Animal models of human diseases are often used in biomedical research in place of human subjects. However, results obtained by animal models may fail to hold true for humans. One way of addressing this problem is to make animal models more similar to humans by placing human tissue into animal models, rendering them chimeric. Since technical and ethical limitations make neurological disorders difficult to study in humans, chimeric models with human neural tissue could help advance our understanding of neuropathophysiology. In (...) this article, we examine whether the introduction of human neural tissue and any consequent cognitive change is relevant to the way we ought to treat chimeras. We argue that changes in cognitive abilities are morally relevant to the extent that they increase the capacities that affect the moral status of any entity, including awareness, autonomy, and sociability. We posit that no being, regardless of species, should be treated in a way that is incommensurate with its moral status. Finally, we propose a framework that can be used to guide ethical assessment of research involving chimeras with advanced cognitive capacities. We advance this framework as a useful tool for bringing relevant considerations to the forefront for those considering the ethical merit of proposed chimeric research. In doing so, we examine concepts relevant to the question of how any entity may be treated, including moral status, dignity, and capacities. (shrink)

Purpose: To survey the attitudes of the general public in Sweden to biobank research and to discuss the findings in the light of some well-known ethical principles.Methods: A questionnaire was used to survey the opinions of the general public in Sweden, and an ethical analysis (using the principles of autonomy, non-maleficence, beneficence and justice) was performed to discuss the possible conditions of such research.Findings: Between 3 and 9% answered that they did not want their samples to be collected and stored (...) in a biobank. Many respondents required information about the purpose of the research and wanted to be able to consent or refuse. About one third of the respondents said they would have answered differently if financial gain was involved and those who commented indicated a more negative attitude. The principle of autonomy maintains that the right to self-determination should be respected, and the principles of non-maleficence and beneficence that the probable harms and benefits resulting from a particular project by using samples from a biobank should be balanced. The general public disagree about how these principles are to be balanced. Interpretation: In the light of the findings different interpretations of the situation as well as possible alternatives are discussed in this paper. (shrink)

Twenty-four children (aged 5 months to 18 years) who were admitted to a university hospital were observed for a total of 135 hours with the aim of describing their degree of participation in decisions concerning their own care. Grading of their participation was made by using a 5-point scale. An assessment was also made of what was considered as optimal participation in each situation. The results indicate that children are not always allowed to participate in decision making to the extent (...) that is considered optimal. In no case was it judged that a child participated in or was forced to make a decision that was too difficult for the child. The interactions between children, parents and staff were also described in connection with discussions and decision-making processes. This showed that parents do not always support their children in difficult situations and that health care staff often inform children about what is going to happen without presenting alternatives or asking for their views. Staff may, however, find themselves facing an ethical conflict in deciding between supporting a child’s view or following hospital routine. It is of great importance that children are looked upon as potentially autonomous individuals and that staff members realize that one of their core duties is to facilitate children’s participation in decision making concerning their health care. (shrink)

The paper discusses the concept of explanation in metaphysics. Different types of explanation are identified and explored. Scientific explanation is compared with metaphysical explanation. The comparison illustrates the difficulties with applying the concept of explanation in metaphysics.

The purpose of this paper is to clarify the role of value uncertainty and value instability in decision-making that concerns morally controversial issues. Value uncertainty and value instability are distinguished from moral uncertainty, and several types of value uncertainty and value instability are defined and discussed. The relations between value uncertainty and value instability are explored, and value uncertainty is illustrated with examples drawn from the social sciences, medicine and everyday life. Several types of factor producing value uncertainty and/or value (...) instability are then identified. They are grouped into three categories and discussed under the headings ‘value framing’, ‘ambivalence’ and ‘lack of self-knowledge’. The paper then discusses the role of value uncertainty in decision-making. The concluding remarks summarize what has been achieved and what remains to be done in this area. (shrink)

The aims of this article are to consider (1) whether there are medical and societal differences among diseases regarding which patient groups should be asked to participate in first-in-human (FIH) trials of stem-cell-based therapies; (2) any differences in the light of values generally endorsed by different types of ethical theories, since the question in the title of this article is value laden, and its answer depends on which values one wants to promote and protect, and how they are ranked in (...) importance; (3) whether the answer to that question is disease-specific, or whether it depends on factors common to several diseases. To illustrate these problems, we use Parkinson’s disease (PD) and Huntington’s disease (HD), between which there are important medical and societal differences. Moreover, research on stem-cellbased therapies for these diseases is being translated from research to practice. This approach to the problem can be applied to decision making about similar problems raised by other diseases that exhibit the same types of differences. (shrink)

It is well known that close relatives of terminally ill patients endure great emotional stress. Many factors, such as existential concerns, contribute to the distress of these relatives. In this study, interviews were conducted to explore experiences concerning life restrictions, emotional distress, and limited support, in a group of close relatives of patients with amyotrophic lateral sclerosis (ALS). The purpose was to identify, illuminate and clarify ethical problems related to these experiences. The results indicate that close relatives of patients with (...) ALS need someone to talk to, as well as more information about the disease and its process. Furthermore, the study illustrates how ethical problems are related to choices and conflicts, and that a process including shared decision making is often an ideal when trying to find a solution to ethical problems. (shrink)

The achievement of optimal therapeutic results presupposes the use of appropriate treatment combined with maximal utilization of placebo effects. These aims may sometimes be difficult to satisfy in randomized clinical trials (RCTs). The question thus arises whether there is a conflict between the goals of therapy and those of experimental research; and if so, to what extent, and how is it handled in practice by clinicians and researchers. Various ethical problems have been discussed in several reports connected with RCTs. But (...) we have found no discussion concerning the conflict between obtaining informed consent and promoting optimal placebo effects. Information about RCTs can be given in various ways. Sometimes appropriate information about RCTs to patients involves non-optimal utilization of placebo effects. This gives rise to ethical and methodological problems, which are discussed in this article. (shrink)

In this article I focus on some of Joseph Margolis's contributions to medical ethics. I first discuss some of Margolis's normative and metaphysical views on death and abortion, particularly in his early work Negativities, as well as some of his metaphysical assumptions. Then these views and assumptions are related to his theory of persons and, by implication, his theory of culture, set forth in a number of later works. In the course of the discussion, I call attention to some controversial (...) issues of today, such as embryonic stem cell research and the creation of embryos for the sole purpose of research, and ask for Margolis's views on them, given his earlier contributions and assumptions. Finally, I comment on his relativism and his program for research in aesthetics and ethics. (shrink)

The overriding question discussed in this Element can be stated simply as: Can computers create art? This Element presents an overview of the controversies raised by various answers to this question. A major difficulty is that the technology is developing rapidly, and there are still many uncertainties and knowledge gaps as to what is possible today and in the near future. But a number of controversial issues are identified and discussed. The position taken on controversial issues will depend on assumptions (...) made about the technology, about the nature and location of consciousness, about art and creativity. Therefore, a number of hypothetical answers are outlined, related to the assumptions made. (shrink)

This paper discusses the future of migrants with acute heart problems and without permanent permission to remain in the country where they are seeking asylum. What does the country they have traveled to owe them? Specifically, what healthcare services are they entitled to? This may seem a niche problem, but numbers of migrants with acute heart problems could increase in the future. Besides, similar problems could be raised by, for instance, traumatized migrants with acute needs for healthcare services for other (...) serious conditions. The paper identifies the issues and some positions on them. Arguments for and against these positions are explored. This particular set of problems in healthcare ethics creates several challenges, at both national and international levels, concerning access to transplantation, public willingness to donate organs, optimal use of organs, justice and fairness, and potential conflicts of law, politics and ethics, as well as issues revolving around interaction and communication between agencies and professions. (shrink)

Name der Zeitschrift: Jahrbuch für Wissenschaft und Ethik Jahrgang: 18 Heft: 1 Seiten: 85-122.

The first main purpose of this paper is to identify and to distinguish between a number of problems and conflicts of interest in the area where medical personal registers are used in research, particularly when the registers are computerized. The second main purpose is to suggest and comment upon a method for solving or minimizing such conflicts of interest.

The purpose of this paper is first to discuss and criticize some general theses about interpretation. The concept of interpretation is shown to be more complex than these general theses indicate. Distinctions are suggested between different types o f interpretations, and an attempt is made to state criteria of interpretation and arguments which can be used to support or criticize proposed interpretations. The relations between the various types of interpretations and the criteria (arguments) are then explored. Can they be combined? (...) How? Can they comie into conflict with each other? How are such conflicts in that case to be solved? It is argued that at least partly different criteria and arguments are used, and ought to be used, when different types of interpretations are proposed, checked, and criticized. Sometimes a particular criterion is given, and ought to be given, different weight when different types of interpretations are considered. (shrink)

The research literature suggests that physicians’ attitudes regarding disclosing a diagnosis of cancer have changed, from nondisclosure to full disclosure. Physicians’ attitudes towards disclosing a patient’s prognosis are likewise said to have changed, although not to the same degree.The aim of this study was to identify inherent challenges in communicating information about imminent death. It included one set of interviews with patients and another set with doctors, and subsequent discussions of ways to overcome obstacles to patients’ understanding their situation. Patients (...) were diagnosed with leukemia, myeloma, or lung cancer; the doctors were hematologists and lung oncologists. The two sets of interviews were analyzed separately using a content analysis model developed by Graneheim and Lundman. For each set of interviews, eight content areas were defined as belonging to an area of interest and scrutinized for the information they included regarding communicating prognoses to patients.The main finding was a discrepancy between patients’ desire to be fully informed regarding their prognosis and physicians’ reluctance to offer a prognosis until a patient had overt signs of approaching death. We conclude that existing guidelines for disclosure of bad news should be modified to encourage disclosure and discussion of uncertain prognostic information, unless a patient is clearly opposed to receiving such information or otherwise not a suitable partner for dialogue. (shrink)

The purpose of this paper is first to discuss and criticize some general theses about interpretation. The concept of interpretation is shown to be more complex than these general theses indicate. Distinctions are suggested between different types o f interpretations, and an attempt is made to state criteria of interpretation and arguments which can be used to support or criticize proposed interpretations. The relations between the various types of interpretations and the criteria (arguments) are then explored. Can they be combined? (...) How? Can they comie into conflict with each other? How are such conflicts in that case to be solved? It is argued that at least partly different criteria and arguments are used, and ought to be used, when different types of interpretations are proposed, checked, and criticized. Sometimes a particular criterion is given, and ought to be given, different weight when different types of interpretations are considered. (shrink)

Notions of the Aesthetic and of Aesthetics: Essays on Art, Aesthetics and CultureÅhlbergLars-OlofPeter Lang. 2014. pp. 427. £60.00.

After a brief sketch of the historical background, the current political situation in Sweden is outlined. Since 1985 the National Council on Medical Ethics has played an important role in the biopolitical debate in Sweden, and its activities and influence are described. Religious teachings are often combined with moral precepts. But what makes a statement religious is not easy to say, especially in societies where religious concerns have been intertwined with humanitarian common sense morality for a long time. Summing up, (...) it can be said that the debate in Sweden on biopolitical issues has not shown many signs of the influence of religious arguments, though some religious actors are active in this debate. (shrink)

The Fregean distinction between Sinn ("sense") and Bedeutung ("reference") can be applied also to pictures. As to pictorial representation, one may distinguish between what a picture refers to and the properties of the picture that make it possible to tell what it refers to. It is tempting to try to define or elucidate notions like depiction in terms of the Sinn of pictures. But to avoid certain obvious objections to such an approach, the properties of the picture must be construed (...) broadly; they should not only include patches of colors and light, but also complex relational properties. This paper tries to pave the way for such an analysis of pictorial representation in terms of certain combinations of intentions, seeing as, and traditions of representation. An attempt is also made to explore the relations between pictorial representation and structural similarity, and to outline distinctions between some relevant senses of "see-as". Applications to different kinds of art are briefly discussed. (shrink)

The Fregean distinction between Sinn ("sense") and Bedeutung ("reference") can be applied also to pictures. As to pictorial representation, one may distinguish between what a picture refers to and the properties of the picture that make it possible to tell what it refers to. It is tempting to try to define or elucidate notions like depiction in terms of the Sinn of pictures. But to avoid certain obvious objections to such an approach, the properties of the picture must be construed (...) broadly; they should not only include patches of colors and light, but also complex relational properties. This paper tries to pave the way for such an analysis of pictorial representation in terms of certain combinations of intentions, seeing as, and traditions of representation. An attempt is also made to explore the relations between pictorial representation and structural similarity, and to outline distinctions between some relevant senses of "see-as". Applications to different kinds of art are briefly discussed. (shrink)

In this study, 10 hematologists and 10 lung oncologists were interviewed regarding the information they provide to patients in four situations of uncertainty: determining the treatment that is in the patient’s best interest; recurrence or progression of the patient’s disease; determining when to withdraw life-prolonging treatment; discussing death, addressing questions such as whether the patient will die from the disease, and when. The primary finding is that delivery of information to patients with low survival rates can be improved by more (...) and better disclosure by physicians at an earlier stage. The crucial point for physicians is to ascertain the wishes of patients, to learn what to reveal about what patients should expect, short term and long term, as death approaches. (shrink)

The role of mothers in prenatal research has been discussed extensively. Significantly less work has been done on the father’s role. In this article, focusing on ethical issues, we seek to redress this imbalance. Examining the father’s position in research conducted on pregnant women, we ask whether or not paternal consent ought to be required in addition to that of the pregnant woman. Having distinguished between different concepts of father and mother, we proceed by giving an overview of the reasons (...) for requiring consent of the woman who is carrying the child. We then examine which of these reasons apply to the biological father, and show that some of them are relevant to the father. The case, roughly speaking, revolves around privacy issues, the father’s future legal responsibilities, and the likelihood that he will care about the health and wellbeing of his future child. These factors in the decision problem should all be recognized, as should the fact that they can in principle be trumped by other considerations. (shrink)

The paper discusses the concept of explanation in metaphysics. Different types of explanation are identified and explored. Scientific explanation is compared with metaphysical explanation. The comparison illustrates the difficulties with applying the concept of explanation in metaphysics.