Children of prisoners are often negatively affected by their parents’ incarceration, which raises issues of justice. A common view is that the many negative effects associated with parental imprisonment are unjust, simply because children of prisoners are impermissibly harmed or unjustly punished by their parents’ incarceration. We argue that proposals of this kind have problems with accounting for cases where it is intuitive that prison might create social injustices for children of prisoners. Therefore, we suggest that in addition to the question of whether children of prisoners are impermissibly harmed, we should ask whether the inequalities that these children endure because of their parent’s incarceration are objectionable from a social justice perspective. To answer this latter question, we examine the negative effects associated with parental imprisonment from the perspective of luck egalitarianism. We develop a luck egalitarian account that incorporates insights from the philosophy of childhood. On our account, children of prisoners might endure two different types of objectionable inequalities, since they are often deprived of resources that are important for ensuring fair equality of opportunity in adulthood, but also because they are likely to suffer inequalities in terms of childhood welfare. After defending this account, we explore its implications for policy.

This Innovative Practice Full Paper presents an approach to integrate three critical elements in Computer Science education.The call to imbue computer science graduates with strategic skills needed to address our pressing global sustainability challenges is extremely important, and a great challenge to degree programmes in computer science and software engineering. Doing this successfully requires great care, and possibly several iterations across an entire curriculum. In this regard, learning for sustainability faces similar challenges as understanding scientific results and ethics. Improving skills in searching for, reading, and producing academic texts are often neglected, as are skills in understanding ethics; what norms and values that guide our choices of methods for solving problems. To handle the fact that these subjects (academic writing, ethics and sustainability) are treated separately, and thereby lowering student engagement with the topics, we have successfully integrated them into one coherent subject of Professionalism in Computer Science. By integrating the three subjects, we do three things: a) describe a multi-faceted but integrated engineering role; b) integrate the three aspects of the role we focus on in education and steer away from the view that these are add-ons; and c) increase the motivation of students to take on these aspects of the engineering role.Our approach uses a flipped-classroom style with students playing educational games, participating in discussion seminars and conducting critical analyses of other students’ choices in IT system design. Much emphasis is on the students academic writing abilities, including critical information search and a student peer-review procedure. Also, we do this using an integrated assessment format where teachers from different disciplinary backgrounds jointly assess material from students, which stimulates discussions among ourselves about what and how to assess, and provides a practical way to integrate assessments. We present results from attitude surveys, course evaluations and the contents of the students’ analyses in their final essays. In conclusion, our approach demonstrates a clear shift in how students perceive sustainability, showing that it is possible to achieve changes in attitude towards the subjects as such and their importance for computer scientists.

The fundamental function of the state is safeguarding the safety of its citizens. Thecombination of Nozick’s invisible hand explanation with his theory of justice implies thatindividuals can have full private property rights in the state. An individual with suchproperty rights thus has the right to sell and destroy what he or she owns. This impliesthat it is perfectly fair to buy a state and dismantle it, thereby leaving citizens withoutprotection. I conclude that Nozick’s theory of the state fails since it cannot guarantee theprotection of its citizens’ safety.

The debate on the appropriate metric of justice has standardly been conducted with the characteristics and capacities of adults in mind. Recently, this approach has been challenged. This contribution aims to explain this development and to identify the philosophical issues at stake. There are the two major areas of debate. One is the Agency Assumption; standard theories of the metric assume an ideal of responsible agency that may make them inappropriate as a metric for children. The second area of debate revolves around the issue of the intrinsic goods of childhood (see ch. 7). Are there some human goods that are only, or especially, valuable in childhood? Such goods would put the ideal that justice should be neutral with regards to conceptions of the good in question. It is concluded that taking childhood seriously raises new questions regarding neutrality and responsibility for the metric of justice.

The state can act in ways that cause injustice between children, but the standard opportunity accounts of the distribuendum fail to explain how this can be the case. Such accounts have a problem of distribuendum gaps. First, they fail to identify the locus of injustice between children, as they must explain such injustice in terms of inequalities between adults. Second, they have an inability to identify cases of injustice where adulthood is not affected. In order to solve these problems, while retaining the insights of the standard accounts, the distribuendum must include some goods appropriate for children and others for adults. G.A. Cohens theory of access to advantage can solve these problems of distribuendum gaps, and this speaks in favor it being the correct distribuendum of justice.

The concept of responsibility plays a crucial part in the debate between proponents of democratic equality, like Rawls, and defenders of luck egalitarianism, such as Dworkin. In this paper it is argued that the two theories can be combined, and that they should be combined to achieve a theory of justice that puts personal responsibility in its proper place. The concept of justice requires two different conceptions. The two theories can be combined because they deal with different problems of justice. They ought to be combined because, first, luck egalitarianism needs a theory of background justice, and second, a theory of justice must supply an answer to the question of just individual allocations, something that is not provided by democratic equality. Democratic equality and luck egalitarianism solve each other’s problems. The combined theory will lead to allocations of goods that respect both the difference principle and the envy test.

A common idea is that market exchange is justified by informed and free agreement between parties. This paper investigates the idea that employer authority is justified by consent. According to this view, agents in the market are informed of the consequences of their actions and are not coerced. This makes their acts voluntary. A problem in the application of this justification to the employer/employee relationship is pointed out. If the contemporary economics of the employment contracts is correct, we must, in order to explain the existence of such contracts, make the assumption that the contracting parties are attempting to deal with decision-theoretic ignorance. This is why the parties agree to an incomplete contract in which the employer has authority. However, this implies that consent to acts of authority has been given under conditions of ignorance; it follows, then, that the course of action that the employer chooses to take cannot be justified by consent because the informedness criterion of consent will not have been satisfied due to this ignorance. Another method of justification must be sought. It is suggested that in order to achieve justification of acts of authority, there should be in place a real possibility to contest employers’ decisions. This possibility is needed, rather than just more information, because if the “volenti not fit injura”-principle is not in effect, then the employee is in a coercive situation. This problem of coercion must be alleviated before justification on the basis of informed voluntariness can be achieved. Pettit’s idea of contestability will then be applied. The firm must satisfy three conditions in order to make effective contestability possible. There must be a basis and channels for contest, which means that there must be transparency as well as effective measures to make grievances heard. There must also be a forum of contest where proper hearings of contestations are guaranteed.

KEYWORDS: Contestability, Consent, Ignorance, Incomplete Contracts, Employment Contracts.

This article provides a normative justification for unions. It discusses three arguments. The argument from consent justifies unions in some circumstances, but if the employer prefers to not bargain with unions, it may provide very little justification. The argument from contestability takes as its starting point the fact that employment contracts are incomplete contracts, where authority takes the place of complete contractual terms. This theory of contracts implies that consent to authority has been given under ignorance, and, therefore, that authority cannot be justified by consent. Contestability is a mechanism that can handle this problem for consent theory. It demands transparency, channels for voice, and a forum where contestations can be evaluated. This idea can be implemented in firms in different ways, but the argument from the separation of powers implies that unions are uniquely suited to implement contestability, since they are organized outside of the employer’s domain of authority.

The ethical debate on whistleblowing concerns centrally the conflict between the right to political free speech and the duty of loyalty to the organization where one works. This is the moral dilemma of whistleblowing.  Political free speech is justified because it is a central part of liberal democracy, whereas loyalty can be motivated as a way of showing consideration for one’s associates. The political philosophy of John Rawls is applied to this dilemma, and it is shown that that the requirement of loyalty, in the sense that is needed to create the moral dilemma of whistleblowing, is inconsistent with that theory. In this sense, there is no moral dilemma of whistleblowing. This position has been labeled extreme in that it says that whistleblowing is always morally permitted. In a discussion and rejection of Richard De George’s criteria on permissible whistleblowing, it is pointed out that the mere rejection of loyalty will not lead to an extreme position; harms can still be taken into account. Furthermore, it is argued that the best way is, in this as in most other political circumstances, to weigh harms is provided by the free speech argument from democracy.

Keywords: Free Speech, Justice as Fairness, Loyalty, Permission for Whistleblowing, Whistleblowing

The debate on justice in philosophy revolves around two different problems. Roughly, the issue of retributive justice concerns the justification of punishment for crimes, whereas the problem of distributive justice has to do with who should get what goods. Large parts of the UN Convention of the Rights of the Child (crc) can be read as spelling out what rights, resources and support children should have access to. This chapter, then, concerns distributive justice. However, the problem of distributive justice tends to be conceptualized as a problem concerning adults. The social contract tradition in political philosophy is a case in point.1 It takes the problem of politics to be about a group of people who gather to come to an agreement about how they should live together. They set down the principles for this in a contract to which they all agree. Underlying this approach to justice are ideas of autonomy and, especially, responsibility. To be autonomous is to be self-governing. Usually, this ideal is set out in three assumptions. An autonomous agent is rational, informed, and not coerced.2 If the parties to the agreement were not autonomous and hence not able to govern themselves, then it would be difficult to see the point of the contract exercise. Such assumptions of autonomy run deep in political philosophy. One way of explaining what it is to be a child is to say that it is to be a person who has yet to develop autonomy.3 This is also what justifies giving children education. They have a need to become informed and to develop their capacity for rationality. Another way of thinking about childhood is that it is a period of vulnerability.4 If the autonomy of children is vulnerable, then it would be wrong to hold them accountable in the same way as autonomous adults. Both ideas of childhood point in the same direction: we should not hold children responsible the same way we do adults, and perhaps we should not hold children responsible at all in this regard. This is not because children would be in some sense worse off than adults, but because they are different in a morally relevant way.5 In this chapter, I will investigate what happens to theories of justice if children and related ideas of responsibility are taken seriously.6 In particular, I will look at issues of equality of education through this lens. In order to have an account of distributive justice, one needs to define both a principle of distribution and a metric of justice.7 A principle of distributive justice specifies how things should be distributed. One example is the principle of strict equality – that each person should have an equal amount of what is valuable – but, somewhat surprisingly, equality has been understood in several different ways in recent literature. Some have suggested that justice is about each person having a sufficient but not necessarily equal amount of what is valuable.8 Others have proposed that equality should be understood as responsibility-catering, so that a just distribution tracks responsibility where appropriate.9 Another approach starts from the observation that we could care about equality either because we find it important that each person gets an equal share or because we care about the situation of those who are worst off.10 A prioritarian principle of justice then says that justice demands the distribution that is most beneficial to the least fortunate, even if this distribution is unequal. In this chapter, however, we will not focus on this question,11 but will instead investigate a set of topics that are more directly connected to how childhood may affect an account of justice. In particular, we will focus on the metric of justice. This is an account of the goods with which the theory of justice is concerned. If we say e.g. that justice has to do with equality, then we must ask: equality of what? In the next section, we investigate how the assumption of responsibility and taking childhood seriously affect what this metric might be. Our answers there will have impact on other aspects of the theory of justice. Section three addresses the topic of time and justice; if the metric of justice involves goods that are only or especially valuable in childhood, then it seems that some costs in terms of such a metric cannot be compensated for in adulthood. Section 4 applies a distinction regarding approaches to justice – usually found in debates about economic policy – to the issue of education. Redistribution is where resources are redeployed to help out people who find themselves in a problematic situation, whereas pre-distribution is the idea that we should ensure that people have sufficient resources to avoid problematic situations. The final section investigates whether there might be several different problems of justice, so that, for instance, one principle might be appropriate for the sphere of healthcare while some other rule may be more to the point for education. The chapter also sums up an account of distributive justice which takes children seriously by saying that the fundamental problem of justice is how to organize the main social institutions so that they cohere into a single, just system of social cooperation. This means, importantly, that e.g. the education system should be understood as working together with other important institutions like the family and the labour market. It means also that the institution of education may run on one principle of justice, but that the appropriate principle of justice for teachers may be another.

Ronald Dworkin’s theory of equality of resources makes extensive use of markets. I show that all these markets rely on one specific neoclassical conception of the ideal market in full equilibrium, as analyzed by Debreu. This market must be understood as operating under circumstances of certainty, and this is incompatible with several components of Dworkin’s account. In particular, it does not allow one to hold people responsible for their option luck, and it implies a high social safety net rather than insurance schemes for addressing brute luck. I conclude by outlining an interpretation of equality of resources that takes the ideal market seriously.

This paper revisits the equality of what-debate and asks whether previous conclusions hold if we analyze the arguments from the perspective of children. It makes three claims. First, that even if welfare cannot be justified as an equalisandum for adults, it remains a reasonable position for the case of children. This claim is argued for by showing that Dworkin's rejection of equality of welfare relies on an idea of responsible agency that is inappropriate for the case of children. Equality of welfare cannot, by this route, be rejected with regards to children. Second, we owe children welfare rather than opportunity for welfare. Here it is argued that Richard Arneson's move from equality of welfare to equality of opportunity for relies on the same kind of problematic assumption about responsible agency as Dworkin's argument for resources. However, the assumption about responsible agency still holds for adults, and for them we need an equalisandum that takes responsibility into account. Moreover, since children will grow up to be adults, they will need preparation for this stage in life. Therefore, both welfare and the appropriate responsibility-sensitive equalisandum will be relevant for children. The third claim is that a general theory of the equalisandum of justice should have a structure like Cohen's ( 99: 906-944, 1989) equality of access to advantage. Advantage is understood as consisting of both welfare and resources, and access is comprised of both actually having something that is an advantage and having the opportunity to achieve a good.

This article presents the promising framework for educational decision makers developed by Brighouse, Ladd, Loeb, and Swift (BLLS). The framework consists of an account of the educational goods, distributional principles and independent values at stake in education, and a method for making policy decisions on the basis of these and solid social science. I present three criticisms of this approach. The first says that the derivation of educational goods proceeds on the basis of a too narrow conception of values. I suggest that this foundation should consist of an overlapping consensus, rather than flourishing. The second criticism has to do with the way that the distributive principles are characterized. I argue that BLLS’s characterization of distributive principles should be complemented with accounts of what domains of social life these principles regulate and a specification of whether the distributive principles should be understood as applying over time or at specific instances. The final criticism is that BLLS’s conception of independent values focuses solely on values that constrain the pursuit of educational goods. I claim that this part of the framework should be revised to include aspects of values that also support this pursuit. I conclude arguing that the BLLS frameworks should be further developed rather than rejected.

Abstract

Richard Arneson argues that Fair Equality of Opportunity (FEO) should be rejected, since it is not only too weak and too strong, but also problematically meritocratic. The paper aims to defend FEO, and argues that it is not too weak, since, pace Arneson, it does apply to the problem of stunted ambition. The argument from meritocracy is shown to be based on a conflation of different senses of meritocracy. Finally, it is shown that FEO, correctly interpreted, gives intuitive answers to the examples put forward to bolster the too strong charge. It is concluded that Arneson’s refutation of FEO fails.

This article presents a normative epistemological argument for unions, developed from libertarian premises. According to Friedman, the state should set up rules for the market, whereas managers should focus on profits. On this view, business ethics can be handled by regulations, but Hayek’s theory of the market indicates that this position is problematic, since it relies on the state being able to collect the relevant ethical information. Hayek argued that a market system is more efficient than planned economies, since it handles information more efficiently. However, there is also reason to doubt that markets can provide the needed information. The price mechanism carries information solely about preferences, but ethics also concerns rights, voluntariness and needs. Moreover, Coase showed that inside firms there are no Hayekian price mechanisms. Firms are characterized by hierarchy, which means that both employers and employees may have incentives to not be forthcoming with information relevant information. The moral epistemology of Anderson, with an important role for civil society, is used to identify solutions to these informational problems. As a part of civil society, unions complement the market as a source of ethical information, and inside the firm they balance power and provide an avenue for voice.

Likvärdighet är ett mångtydigt begrepp. I Skollagen innebär likvärdighet lika tillgång, lika kvalitet och ett kompensatoriskt uppdrag, vilket kan öppna för konflikter mellan dimensionerna.

Artikeln föreslår en teori om likvärdighet med avstamp i teorier om jämlikhet inom den politiska filosofin och föreslår ett sätt att uttolka likvärdighet som löser upp denna sorts värdekonflikter. Den argumenterar för en princip för lika möjligheter och för att resurser är värdet som bör fördelas för vuxna, medan välfärd är det lämpliga fördelningsvärdet för barn. 

När man undervisar vill man göra det på ett sätt som faktiskt fungerar. Om någon kan svara på vilka undervisningsmetoder som faktiskt fungerar, och vilka metoder som fungerar bättre än andra, så gör den personen alla oss som undervisar en stor tjänst. Ingen som följt svensk undervisningsdebatt har missat att John Hattie har levererat svar på dessa frågor. Hans slutsatser i Visible learning från 2009 bygger på ett stort antal andra forskares resultat och har fått enormt genomslag: på bara några få år har han citerats drygt 4 000 gånger i forskningslitteraturen. Rimligen behöver hans approach kompletteras med andra, mer kvalitativa, forskningsmetoder – men det hindrar inte att hans resultat ändå bör tas på största allvar....

Likvärdighet är ett komplicerat begrepp. När Skolverket gjorde en utvärdering för något år sedan noterade man att det faktiskt inte finns något givet sätt att mäta om skolan är likvärdig eller inte. Det beror delvis på att det är svårt att veta hur man ska gå till väga för att undersöka de komplicerade sociala samband som finns inom undervisningsverksamhet, men också, tror jag, på att själva begreppet likvärdighet kan förstås på många olika sätt....

This thesis investigates what work ought to be like. The answer it presents consists of an outline of a liberal theory of justice in the employment contract based on theory developed in the area of political philosophy. The thesis also examines issues of efficiency—How should measures to improve working conditions be evaluated?—and the ethical implications of the economic theory of employment contracts and the neoclassical theory of the market.

Paper I: A theoretical framework is introduced for the evaluation of workplace inspections with respect to their effects on working conditions. The choice of a concept of efficiency is discussed, and its relation to criteria for a good working environment is clarified. It is concluded that in order to obtain reliable information on the effects of different inspection methods, it is necessary to perform controlled comparative studies in which different methods are used on different workplaces.

Paper II: This article outlines the structure of a Rawlsian theory of justice in the employment relationship. The theory answers three questions about justice and the workplace. What is the relationship between social justice and justice at work? How should we conceive of the problem of justice within the economic sphere? And, what is justice in the workplace? Reasons for a specific construction of a local original position are given and arguments are presented in support of a principle of local justice in the form of a choice egalitarian local difference principle.

Paper III: The political philosophy of John Rawls is applied to the moral dilemma of whistleblowing, and it is shown that that the requirement of loyalty, in the sense that is needed to create this dilemma, is inconsistent with that theory. In a discussion and rejection of Richard De George’s criteria on permissible whistleblowing, it is pointed out that the mere rejection of loyalty will not lead to an extreme position; harms can still be taken into account.

Paper IV: The case is made that if contemporary economics of the employment contract is correct, then in order to explain the existence of employment contracts, we must make the assumption that the contracting parties are attempting to deal with decision theoretic ignorance. It follows that the course of action that the employer chooses to take when acting from authority cannot be justified by consent, since the informedness criterion of consent cannot be satisfied under ignorance. It is then suggested that in order to achieve justification of acts of authority, there must be in place a real possibility to contest employers’ decisions.

Paper V: According to Ronald Dworkin’s theory of equality of resources, mimicking the ideal market from equal starting points is fair. According to Dworkin, the ideal market should be understood as described in Gérard Debreu’s influential work, which implies that we should conceive of trade as taking place under certainty. There are no choices under risk in such a market. Therefore, there is no such thing as option luck in the ideal market. Consequently, when mimicking this market, we cannot hold people responsible for option luck. Mimicking this market also implies that we ought to set up a social safety net, since rational individuals with perfect foresight would see to it that they always have sufficient resources at each point in life. Furthermore, the idea of insurance is incompatible with the ideal market.

This article outlines the structure of a Rawlsian theory of justice in the employment relationship. A focus on this theory is motivated by the role it plays in debates in business ethics. The Rawlsian theory answers three central questions about justice and the workplace. What is the relationship between social justice and justice at work? How should we conceive of the problem of justice in the economic sphere? And, what is justice in the workplace? To see fully what demands justice makes on the workplace, we should first spell out the implications that domestic justice has for working conditions. When this is done, we can develop a conception of workplace justice and investigate what content such local justice should have. John Rawls’s political liberalism was constructed for the specific problem of a just basic structure; in order to apply it to another problem the key theoretical concepts must be revised. Reasons for a specific construction of a local original position are given and arguments are presented in support of a principle of local justice, which takes the form of a choice egalitarian local difference principle.

Background

The regulatory approach used by SKI has an impact on the licensee and, therefore, indirectly on the safety of the nuclear facilities. The regulatory policy and its implementation also influences the way SKI is working and the competency needed by the regulator as well as by the industry. One of SKI´s tasks is to be able adjust the regulatory approach to current and future needs.

Little research is available on the use of regulatory strategies, methods and activities used by regulatory agencies in their work (to assure safety), as well as their impacts. To address this gap in knowledge, SKI has contracted two separate research projects. This project, where the focus is on comparing inspection policies in Swedish government agencies, and another one where regulatory strategies across selected countries, are studied and compared.

SKI´s purpose and goals

The goal of this research project is to gain knowledge about selected Swedish agencies and their inspection policies. All the selected agencies are working with issues regarding health, environmental protection or safety. A number of persons at each agency have been interviewed about the regulatory work at their organizations. A questionnaire was developed as a first part of the project, and it was used during the interviews.

In addition to provide insights as a basis for improvement within SKI, the purpose has been to promote exchange of experience between agencies with similar tasks. By this study SKI also wanted to contribute to the development of competency in this field of research.

Results

A lot of information has been gathered and analyzed during the project. The focus of the research is on comparing agencies and their practices. The report includes an analysis regarding similarities and differences in a number of areas across the agencies. The report also provides information and evidence on the problems related to comparison between agencies, partly due to the difference in the use of definitions. The recommendations resulting from this study focus on improving cooperation among Swedish agencies and on improving inspection methodologies, areas where further analysis is suggested. The conclusions and recommendations in the report belong to the persons participating in this work, and are not necessarily the same as the once drawn by SKI.

Workplace inspections are undertaken because they are believed to lead to better conditions In the workplace. It is therefore essential to know if inspections have the desired effects on working conditions. We introduce a theoretical framework for the evaluation of workplace inspections with respect to their effects on working conditions. Criteria of efficiency and priority-setting are discussed. Some empirical results concerning priority-setting in Swedish inspection agencies are presented. Further, we argue that in order to obtain reliable information about the effects of different inspection methods, it is necessary to perform controlled comparative studies in which different methods are used in different workplaces. Given the facility with which such studies can be performed, it is surprising how few such studies have been made. We conclude by surveying some empirical studies that concern the issue of efficient inspections.

A theoretical framework is introduced for the evaluation of workplace inspections with respect to their effects on working conditions. The choice of a concept of efficiency is discussed, and its relation to criteria for a good working environment is clarified. It is concluded that in order to obtain reliable information on the effects of different inspection methods, it is necessary to perform controlled comparative studies in which different methods are used on different workplaces. Given the facility with which such studies can be performed, it is surprising how few such studies have been made. The studies that are available provide sufficient evidence that inspections can increase compliance with regulations and that they can also increase workplace safety, but not much can be concluded about the relative efficiency of different inspection methods.

Some libertarians argue that informed consent alone makes transactions in the labour market morally justified. In contrast, some of their critics claim that such an act of consent is no guarantee against coercion. To know whether agreements are voluntary, we need to assess the quality of the offers or the prevailing background conditions. ISCT theorists argue that it is imperative to take social norms into account when evaluating the labour market. We present a novel framework for moral assessment in the labour market, which takes consent, background conditions and norms into account, but which mainly focuses on the offers and demands made. Consent renders a transaction legitimate in the same way we regard a fair election legitimate even if we object to its outcome. For offers to be substantially justified, exploitation must be avoided and offers must give expression to the value of community. Only then they are morally justified.

This chapter discusses the justification of Bitcoin from the perspective of political philosophy. Bitcoin is a form of digital money that is not tied to a central bank or government and that primarily facilitates anonymous economic transactions on the internet. The chapter suggests that the Bitcoin movement to a large extent has been driven by a libertarian framework, stressing the right of individuals to choose their own means of transaction without government interference or oversight. However, it argues that the libertarian case ultimately is unconvincing. A better case for Bitcoin can be formulated by using an egalitarian framework, more specifically, concerns about unequal distribution of power and resources. In the end, however, the chapter makes the claim that the justification also must depend on the political and economic context, and that this seems to speak against the use of Bitcoin in reasonably well-ordered societies.

Slutsatser

Vid psykisk och muskuloskeletal sjukdom

• Unimodala insatser, multimodala insatser och insatser som involverar arbetsplatskontakt eller koordinering mot arbetsplats har möjligen positiv effekt på återgång i arbete på kort sikt (upp till 12 månader) för personer sjukskrivna på grund av psykisk eller muskuloskeletal sjukdom (låg tillförlitlighet)³. Det går inte att bedöma effektens storlek.

• Det går inte att bedöma effekten på återgång i arbete av insatser som riktar sig till vårdgivare².

• Det går inte att bedöma effekten på återgång i arbete på längre sikt för någon typ av insats.

• Effekterna på hälsa och funktion går inte att bedöma för någon typ av insats, varken på kort eller lång sikt⁴.

^2. Med vårdgivare avses den organisation som bedriver hälso- och sjukvård på en övergripande nivå, inte den enskilda läkaren. De insatser som studerats som riktas till vårdgivare kan förutom till vårdgivaren dock även vara riktade till behandlande personal.

^3. För noggrannare beskrivning av vilka populationer som slutsatsen gäller, se Tabell 1.

^4. Slutsatserna gäller för insatser som syftar till att underlätta återgång i arbete.

Vid bröstcancer

• Det går inte att bedöma insatsernas effekt på återgång i arbete eller hälsa och funktion för personer sjukskrivna på grund av bröstcancer⁵.

^5. Slutsatserna gäller för insatser som syftar till att underlätta återgång i arbete och inkluderar inte medicinska insatser som har kurativt syfte.

Kommentar

Majoriteten av de inkluderade studierna uppvisar inga statistiskt säkerställda effekter, men resultat från flera studier talar för att vissa insatser kan ha effekter som är betydelsefulla för patienter och samhälle. Det går inte att dra slutsatser om specifika insatser eller om vilka komponenter i insatserna som fungerar. Framtida forskning kan bidra med kunskap genom att replikera studier som uppvisat positiva resultat.

Det är önskvärt att forskning om insatser som syftar till att främja återgång i arbete i möjligaste mån använder standardiserade mät- och analysmetoder och att forskare utvärderar ett begränsat antal prioriterade utfallsmått på ett vis som gör att dessa kan inkluderas i metaanalyser.

De studier som ligger till grund för slutsatserna i denna rapport är i huvudsak genomförda i Nederländerna, Norge, Sverige och Danmark. Projektgruppen bedömer att resultatens överförbarhet till svenska förhållanden är god. Samtidigt kan arbetsmarknad, sjukförsäkringslagstiftning och hälso- och sjukvårdens organisation och arbetssätt ha betydelse för hur insatser genomförs och vilka effekter de har, och dessa faktorer kan dessutom förändras över tid.

Ett krav för att en studie skulle inkluderas var att den undersökte insatsens effekt på återgång i arbete. I vissa fall har författarna även undersökt insatsens effekter på hälsa och funktion. Slutsatsen från denna rapport är att det inte går att bedöma insatsernas effekt på hälsa och funktion. Detta ska dock inte tolkas som att det är säkerställt att insatserna saknar effekt på dessa utfall, utan att det skulle behövas ytterligare, välgjorda studier för att kunna bedöma effekten. De sammanvägda resultaten ger inget stöd för att metoderna har negativa effekter, vare sig på återgång i arbete eller hälsa och funktion.

Det är svårt att dra slutsatser om kostnadseffektivitet för de olika insatskategorierna som definierats i projektet. Hälsoekonomiska studier har bara identifierats för ett mindre antal av de specifika insatser som omfattas av utvärderingen, och det är oklart om dessa insatser är representativa för kategorierna som helhet. En hälsoekonomisk analys som genomförts i projektet visar att det räcker med en förhållandevis liten effekt på arbetsåtergång för att en insats ska bli kostnadsbesparande i ett samhällsekonomiskt perspektiv.

I statistik över långtidssjukskrivning finns ofta könsskillnader. I de inkluderade studierna rapporterades endast undantagsvis separata resultat för kvinnor och män. De inkluderade studierna har inte redovisat effekter utifrån olika yrken eller arbetsmiljöer.

Det identifierades inga studier som undersökt insatser till personer sjukskrivna på grund av bipolär sjukdom eller till följd av postinfektiöst tillstånd, inklusive postcovid.

Den etiska analysen visar att insatser i vården vid långtidssjukskrivning berör etiska värden som jämlikhet, rättvisa, autonomi och integritet samt kan påverka tredje part vilket ställer höga krav på hur insatser planeras och genomförs i praktiken.

Standard tools used in societal risk management such as probabilistic risk analysis or cost–benefit analysis typically define risks in terms of only probabilities and consequences and assume a utilitarian approach to ethics that aims to maximize expected utility. The philosopher Carl F. Cranor has argued against this view by devising a list of plausible aspects of the acceptability of risks that points towards a non-consequentialist ethical theory of societal risk management. This paper revisits Cranor’s list to argue that the alternative ethical theory responsibility-catering prioritarianism can accommodate the aspects identified by Cranor and that the elements in the list can be used to inform the details of how to view risks within this theory. An approach towards operationalizing the theory is proposed based on a prioritarian social welfare function that operates on responsibility-adjusted utilities. A responsibility-catering prioritarian ethical approach towards managing risks is a promising alternative to standard tools such as cost–benefit analysis.