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  • 1.
    Michailakis, Dimitris
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Culture and Society, Division of Social Work.
    Kelfve, Susanne
    Linköping University, Department of Culture and Society, Division of Social Work. Linköping University, Faculty of Arts and Sciences.
    Arbetsmiljön för personal som arbetade på sina ordinarie arbetsplatser under coronapandemin2023Report (Other academic)
  • 2.
    Kjellbom, Pia
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Culture and Society, Division of Social Work.
    Michailakis, Dimitris
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Culture and Society, Division of Social Work.
    Ett ’litet hjärtas’ rättigheter – en mångfald av perspektiv2023In: De sociala rättigheternas politik / [ed] Magnus Dahlstedt, Gleerups Utbildning AB, 2023, p. 67-84Chapter in book (Other academic)
  • 3.
    Dahlstedt, Magnus
    et al.
    Linköping University, Department of Culture and Society, Division of Social Work. Linköping University, Faculty of Arts and Sciences.
    Lundberg, Anna
    Linköping University, Department of Culture and Society, Division of Social Work. Linköping University, Faculty of Arts and Sciences.
    Michailakis, Dimitris
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Culture and Society, Division of Social Work.
    Inledning2023In: De sociala rättigheternas politik / [ed] Magnus Dahlstedt; Anna Lundberg, Dimitris Michailakis, Gleerups Utbildning AB, 2023, p. 9-32Chapter in book (Other academic)
  • 4.
    Gillingsjö, Jenny
    et al.
    Linköping University, Department of Culture and Society, Division of Social Work. Linköping University, Faculty of Arts and Sciences.
    Olaison, Anna
    Linköping University, Department of Culture and Society, Division of Social Work. Linköping University, Faculty of Arts and Sciences.
    Michailakis, Dimitris
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Culture and Society, Division of Social Work.
    To be or not to be open in everyday life: the use of impression management strategies among older LGBTQ adults2023In: Relational Social Work, E-ISSN 2532-3814, Vol. 7, no 1, p. 52-70Article in journal (Refereed)
    Abstract [en]

    The key issue in this article is to identify and interpret how older LGBTQ adults use impression management strategies in social interaction with non-LGBTQ persons in everyday life situations. The collection of data consists of 15 semi-structured interviews with older LGBTQ adults (65+) in Sweden. A reconstructive methodology for analyzing the material were used and we focused mainly on the latent meaning in the interviewee’s communication. Our findings indicate that the interviewees employed specific impression management strategies. Some of the informants disclosed their LGBTQ identity while others instead tried to conceal this part of their identity, and this depended on individuals’ openness and/or visibility. We also noted differences in using a defensive or assertive impression management strategy and differences between the older LGBTQ adults. A thorough understanding of how older LGBTQ persons deal with being LGBTQ in social interaction with non-LGBTQ persons could be useful knowledge in a practice context. By illuminating the different initial positions of older LGBTQ adults as well as their different impression management strategies in every day social interaction we hope this will be practical knowledge also in different social service settings. This could facilitate the acceptance and the inclusion of older LGBTQ persons. The findings can hopefully be useful for social service personnel to help older LGBTQ adults feel secure about disclosing their LGBTQ identities.

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  • 5.
    Michailakis, Dimitris
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Culture and Society, Division of Social Work.
    Ένταξη αλλοδαπών: μία διαφορετική προσέγγιση; Μία προς αποφυγή πρακτική: Η περίπτωση της Σουηδίας.: [Integration av invandrare: Ett alternativt betraktelsesätt?]2023In: Greek Politics Journal, Vol. 14Article in journal (Other academic)
  • 6.
    Michailakis, Dimitris
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Culture and Society, Division of Social Work.
    Τι ψηφίζετε όταν ψηφίζετε; Οι εκπλήξεις του συμβατικού κοινοβουλευτισμού2023In: Greek Politics Journal, Vol. 15Article in journal (Other academic)
  • 7.
    Björngren Cuadra, Carin
    et al.
    Malmö University, Sweden.
    Hansson, Kristoffer
    Malmö University, Sweden.
    Michailakis, Dimitris
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Culture and Society, Division of Social Work.
    Neergaard, Anders
    Linköping University, REMESO - Institute for Research on Migration, Ethnicity and Society. Linköping University, Department of Culture and Society, Division of Migration, Ethnicity and Society (REMESO). Linköping University, Faculty of Arts and Sciences.
    Förord:I pandemins spår. Socialvetenskapliga perspektiv på covid-192021In: Socialvetenskaplig tidskrift, ISSN 1104-1420, E-ISSN 2003-5624, Vol. 28, no 4, p. 377-386Article in journal (Other academic)
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  • 8.
    Kelfve, Susanne
    et al.
    Linköping University, Department of Culture and Society, Division of Social Work. Linköping University, Faculty of Arts and Sciences.
    Michailakis, Dimitris
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Culture and Society, Division of Social Work.
    Kvantitativ datainsamling2020In: Metoder för forskning i socialt arbete: hur, var och varför? / [ed] Magnus Dahlstedt, Sabine Gruber, Malmö: Gleerups Utbildning AB, 2020, Vol. Sidorna 57-75, p. 57-75Chapter in book (Other academic)
    Abstract [en]

    Finns det något samband mellan ungdomskriminalitet och antalet fritidsgårdar i en kommun? Är socialsekreterare mer stressade i dag än för tio år sedan? Är pojkar oftare utsatta för våld än flickor? Hur har ungdomars alkoholvanor förändrats över tid? Det här är exempel på frågeställningar som är relevanta för socialt arbete, och där vi behöver använda kvantitativa forskningsmetoder för att kunna besvara dem, eftersom det i samtliga fall handlar om kvantitet, frekvens och om relationen mellan mätbara faktorer.

  • 9.
    Michailakis, Dimitris
    et al.
    Linköping University, Department of Culture and Society, Division of Social Work. Linköping University, Faculty of Arts and Sciences.
    Gillingsjö, Jenny
    Linköping University, Department of Culture and Society, Division of Social Work. Linköping University, Faculty of Arts and Sciences.
    Olaison, Anna
    Linköping University, Department of Culture and Society, Division of Social Work. Linköping University, Faculty of Arts and Sciences. Uppsala universitet.
    Tolkande innehållsanalys2020In: Metoder för forskning i socialt arbete: hur, var och varför? / [ed] Magnus Dahlstedt, Sabine Gruber, Malmö: Gleerups Utbildning AB, 2020, p. 129-141Chapter in book (Other academic)
    Abstract [sv]

    Tolkande innehållsanalys är inte en ny metod. Den utvecklades som en specifik forskningsteknik under 1900-talet av sociologer och socialpsykologer som intresserade sig för att undersöka fenomenet kommunikation. Metoden användes också av pedagoger i studier av läroplaner och läroböcker för att identifiera fördomar och stereotyper om människor med till exempel olika födelseland eller funktionsvariation. Innehållsanalys associeras vanligtvis med den breda kategorin kvalitativa metoder och används på en rad olika texter, till exempel nedskrivna intervjuer, statliga utredningar, myndighetsrapporter, debatter i riksdagen och tidningsartiklar.

  • 10.
    Michailakis, Dimitris
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Social and Welfare Studies, Social Work.
    Swedish Family Policy – Facts and prospects2019In: Science and Society: Journal of Political and Moral Theory, E-ISSN 1108-3697, Vol. 39Article in journal (Other academic)
  • 11.
    Schirmer, Werner
    et al.
    Uppsala university, Sweden.
    Michailakis, Dimitris
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Systems Theory for Social Work and the Helping Professions2019Book (Refereed)
  • 12.
    Löf (Gillingsjö), Jenny
    et al.
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Michailakis, Dimitris
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Olaison, Anna
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    HBTQ-äldre i den politiska debatten2018In: Gränsöverskridande socialt arbete: teorier, tillämpningar, tolkningar / [ed] Magnus Dahlstedt, Malmö: Gleerups Utbildning AB, 2018, 1, p. 41-61Chapter in book (Other academic)
  • 13.
    Schirmer, Werner
    et al.
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Michailakis, Dimitris
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Inclusion/Exclusion as the Missing Link. A Luhmannian Analysis of Loneliness Among Older People2018In: Systems research and behavioral science, ISSN 1092-7026, E-ISSN 1099-1743, Vol. 35, no 1, p. 76-89Article in journal (Refereed)
    Abstract [en]

    This article contributes to the interdisciplinary study of loneliness among older people with some insights based on Luhmann's systems theory. We argue that loneliness is a consequence of the way society includes/excludes people. In contrast to traditional societies, modern society forces people to act as individuals. In order to prevent loneliness, individuals themselves must search for membership in functionally diffuse collectivities (couple relations, friendships, communities). Luhmann's theory provides the framework to integrate the findings of empirical research. We claim that older people are more prone to loneliness for three reasons: first, after retirement they lose their performance role, which limits access to informal communities. Second, because they suffer from illness, impairment and a lack of resources more often than younger people, their access to functionally diffuse collectivities is impeded. Finally, because of structural and semantic changes in the family system, older people often find themselves at the margins of families.

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  • 14.
    Schirmer, Werner
    et al.
    Uppsala university, Sweden.
    Michailakis, Dimitris
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Social and Welfare Studies, Social Work.
    Luhmann’s Sociological Systems Theory and the Study of Social Problems2018In: The Cambridge Handbook of Social Problems, Vol 1 / [ed] Treviño, A. Javier., Cambridge: Cambridge University Press, 2018, p. 221-240Chapter in book (Other academic)
    Abstract [en]

    This chapter discusses social problems from the perspective of Niklas Luhmann's sociological systems theory. We argue that his theory provides a rich framework to gain relevant insights for the study of social problems. The key element of systems theory is the concept of functionally differentiated society, that is, a heterarchical arrangement of social systems such as the economy, polity, religion, science. Luhmann's theory connects core ideas from both realist and constructionist epistemologies without ending up in inconsistencies or contradictions. The theory gives justice to realism insofar as it takes the systemic nature of social phenomena seriously and it defies simplistic models of causality, steering, planning, and intervention. Systems theory is constructionist insofar as it takes the multiperspectivity of modern society seriously: many social systems construct their own definitions of social problems including underlying causalities and values. The same social problem appears differently from different systems’ perspectives.

  • 15.
    Schirmer, Werner
    et al.
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Michailakis, Dimitris
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Loneliness among older people as a social problem: the perspectives of medicine, religion and economy2016In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 36, no 8, p. 1559-1579Article in journal (Refereed)
    Abstract [en]

    This article offers a theoretical framework for studying loneliness among older people from a social problems perspective. The framework combines the constructionist approach to social problems (Spector and Kitsuse) and systems theory (Luhmann). Based on the first approach, we understand the social problem of loneliness among older people to be the result of claims-making activities by different key actors. These activities are guided by underlying moralities, causalities and solutions. With the second approach, we can explain how social problems are framed differently within different social systems. The proposed framework is primarily aimed at researchers studying social (in contrast to bio-medical or psychological) aspects of loneliness among older people. It helps not only to guide research designs in order to address conflicting perspectives, rationalities and interests but also to enable researchers to grasp fully how loneliness among older people is attributed (potentially shifting) meanings through communicative acts by influential stakeholders in the social problems industry. Combining constructionism and Luhmanns theory also helps to interpret and explain concrete claims-making concerning loneliness as a social problem. The argument in this article is illustrated via three different social systems: medicine, religion and economy. Loneliness among older people appears to be something different from each of these perspectives: as a matter of health and illness, of spirituality, and of incentives and commodities, respectively.

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  • 16.
    Michailakis, Dimitris
    et al.
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Schirmer, Werner
    Linköping University, Department of Social and Welfare Studies.
    The Help system and its Reflection Theory: A Sociological Observation of Social Work2015In: Nordic Social Work Research, ISSN 2156-857X, E-ISSN 2156-8588, Vol. 5, no Sup. 1, p. 71-84Article in journal (Refereed)
    Abstract [en]

    The relation between sociology and social work is analysed in this article as a relation between observer and object of observation. As a theoretical framework, we use Luhmannian systems theory, according to which modern society is characterised by functional differentiation, that is a horizontal structure of function systems such as polity, economy, education, science, law, etc. Each of these ful fils a particular function for society. One such system is the help system, referring to social services and their practice. Its societal function is the management of inclusion/exclusion and social integration. Function systems contain what Luhmann calls‘reflection theories’, which are associated with specific academic disciplines (such as the political system/political theory/political science or the education system/pedagogical theory/ educational science). Although their basic operations are linked to science (research, theories and methods, publications), reflection theories are part of their system; their function is to reflect on the unity and meaning of the function system. This article argues that the discipline of social work serves as the reflection theory for the help system. A solid reflection theory in the help system is important in order to define guiding criteria for professional ethics to be used in social services. The lack of an adequate reflection theory can lead to the intrusion of ideologies that are inappropriate to the logic of the help system, such as New Public Management or administrative technocracy, which might threaten the integrity of the help system.

  • 17.
    Michailakis, Dimitris
    et al.
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Schirmer, Werner
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Arts and Sciences.
    The lost Gemeinschaft: How people working with the elderly explain loneliness2015In: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 1879-193X, no 33, p. 1-10Article in journal (Refereed)
    Abstract [en]

    We conducted a qualitative interview study with people of different professions working with lonely elderly people. The rationale of the study was to examine how these respondents explain loneliness among the elderly. The present article focuses on the social explanations, i.e. explanations that identify causes of loneliness in the structure of modern society. We found that many of the social explanations given are aspects of a more encompassing and general pattern underlying all the reasoning about loneliness among the elderly. This pattern is the expression of two contrasting images of society which the classical sociologist Ferdinand Tönnies termed Gemeinschaft (community) and Gesellschaft (society). The former refers to traditional or small-size rural communities characterized by high degrees of social cohesion, integration, solidarity, proximity and familiarity, whereas the latter refers to functional differentiation, distance, individualization, exchanged-based social relations and anonymity. Loneliness among the elderly is explained by the lack of Gemeinschaft and its characteristics in contemporary society. This explanatory pattern goes hand in hand with a critical view of contemporary society and a nostalgic yearning for the lost communities of past societies, where inhabitants find their staked-out place and sense of belonging, and thus loneliness hardly seems to occur. We summarized this view under the label the "lost Gemeinschaft".

  • 18.
    Schirmer, Werner
    et al.
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences. Ghent University, Belgium .
    Michailakis, Dimitris
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    The Luhmannian approach to exclusion/inclusion and its relevance to Social Work2015In: Journal of Social Work, ISSN 1468-0173, E-ISSN 1741-296X, Vol. 15, no 1Article in journal (Refereed)
    Abstract [en]

    Summary: Although the concept of social exclusion is central to the academic discipline of social work, there is not much theoretical clarity about what it actually means. For instance, exclusion is used as a synonym for poverty, marginalization, detachment, unemployment, or solitude. We argue that the systems-theoretical framework developed by the German social theorist Niklas Luhmann (1927–1997) provides the conceptual tools to understand inclusion and exclusion in a theoretically adequate way that is highly relevant to Social Work.                 

    Since there is scarcely any literature on Luhmann's work in the field of social work not written in German, this article aims to provide a systematic introduction to the Luhmannian theory of society with respect to the distinction of inclusion/exclusion and its relation to social work to an English-speaking audience.

    Findings: After a presentation of some basic concepts, it will be argued that exclusion is not a problem per se nor is inclusion always and per se unproblematic. The Luhmannian approach suggests that inclusion and exclusion are operations of social systems that treat human beings as relevant addresses for communication. Against that background, systems theory gives a clear and accurate description of what social work can (and cannot) do in terms of inclusion/exclusion.                 

    Applications: The main purpose of social work is exclusion management. Exclusion management involves working on the social addresses of individuals with the aim of improving their attractiveness for other social systems, a (re)orientation towards being includable. It appears in three forms: exclusion prevention, inclusion mediation, and exclusion administration.

  • 19.
    Michailakis, Dimitris
    et al.
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Schirmer, Werner
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences. Ghent University, Belgium.
    Social work and social problems: A contribution from systems theory and constructionism2014In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 23, no 4, p. 431-442Article in journal (Refereed)
    Abstract [en]

    Social work builds its identity on social problems. The goal is to generate knowledge about causes, consequences and solutions. However, there is a lack of theory of social problems. We suggest that research on social problems can benefit by ‘bringing the observer in’: Loseke's constructionist framework and Luhmann's systems theory. According to Loseke, social problems appear differently when constructed by different observers. Constructions vary in terms of morality, conditions, victims/villains and solutions. From Luhmann we learn that modern society consists of a multitude of social systems (e.g. politics, science, economy etc.), each operating with their own communicative codes. Combining both approaches, we hypothesise that any social system constructs its own (version of) social problems. Illustrating with the empirical case ‘suicide among mentally ill people’, we examine how a phenomenon is constructed differently as a social problem by four different social systems: the disability movement, politics, medicine and social work.

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  • 20.
    Schirmer, Werner
    et al.
    Linköping University, Department of Social and Welfare Studies.
    Michailakis, Dimitris
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Two ways of dealing with polycontexturality in priority-setting in swedish health care politics2014In: Systems theory and the sociology of health and illness: observing healthcare / [ed] Morten Knudsen, Werner Wogd, London: Routledge, 2014, p. 63-80Chapter in book (Refereed)
  • 21.
    Michailakis, Dimitris
    et al.
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Schirmer, Werner
    Linköping University, Department of Social and Welfare Studies.
    Vad händer när teori och praktik i socialt arbete integreras?2014In: Socialvetenskaplig tidskrift, ISSN 1104-1420, E-ISSN 2003-5624, no 4, p. 127-141Article in journal (Refereed)
  • 22.
    Michailakis, Dimitris
    et al.
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Schirmer, Werner
    Sociologiska Institutionen, Uppsala Universitet.
    Solidaritet som finansieringsform och som prioriteringsprincip2012Report (Other academic)
    Abstract [en]

    Solidarity is a central value in Swedish healthcare. Not only are healthcare costs financed by taxpayers proportional to their income (solidarity-based funding), solidarity is also one of the basic ethical principles for priority setting in healthcare (the so called need- and solidarity principle). Despite its significance, the term 'solidarity' has been given different, sometimes contradictory meanings, in both academic and political contexts. In a political context such contradictions can be handled since political standpoints always try to embrace a big variety of meanings within a certain terminology. In the context of healthcare, though, semantic ambiguities will severely hamper efficient decision‐making.

    Against this background this report aims at examining potential semantic ambiguities/contradictions with respect to the meaning of 'solidarity' as it is used in Swedish public debates on healthcare funding and prioritization between 1990 and 2010. We investigated relevant public reports and policy documents on prioritization as well as articles in medical journals and major daily newspapers in which the meaning of 'solidarity' had a key role. The selected data were analyzed with a method based on the systems-theoretical epistemology by sociologist Niklas Luhmann.

    The study shows that 'solidarity' as a value in Swedish healthcare appears in two separate, at best loosely coupled debates. One mainly takes place in mass media and is a political debate on whether the healthcare system should be opened to private investors and insurances. Here, solidarity is discussed as a means of healthcare funding. The other debate takes place in professional forums and discusses formulations of guidelines for priority setting. Here, solidarity is discussed as an integral part of an ethical platform for priority principles.

    Our study of the debate in media reveals that there are surprisingly few differences in the meaning of 'solidarity'. There is a vast consensus that those who are better off should stand up for the weak, which resembles a Christian liberal understanding of solidarity. The positions differ in the reference of solidarity: who is the legitimate recipient/address of solidarity? We found that these references can be interpreted with help of the guiding distinction agency/(in)equality. If society is mainly understood as a stratified society, the agency of patients is seen as a potential reason for inequality and a threat for equality. By contrast, if society is mainly seen as an assembly of individual agents, too much significance given to equal health outcomes is interpreted as a limitation of people's scope. Whether agency appears as a threat or blessing depends on two mutually exclusive value systems that are guided by their own views on the distinction agency/(in)equality.

    We argue that the difference between the two most important positions in the other debate, i.e. the prioritization debate, also can be described in terms of the distinction agency/(in)equality. The positions are clearly expressed in two major reports: the Swedish Government Official report Health Care's difficult choices as provided by the Priorities Commission and the report by The Swedish National Centre for Priority Setting Resolving Health Care's difficult choices. Both reports conclude a proposal of guidelines for priorities. In the same way as in the fundingdebate, the term 'solidarity' in the priorities-debate is used in the meaning that the better off should help the weak. Again, the difference is to be found in the references of solidarity, that is, the definition of the 'weak': Who can justifiably be considered as weak? The Priorities Commission defines weakness by low socioeconomic status. In the report by the Swedish National Centre for Priority Setting the weak are rather identified by lack of sufficient agency (such as children, dementia-patients, unconscious patients or mentally ill).

    In accordance with the guiding difference agency/(in)equality we can distinguish an agency-based solidarity (the weak as non-agents) underlying the report by the Swedish National Centre for Priority Setting and an inequality-based solidarity (the weak are the marginalized) underlying the report by the Priorities Commission. These different references of 'solidarity' have considerable consequences on which role the solidarity principle can play in an ethical platform.

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    Solidaritet som finansieringsform och som prioriteringsprincip
  • 23.
    Schirmer, Werner
    et al.
    Uppsala University.
    Michailakis, Dimitris
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    The latent function of responsibility for ones health in Swedish healthcare priority-setting2012In: Health Sociology Review, ISSN 1446-1242, E-ISSN 1839-3551, Vol. 21, no 1, p. 36-46Article in journal (Refereed)
    Abstract [en]

    Applying Luhmanns theoretical framework, this article analyses the function of the notion responsibility for ones health in prioritisation in Swedish healthcare. A document called Ethical Platform was adopted in 1997 in order to guide decisions about prioritisation. Evaluations deemed it a failure. Against its official purpose, we argue that this document is not a failure as it has the latent function of protecting the credibility of the self-description of the Swedish political system as a highly inclusive and caring welfare-state. Since prioritisation implies exclusion it poses a threat for this self-description. less thanbrgreater than less thanbrgreater thanThe responsibility principle, suggested in 2007 as an improvement for the platform, has the latent function of helping overcoming the contradiction between the self-description of the welfare-state (inclusion) and prioritisation (exclusion). While inclusion into healthcare is still offered for everybody (respect), this right becomes conditional when citizens are regarded as agents who account for their unhealthy lifestyle (responsibility).

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  • 24.
    Schirmer, Werner
    et al.
    Uppsala University.
    Michailakis, Dimitris
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    The responsibility principle. Contradictions of priority-setting in Swedish healthcare2011In: Acta Sociologica, ISSN 0001-6993, E-ISSN 1502-3869, Vol. 54, no 3, p. 267-282Article in journal (Refereed)
    Abstract [en]

    Medical priority-setting has been discussed heatedly in Sweden since the 1990s. While criteria such as medical need, solidarity and cost-effectiveness were established long ago, they failed to give clear directives to decision-makers on how to apportion priority. The notion of individual responsibility for ones health was suggested as one solution out of the impasse. According to the responsibility principle, anyone who fails to live up to the norms of a healthy lifestyle can legitimately be given lower priority. Although the principle is gaining support, its effectiveness is being hampered by structural problems. We have analysed official reports and pertinent fora of the Swedish debate on priority-setting from the period 1990-2009 and have examined the responsibility principle using a Luhmannian framework. Unlike common criticism emphasizing difficulties of assessing whether individuals can actually be held accountable for their lifestyle, we found that the responsibility principle fails in its current form because it unifies two incompatible logics deeply rooted in the functionally differentiated structure of society: those of medical reasoning (connecting health condition with lifestyle) and political expediency (attributing responsibility). We conclude that future policy-making cannot simply overlook this conflict, but has to acknowledge its presence and constructively utilize its potential.

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