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  • 1.
    Guntram, Lisa
    et al.
    Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    Williams, Nicola Jane
    Univ Lancaster, England.
    Positioning uterus transplantation as a more ethical alternative to surrogacy: Exploring symmetries between uterus transplantation and surrogacy through analysis of a Swedish government white paper2018In: Bioethics, ISSN 0269-9702, E-ISSN 1467-8519, Vol. 32, no 8, p. 509-518Article in journal (Refereed)
    Abstract [en]

    Within the ethics and science literature surrounding uterus transplantation (UTx), emphasis is often placed on the extent to which UTx might improve upon, or offer additional benefits when compared to, existing treatment options for women with absolute uterine factor infertility, such as adoption and gestational surrogacy. Within this literature UTx is often positioned as superior to surrogacy because it can deliver things that surrogacy cannot (such as the experience of gestation). Yet, in addition to claims that UTx is superior in the aforementioned sense it is also often assumed (either implicitly or explicitly) that UTx is less fraught with ethical difficulties and thus should be considered a less morally problematic option. This article seeks to examine this assumption. Given that much UTx research has been performed in Sweden, a country where surrogacy is effectively although not currently explicitly forbidden, we do this through an analysis of the arguments underpinning a 2016 Swedish white paper which considered amending existing policy such that altruistic surrogacy arrangements would be permitted. By applying the white papers arguments for a restrictive position on altruistic surrogacy to the case of UTx using living altruistic donors we find that such arguments, if they hold in the case of surrogacy, apply similarly to UTx. We thus suggest that, for reasons of consistency, a similar stance should be taken towards the moral and legal permissibility of these two practices.

  • 2.
    Gustavsson, Erik
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Patients with multiple needs for healthcare and priority to the worse off2019In: Bioethics, ISSN 0269-9702, E-ISSN 1467-8519, Vol. 33, no 2, p. 261-266Article in journal (Refereed)
    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).

  • 3.
    Jaarsma, Pier
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Welin, Stellan
    Linköping University, Department of Culture and Communication, Arts and Humanities. Linköping University, Faculty of Arts and Sciences.
    Autism, Accommodation and Treatment: A Rejoinder to Chong-Ming Lims Critique2015In: Bioethics, ISSN 0269-9702, E-ISSN 1467-8519, Vol. 29, no 9, p. 684-685Article in journal (Other academic)
    Abstract [en]

    We are very grateful to Chong-Ming Lim for his thoughtful reply published in this journal on one of our articles, which motivated us to think more carefully about accommodating autistic individuals and treating autism. However we believe there are some confusions in Lims argument. Lim uses the accommodation thesis, according to which we should accommodate autistic individuals rather than treat autism, as the starting point for his reasoning. He claims that if the accommodation thesis is right, then we should not treat autistic individuals for their autism, not even low-functioning (i.e. intellectually disabled) ones, because this would be disrespectful to all autistic individuals. We should instead limit ourselves to accommodate all autistic individuals. However, the opposition between accommodation and treatment is not valid in the case of autism, because of ambiguity in the concepts of accommodation and treatment. Moreover there is confusion in Lims reasoning caused by omitting important facts about the practice of treating autism.

  • 4.
    Malmqvist, Erik
    entre for Studies on Meaning,Ethics and Society, Université Paris Descartes, in Paris, France.
    Are bans on kidney sales unjustifiably paternalistic?2014In: Bioethics, ISSN 0269-9702, E-ISSN 1467-8519, Vol. 28, no 3, p. 110-118Article in journal (Refereed)
    Abstract [en]

    This paper challenges the view that bans on kidney sales are unjustifiably paternalistic, that is, that they unduly deny people the freedom to make decisions about their own bodies in order to protect them from harm. I argue that not even principled anti-paternalists need to reject such bans. This is because their rationale is not hard paternalism, which anti-paternalists repudiate, but soft paternalism, which they in principle accept. More precisely, I suggest that their rationale is what Franklin Miller and Alan Wertheimer call ‘group soft paternalism’. Group soft paternalistic policies restrict the freedom of autonomous individuals, not for their own good (hard paternalism), but as an unavoidable consequence of seeking to protect other, non-autonomous individuals from harms that they have not voluntarily chosen (soft paternalism). Group soft paternalism supports prohibiting kidney sales on three conditions: (1) that such sales are potentially harmful to vendors, (2) that many vendors would suffer impaired autonomy, and (3) that distinguishing between autonomous and non-autonomous vendors and interfering only with the latter is unfeasible. I provide reasons for thinking that these conditions will often hold.

  • 5.
    Nikku, Nina
    et al.
    Linköping University, The Tema Institute, Media and Communication Studies. Linköping University, Faculty of Arts and Sciences.
    Eriksson, Bengt Erik
    Linköping University, The Tema Institute, Media and Communication Studies. Linköping University, Faculty of Arts and Sciences.
    Microethics in Action2006In: Bioethics, ISSN 0269-9702, E-ISSN 1467-8519, Vol. 20, no 4, p. 169-179Article in journal (Refereed)
    Abstract [en]

    The future development of bioethics has been discussed in a number of articles in recent years, principally with regard to the trend towards empirical studies. However, what is meant by empirical studies in this context and how it is to be used concretely have been subject to varying interpretations. The purpose of this article is to develop what we term the microethical approach as a concrete method for an empirically driven bioethics. By adopting a microethical perspective, we will illustrate an analytical concept for describing and demonstrating how, as a result of contextual circumstances and forms of understanding, different individuals in their everyday life adopt different coping strategies and behavior patterns in relation to ethical values. From a deepened perspective, the complexity of human behavior becomes apparent, and knowledge is gained about how moral problems are perceived and construed by those whom they in fact affect.

    We intend first and foremost to develop the microethical methodology by elucidating the methods and approaches that can help in clarifying moral dilemmas on a microethical level, and how the relationship between the empirical material and the ethical analysis evolves over the course of the analysis. This is exemplified by a study of caregivers’ entrance into patients’ private lives through the provision of care and assistance in the home.

  • 6.
    Nordenfelt, Lennart
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Comments:Standard circumstances and vital goals: comments on Sridhar Venkatapuram’s critique2013In: Bioethics, ISSN 0269-9702, E-ISSN 1467-8519, Vol. 27, no 5, p. 280-284Article in journal (Refereed)
    Abstract [en]

    This article is a reply to Venkatapuram's critique in his article Health, Vital Goals, Capabilities, this volume. I take issue mainly with three critical points put forward by Venkatapuram with regard to my theory of health. (1) I deny that the contents of my vital goals are relative to each community or context, as Venkatapuram claims. There is no conceptual connection at all between standard circumstances and vital goals, as I understand these concepts. (2) Venkatapuram notes that I stop short of filling the framework of vital goals with any content and thereby make my concept of health less concrete. I reply that some vital goals are indeed universal, viz. the ones which are necessary conditions for survival. Many other vital goals are individual and cannot therefore be included in a universal list. (3) Venkatapuram claims that my definition of vital goals is too broad, since it entails that some persons without any disease can be regarded as ill. However, in my understanding health is a relational concept from a state of complete health to a state of maximal illness. In this framework, a minor reduction of a state of complete health does not entail illness. This article also contains a comparison between my theory of health and Martha Nussbaum's theory of capabilities for dignity.

  • 7.
    Sandman, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    The importance of being pregnant: On the healthcare need for uterus transplantation2018In: Bioethics, ISSN 0269-9702, E-ISSN 1467-8519, Vol. 32, no 8, p. 519-526Article in journal (Refereed)
    Abstract [en]

    Researchers have recently provided proof of concept for uterus transplantation, giving rise to a discussion about priority setting. This article analyses whether absolute uterine-factor infertility (AUFI), the main indication for uterus transplantation, gives rise to a healthcare need and the extent to which such a need places justified claims on public funding in a needs-based welfare system. It is argued that, regardless of the concept of health to which one subscribes, there is a healthcare need for uterus transplantation in women with AUFI. The provision of alternative ways of addressing this need, such as surrogacy and adoption, reduces its severity. Hence, where such alternatives are publicly funded, uterus transplantation is unlikely to become cost-effective. However, where surrogacy and adoption are not publicly funded, uterus transplantation should be given a similar priority level to other assisted reproductive technologies. In these circumstances, public funding for uterus transplants may well be justified, particularly in well-funded healthcare system with relatively generous cost-effectiveness thresholds.

    The full text will be freely available from 2020-10-15 11:32
  • 8.
    Sandman, Lars
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Liliemark, Jan
    Linköping University.
    Withholding and withdrawing treatment for cost-effectiveness reasons: Are they ethically on par?2019In: Bioethics, ISSN 0269-9702, E-ISSN 1467-8519, Vol. 33, no 2, p. 278-286Article in journal (Refereed)
    Abstract [en]

    In healthcare priority settings, early access to treatment before reimbursement decisions gives rise to problems of whether negative decisions for cost-effectiveness reasons should result in withdrawing treatment, already accessed by patients. Among professionals there seems to be a strong attitude to distinguish between withdrawing and withholding treatment, viewing the former as ethically worse. In this article the distinction between withdrawing and withholding treatment for reasons of cost effectiveness is explored by analysing the doing/allowing distinction, different theories of justice, consequentialist and virtue perspectives. The authors do not find any strong reasons for an intrinsic difference, but do find some reasons for a consequentialist difference, given present attitudes. However, overall, such a difference does not, all things considered, provide a convincing reason against withdrawal, given the greater consequentialist gain of using cost-effective treatment. As a result, patients should be properly informed when given early access to treatment, that such treatment can be later withdrawn following a negative reimbursement decision.

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