35 found
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  1.  95
    Shared Decision Making, Paternalism and Patient Choice.Lars Sandman & Christian Munthe - 2010 - Health Care Analysis 18 (1):60-84.
    In patient centred care, shared decision making is a central feature and widely referred to as a norm for patient centred medical consultation. However, it is far from clear how to distinguish SDM from standard models and ideals for medical decision making, such as paternalism and patient choice, and e.g., whether paternalism and patient choice can involve a greater degree of the sort of sharing involved in SDM and still retain their essential features. In the article, different versions of SDM (...)
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  2. Severity as a Priority Setting Criterion: Setting a Challenging Research Agenda.Mathias Barra, Mari Broqvist, Erik Gustavsson, Martin Henriksson, Niklas Juth, Lars Sandman & Carl Tollef Solberg - 2019 - Health Care Analysis 1:1-20.
    Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to today’s severity criteria in (...)
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  3. Shared Decision-Making and Patient Autonomy.Lars Sandman & Christian Munthe - 2009 - Theoretical Medicine and Bioethics 30 (4):289-310.
    In patient-centred care, shared decision-making is advocated as the preferred form of medical decision-making. Shared decision-making is supported with reference to patient autonomy without abandoning the patient or giving up the possibility of influencing how the patient is benefited. It is, however, not transparent how shared decision-making is related to autonomy and, in effect, what support autonomy can give shared decision-making. In the article, different forms of shared decision-making are analysed in relation to five different aspects of autonomy: (1) self-realisation; (...)
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  4.  2
    Severity as a Priority Setting Criterion: Setting a Challenging Research Agenda.Mathias Barra, Mari Broqvist, Erik Gustavsson, Martin Henriksson, Niklas Juth, Lars Sandman & Carl Tollef Solberg - 2020 - Health Care Analysis 28 (1):25-44.
    Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to today’s severity criteria in (...)
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  5. Everyday Ethics in the Care of Elderly People.Ingrid Ågren Bolmsjö, Lars Sandman & Edith Andersson - 2006 - Nursing Ethics 13 (3):249-263.
    This article analyses the general ethical milieu in a nursing home for elderly residents and provides a decision-making model for analysing the ethical situations that arise. It considers what it means for the residents to live together and for the staff to be in ethically problematic situations when caring for residents. An interpretative phenomenological approach and Sandman’s ethical model proved useful for this purpose. Systematic observations were carried out and interpretation of the general ethical milieu was summarized as ‘being in (...)
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  6.  81
    Adherence, Shared Decision-Making and Patient Autonomy.Lars Sandman, Bradi B. Granger, Inger Ekman & Christian Munthe - 2012 - Medicine, Health Care and Philosophy 15 (2):115-127.
    In recent years the formerly quite strong interest in patient compliance has been questioned for being too paternalistic and oriented towards overly narrow biomedical goals as the basis for treatment recommendations. In line with this there has been a shift towards using the notion of adherence to signal an increased weight for patients’ preferences and autonomy in decision making around treatments. This ‘adherence-paradigm’ thus encompasses shared decision-making as an ideal and patient perspective and autonomy as guiding goals of care. What (...)
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  7.  59
    Person Centred Care and Shared Decision Making: Implications for Ethics, Public Health and Research.Christian Munthe, Lars Sandman & Daniela Cutas - 2012 - Health Care Analysis 20 (3):231-249.
    This paper presents a systematic account of ethical issues actualised in different areas, as well as at different levels and stages of health care, by introducing organisational and other procedures that embody a shift towards person centred care and shared decision-making (PCC/SDM). The analysis builds on general ethical theory and earlier work on aspects of PCC/SDM relevant from an ethics perspective. This account leads up to a number of theoretical as well as empirical and practice oriented issues that, in view (...)
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  8.  13
    The Importance of Being Pregnant: On the Healthcare Need for Uterus Transplantation.Lars Sandman - 2018 - Bioethics 32 (8):519-526.
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  9.  26
    Everyday Ethical Problems in Dementia Care: A Teleological Model.Ingrid Ågren Bolmsjö, Anna-Karin Edberg & Lars Sandman - 2006 - Nursing Ethics 13 (4):340-359.
    In this article, a teleological model for analysis of everyday ethical situations in dementia care is used to analyse and clarify perennial ethical problems in nursing home care for persons with dementia. This is done with the aim of describing how such a model could be useful in a concrete care context. The model was developed by Sandman and is based on four aspects: the goal; ethical side-constraints to what can be done to realize such a goal; structural constraints; and (...)
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  10.  20
    Person Centered Care and Personalized Medicine: Irreconcilable Opposites or Potential Companions?Leila El-Alti, Lars Sandman & Christian Munthe - 2019 - Health Care Analysis 27 (1):45-59.
    In contrast to standardized guidelines, personalized medicine and person centered care are two notions that have recently developed and are aspiring for more individualized health care for each single patient. While having a similar drive toward individualized care, their sources are markedly different. While personalized medicine stems from a biomedical framework, person centered care originates from a caring perspective, and a wish for a more holistic view of patients. It is unclear to what extent these two concepts can be combined (...)
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  11.  13
    Health-Care Needs and Shared Decision-Making in Priority-Setting.Erik Gustavsson & Lars Sandman - 2015 - Medicine, Health Care and Philosophy 18 (1):13-22.
    In this paper we explore the relation between health-care needs and patients’ desires within shared decision-making in a context of priority setting in health care. We begin by outlining some general characteristics of the concept of health-care need as well as the notions of SDM and desire. Secondly we will discuss how to distinguish between needs and desires for health care. Thirdly we present three cases which all aim to bring out and discuss a number of queries which seem to (...)
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  12.  2
    Novel Drug Candidates Targeting Alzheimer’s Disease: Ethical Challenges with Identifying the Relevant Patient Population.Erik Gustavsson, Pauline Raaschou, Gerd Lärfars, Lars Sandman & Niklas Juth - 2021 - Journal of Medical Ethics 47 (9):608-614.
    Intensive research is carried out to develop a disease-modifying drug for Alzheimer’s disease. The development of drug candidates that reduce Aß or tau in the brain seems particularly promising. However, these drugs target people at risk for AD, who must be identified before they have any, or only moderate, symptoms associated with the disease. There are different strategies that may be used to identify these individuals. Each of these strategies raises different ethical challenges. In this paper, we analyse these challenges (...)
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  13.  4
    Do Not Despair About Severity—Yet.Mathias Barra, Mari Broqvist, Erik Gustavsson, Martin Henriksson, Niklas Juth, Lars Sandman & Carl Tollef Solberg - 2020 - Journal of Medical Ethics 46 (8):557-558.
    In a recent extended essay, philosopher Daniel Hausman goes a long way towards dismissing severity as a morally relevant attribute in the context of priority setting in healthcare. In this response, we argue that although Hausman certainly points to real problems with how severity is often interpreted and operationalised within the priority setting context, the conclusion that severity does not contain plausible ethical content is too hasty. Rather than abandonment, our proposal is to take severity seriously by carefully mapping the (...)
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  14.  15
    Evaluating Facts and Facting Evaluations: On the Fact-Value Relationship in HTA.Bjørn Hofmann, Ken Bond & Lars Sandman - 2018 - Journal of Evaluation in Clinical Practice 24 (5):957-965.
    Health technology assessment is an evaluation of health technologies in terms of facts and evidence. However, the relationship between facts and values is still not clear in HTA. This is problematic in an era of fake facts and truth production. Accordingly, the objective of this study is to clarify the relationship between facts and values in HTA. We start with the perspectives of the traditional positivist account of evaluating facts and the social-constructivist account of facting values. Our analysis reveals diverse (...)
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  15.  20
    Futile Cardiopulmonary Resuscitation for the Benefit of Others: An Ethical Analysis.Anders Bremer & Lars Sandman - 2011 - Nursing Ethics 18 (4):495-504.
    It has been reported as an ethical problem within prehospital emergency care that ambulance professionals administer physiologically futile cardiopulmonary resuscitation (CPR) to patients having suffered cardiac arrest to benefit significant others. At the same time it is argued that, under certain circumstances, this is an acceptable moral practice by signalling that everything possible has been done, and enabling the grief of significant others to be properly addressed. Even more general moral reasons have been used to morally legitimize the use of (...)
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  16.  11
    Why We Don’T Need “Unmet Needs”! On the Concepts of Unmet Need and Severity in Health-Care Priority Setting.Lars Sandman & Bjorn Hofmann - 2019 - Health Care Analysis 27 (1):26-44.
    In health care priority setting different criteria are used to reflect the relevant values that should guide decision-making. During recent years there has been a development of value frameworks implying the use of multiple criteria, a development that has not been accompanied by a structured conceptual and normative analysis of how different criteria relate to each other and to underlying normative considerations. Examples of such criteria are unmet need and severity. In this article these crucial criteria are conceptually clarified and (...)
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  17.  17
    The (Ir)Relevance of Group Size in Health Care Priority Setting: A Reply to Juth.Lars Sandman & Erik Gustavsson - 2017 - Health Care Analysis 25 (1):21-33.
    How to handle orphan drugs for rare diseases is a pressing problem in current health-care. Due to the group size of patients affecting the cost of treatment, they risk being disadvantaged in relation to existing cost-effectiveness thresholds. In an article by Niklas Juth it has been argued that it is irrelevant to take indirectly operative factors like group size into account since such a compensation would risk discounting the use of cost, a relevant factor, altogether. In this article we analyze (...)
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  18.  11
    Should We Accept a Higher Cost Per Health Improvement for Orphan Drugs? A Review and Analysis of Egalitarian Arguments.Niklas Juth, Martin Henriksson, Erik Gustavsson & Lars Sandman - 2021 - Bioethics 35 (4):307-314.
    In recent years, the issue of accepting a higher cost per health improvement for orphan drugs has been the subject of discussion in health care policy agencies and the academic literature. This article aims to provide an analysis of broadly egalitarian arguments for and against accepting higher costs per health improvement. More specifically, we aim to investigate which arguments one should agree upon putting aside and where further explorations are needed. We identify three kinds of arguments in the literature: considerations (...)
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  19.  24
    Ethical Conflicts in Prehospital Emergency Care.Lars Sandman & Anders Nordmark - 2006 - Nursing Ethics 13 (6):592-607.
    This article analyses and presents a survey of ethical conflicts in prehospital emergency care. The results are based on six focus group interviews with 29 registered nurses and paramedics working in prehospital emergency care at three different locations: a small town, a part of a major city and a sparsely populated area. Ethical conflict was found to arise in 10 different nodes of conflict: the patient/carer relationship, the patient’s self-determination, the patient’s best interest, the carer’s professional ideals, the carer’s professional (...)
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  20.  36
    Ethical Deliberations About Involuntary Treatment: Interviews with Swedish Psychiatrists.Manne Sjöstrand, Lars Sandman, Petter Karlsson, Gert Helgesson, Stefan Eriksson & Niklas Juth - 2015 - BMC Medical Ethics 16 (1):1-12.
    BackgroundInvoluntary treatment is a key issue in healthcare ethics. In this study, ethical issues relating to involuntary psychiatric treatment are investigated through interviews with Swedish psychiatrists.MethodsIn-depth interviews were conducted with eight Swedish psychiatrists, focusing on their experiences of and views on compulsory treatment. In relation to this, issues about patient autonomy were also discussed. The interviews were analysed using a descriptive qualitative approach.ResultsThe answers focus on two main aspects of compulsory treatment. Firstly, deliberations about when and why it was justifiable (...)
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  21.  11
    Individual Responsibility as Ground for Priority Setting in Shared Decision-Making.Lars Sandman, Erik Gustavsson & Christian Munthe - 2016 - Journal of Medical Ethics 42 (10):653-658.
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  22.  26
    Conceptions of Decision-Making Capacity in Psychiatry: Interviews with Swedish Psychiatrists.Manne Sjöstrand, Petter Karlsson, Lars Sandman, Gert Helgesson, Stefan Eriksson & Niklas Juth - 2015 - BMC Medical Ethics 16 (1):34.
    Decision-making capacity is a key concept in contemporary healthcare ethics. Previous research has mainly focused on philosophical, conceptual issues or on evaluation of different tools for assessing patients’ capacity. The aim of the present study is to investigate how the concept and its normative role are understood in Swedish psychiatric care. Of special interest for present purposes are the relationships between decisional capacity and psychiatric disorders and between health law and practical ethics.
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  23.  24
    Withholding and Withdrawing Treatment for Cost‐Effectiveness Reasons: Are They Ethically on Par?Lars Sandman & Jan Liliemark - 2019 - Bioethics 33 (2):278-286.
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  24.  24
    The Concept of Negotiation in Shared Decision Making.Lars Sandman - 2009 - Health Care Analysis 17 (3):236-243.
    In central definitions of shared decision-making within medical consultations we find the concept of negotiation used to describe the interaction between patient and professional in case of conflict. It has been noted that the concept of negotiation is far from clear in this context and in other contexts it is used both in terms of rational deliberation and bargaining. The articles explores whether rational deliberation or bargaining accurately describes the negotiation in shared decision-making and finds that it fails to do (...)
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  25.  8
    Dual Loyalties: Everyday Ethical Problems of Registered Nurses and Physicians in Combat Zones.Kristina Lundberg, Sofia Kjellström & Lars Sandman - 2019 - Nursing Ethics 26 (2):480-495.
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  26.  14
    Ethical Values in Emergency Medical Services.Anders Bremer, María Jiménez Herrera, Christer Axelsson, Dolors Burjalés Martí, Lars Sandman & Gian Luca Casali - 2015 - Nursing Ethics 22 (8):928-942.
    Background:Ambulance professionals often address conflicts between ethical values. As individuals’ values represent basic convictions of what is right or good and motivate behaviour, research is needed to understand their value profiles.Objectives:To translate and adapt the Managerial Values Profile to Spanish and Swedish, and measure the presence of utilitarianism, moral rights and/or social justice in ambulance professionals’ value profiles in Spain and Sweden.Methods:The instrument was translated and culturally adapted. A content validity index was calculated. Pilot tests were carried out with 46 (...)
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  27.  18
    What's the Use of Human Dignity Within Palliative Care?Lars Sandman - 2002 - Nursing Philosophy 3 (2):177-181.
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  28.  15
    Should People Die a Natural Death?Lars Sandman - 2005 - Health Care Analysis 13 (4):275-287.
    In the article the concept of natural death as used in end-of-life decision contexts is explored. Reviewing some recent empirical studies on end-of-life decision-making, it is argued that the concept of natural death should not be used as an action-guiding concept in end-of-life decisions both for being too imprecise and descriptively open in its current use but mainly since it appears to be superfluous to the kind of considerations that are really at stake in these situations. Considerations in terms of (...)
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  29.  5
    On the Autonomy Turf. Assessing the Value of Autonomy to Patients.Lars Sandman - 2004 - Medicine, Health Care and Philosophy 7 (3):261-268.
    Within the western health-care context autonomyis a central value. Still, as it is used withinthis context it is far from clear what we areactually talking about. In this article theauthor outlines four different uses or aspectsof autonomy: self-determination, freedom,desire-fulfilment and independence. Oneimportant conclusion will be that in order tobe able to respect autonomy in a way thatactually brings value to the patient’s life weneed to clearly assess what aspect of autonomythe patient values and for what reason it isvalued by the (...)
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  30.  29
    Ethical Considerations of Refusing Nutrition After Stroke.Lars Sandman, Ingrid Ågren Bolmsjö & Albert Westergren - 2008 - Nursing Ethics 15 (2):147-159.
    The aim of this article is to analyse and discuss the ethically problematic conflict raised by patients with stroke who refuse nutritional treatment. In analysing this conflict, the focus is on four different aspects: (1) Is nutritional treatment biologically necessary? (2) If necessary, is the reason for refusal a functional disability, lack of appetite or motivation, misunderstanding of the situation or a genuine conflict of values? (3) If the latter, what values are involved in the conflict? (4) How should we (...)
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  31.  4
    Rare and Common Diseases Should Be Treated Equally and Why the Article by de Magalhaes Somewhat Misses its’ Mark.Lars Sandman - 2022 - Journal of Medical Ethics 48 (2):97-98.
    In the article Should rare diseases get special treatment? by Monica Q F de Magalhaes,1 it is argued that rarity is not a morally relevant feature to consider in prioritising treatment in healthcare, but severity is. A central conclusion in the article is that severity rather than prevalence should guide different cost-effectiveness thresholds. Hence, I take it, she answers no to the question in her own heading. I agree with all of this—and with most of her other arguments and conclusions (...)
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  32.  8
    Rethinking Patient Involvement in Healthcare Priority Setting.Lars Sandman, Bjorn Hofmann & Greg Bognar - 2020 - Bioethics 34 (4):403-411.
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  33.  21
    Developing Organisational Ethics in Palliative Care.Lars Sandman, Ulla Molander & Inger Benkel - 2017 - Nursing Ethics 24 (2):138-150.
    Background:Palliative carers constantly face ethical problems. There is lack of organised support for the carers to handle these ethical problems in a consistent way. Within organisational ethics, we find models for moral deliberation and for developing organisational culture; however, they are not combined in a structured way to support carers’ everyday work.Research objective:The aim of this study was to describe ethical problems faced by palliative carers and develop an adapted organisational set of values to support the handling of these problems.Research (...)
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  34.  5
    An Ethics Analysis of the Rationale for Publicly Funded Plastic Surgery.Lars Sandman & Emma Hansson - 2020 - BMC Medical Ethics 21 (1):1-14.
    Background Healthcare systems are increasingly struggling with resource constraints, given demographic changes, technological development, and citizen expectations. The aim of this article is to normatively analyze different suggestions regarding how publicly financed plastic surgery should be delineated in order to identify a well-considered, normative rationale. The scope of the article is to discuss general principles and not define specific conditions or domains of plastic surgery that should be treated within the publicly financed system. Methods This analysis uses a reflective equilibrium (...)
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  35.  1
    The Ethics of Disease-Modifying Drugs Targeting Alzheimer Disease: Response to Our Commentators.Erik Gustavsson, Pauline Raaschou, Gerd Lärfars, Lars Sandman & Niklas Juth - 2022 - Journal of Medical Ethics 48 (3):193-193.
    In Gustavsson et al,1 we discussed the ethical issues that arise when identifying the relevant population for disease-modifying drugs targeting Alzheimer disease. More specifically, we focused on novel immunotherapies aimed at amyloid β and tau, two relevant biomarkers. The commentaries to our paper2 3 acknowledge our conclusion: screening for AD involve ethical costs that cannot be justified unless a drug with clinically relevant effect becomes available. Since Aduhelm is the only immunotherapy targeting AD currently approved by the Food and Drug (...)
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