experience ethical problems related to dual loyalties, that is, when they find themselves torn between expectations of doing caring and military tasks, respectively. Aim: This article aims to describe how Swedish healthcare personnel reason concerning everyday ethical problems related to dual loyalties between care and military tasks when undertaking healthcare in combat zones. Design: Abductive qualitative design. Participants and research context: Individual interviews with 15 registered nurses and physicians assigned for a military operation in Mali. Ethical considerations: The participants signed up voluntarily, and requirements for informed consent and confidentiality were met. The research was approved by the Regional Ethics Review Board in Gothenburg (D no. 816-14; 24 November 2014). Findings: Three main categories emerged: reasons for not undertaking combat duties, reasons for undertaking combat duties and restricted loyalty to military duties, and 14 subcategories. Reasons for not undertaking combat duties were that it was not in their role, not according to ethical codes or humanitarian law or a breach towards patients. Reasons for undertaking combat duties were that humanitarian law does not apply or has to be treated pragmatically or that it is a case of force protection. Shortage of resources and competence were reasons for both doing and not doing military tasks. Under some circumstances, they could imagine undertaking military tasks: when under threat, if unseen or if not needed for healthcare duties. Discussion/conclusion: These discrepant views suggest a lack of a common view on what is ethically acceptable or not, and therefore we suggest further normative discussion on how these everyday ethical problems should be interpreted in the light of humanitarian law and ethical codes of healthcare personnel and following this, further training in ethical reflection before going on military operations.

  • 42.
    Malmqvist, Erik
    Linköpings universitet, Institutionen för tema, Tema teknik och social förändring. Linköpings universitet, Filosofiska fakulteten.
    A further lesson from existing kidney markets2014Ingår i: American Journal of Bioethics, ISSN 1526-5161, E-ISSN 1536-0075, Vol. 14, nr 10, s. 27-29Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The target article challenges the increasingly popular portrayal of living kidney sale as potentially a mutually beneficial arrangement, capable not only of saving or improving the lives of patients in need of transplants but also of significantly benefiting poor vendors. Carefully reviewing the literature on harms to vendors in illegal kidney markets and in Iran’s legal market, Koplin (2014) argues that many of these harms would persist in the sort of legal regulated system that kidney sale advocates envision. This is an important argument. The kidney sales debate has been skewed in favor of permitting sales by a simplified view of the potential harms involved and excessive optimism about the capacity of regulation to prevent these harms (Malmqvist 2013). The article counterbalances these tendencies and thus considerably weakens the case for allowing sales. Nonetheless, some market proponents might remain unconvinced. I shall suggest that in addition to the lessons that Koplin draws from existing kidney markets, there is yet another one, which casts further doubt on the advisability of allowing kidney sales.

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  • 43.
    Malmqvist, Erik
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Back to the future: Habermas's "The Future of Human Nature"2007Ingår i: The Hastings center report, ISSN 0093-0334, E-ISSN 1552-146X, Vol. 37, nr 2, s. 4-5Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 44.
    Malmqvist, Erik
    Linköpings universitet, Institutionen för tema, Tema teknik och social förändring. Linköpings universitet, Filosofiska fakulteten.
    Cooper, M. and Waldby, C. Clinical Labour: Tissue Donors and Research Subjects in the Global Bioeconomy (Durham: Duke UP, 2014)2014Ingår i: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 17, nr 4, s. 651-652Artikel, recension (Övrigt vetenskapligt)
  • 45.
    Malmqvist, Erik
    Linköpings universitet, Institutionen för tema, Tema teknik och social förändring. Linköpings universitet, Filosofiska fakulteten.
    Does the ethical appropriateness of paying donors depend on what body parts they donate?2016Ingår i: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 19, nr 3, s. 463-473Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The idea of paying donors in order to make more human bodily material available for therapy, assisted reproduction, and biomedical research is notoriously controversial. However, while national and international donation policies largely oppose financial incentives they do not treat all parts of the body equally: incentives are allowed in connection to the provision of some parts but not others. Taking off from this observation, I discuss whether body parts differ as regards the ethical legitimacy of incentives and, if so, why. I distinguish two approaches to this issue. On a ”principled” approach, some but not all body  parts are inherently special in a way that proscribes payment. On a ”pragmatic” approach, the appropriateness of payment in relation to a specific part must be determined through an overall assessment of e.g. the implications of payment for the health and welfare of providers, recipients, and third parties, and the quality of providers’ consent. I argue that the first approach raises deep and potentially divisive questions about the good life, whereas the second approach invokes currently unsupported empirical assumptions and requires difficult  balancing between different values and the interests of different people. This does not mean that any attempt to distinguish between body parts in regard to the appropriateness of payment necessarily fails. However, I conclude, any plausible such attempt should either articulate and defend a specific view of the good life, or gather relevant empirical evidence and apply defensible principles for weighing goods and interests.

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  • 46.
    Malmqvist, Erik
    Linköpings universitet, Institutionen för tema, Tema teknik och social förändring. Linköpings universitet, Filosofiska fakulteten.
    International clinical research and the problem of benefiting from injustice2014Konferensbidrag (Refereegranskat)
  • 47.
    Malmqvist, Erik
    Linköpings universitet, Institutionen för kultur och kommunikation, Avdelningen för kultur och estetik. Linköpings universitet, Filosofiska fakulteten.
    Jordens fattiga som forskningsresurs2017Ingår i: Tidskrift för politisk filosofi, ISSN 1402-2710, E-ISSN 2002-3383, Vol. 21, nr 3, s. 16-28Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Denna artikel diskuterar de etiska frågor som den ökande flytten av klinisk forskning till låg- och medelinkomstländer väcker. Debatten kring detta fenomen har fokuserat på problem kring risker, samtycke och exploatering. Jag argumenterar för att dessa problem inte är specifika för forskning i dessa länder utan snarare bör ses som generella forskningsetiska utmaningar. Jag försöker också visa att det finns ett annat problem som är specifikt för just denna forskning. Det är ofta fattigdom och otillräcklig tillgång till sjukvård som motiverar forskningspersoner i låg- och medelinkomstländer att delta. När forskare och läkemedelsbolag drar nytta av dessa moraliskt oacceptabla bakgrundsvillkor skapar de också incitament att bevara dem. Jag skisserar avslutningsvis några praktiska konsekvenser av detta resonemang.

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  • 48.
    Malmqvist, Erik
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Kidney sales and the analogy with dangerous employment2015Ingår i: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 23, nr 2, s. 107-121Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Proponents of permitting living kidney sales often argue as follows. Many jobs involve significant risks; people are and should be free to take these risks in exchange for money; the risks involved in giving up a kidney are no greater than the risks involved in acceptable hazardous jobs; so people should be free to give up a kidney for money, too. This paper examines this frequently invoked but rarely analysed analogy. Two objections are raised. First, it is far from clear that kidney sales and dangerous jobs involve comparable risks on an appropriately broad comparison. Second, and more importantly, even if they do involve comparable risks it does not follow that kidney sales must be permitted because dangerous jobs are. The analogy assumes that kidney sales are banned for paternalistic reasons. But there may be other, non-paternalistic reasons for the ban. And paternalists, too, can consistently defend the ban even if kidney sales are no riskier than occupations that they find acceptable. Soft paternalists may want to protect would-be vendors from harms that they have not voluntarily chosen. Egalitarian hard paternalists may want to protect already badly off vendors from further worsening their situation. For neither species of paternalist is the size of the risk prevented decisive. I conclude that the analogy with dangerous jobs, while rhetorically powerful, pulls little real argumentative weight. Future debates on living kidney sales should therefore proceed without it.

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  • 49.
    Malmqvist, Erik
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Misunderstanding, continued2012Ingår i: IRB: Ethics and Human Research, ISSN 0193-7758, Vol. 34, nr 2, s. 19-19Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 50.
    Malmqvist, Erik
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    (Mis)Understanding Exploitation2011Ingår i: IRB: Ethics and Human Research, ISSN 0193-7758, Vol. 33, nr 2, s. 1-5Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The term exploitation is notoriously hard to define. Yet it is frequently invoked to frame moral concerns about clinical research. Recently, a group of influential authors have proposed a so-called “non-exploitation framework” for the ethics of randomized controlled trials that appears to address these concerns. In this paper, I challenge one basic assumption of that framework: the idea that non-exploitation in research requires participants to be protected from excessive risks, understood as risks that are not outweighed by the benefits that the research is expected to lead to. Drawing on examples of exploitation in other contexts, I show that this idea has highly counterintuitive implications. I conclude that the non-exploitation framework obscures concerns about exploitation in biomedical research rather than clarifying them.   

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