AimsTo examine attitudes towards physician-assisted suicide (PAS) among physicians in Sweden and compare these with the results from a similar cross-sectional study performed in 2007.ParticipantsA random selection of 250 physicians from each of six specialties (general practice, geriatrics, internal medicine, oncology, surgery and psychiatry) and all 127 palliative care physicians in Sweden were invited to participate in this study.SettingA postal questionnaire commissioned by the Swedish Medical Society in collaboration with Karolinska Institute in Stockholm. ResultsThe total response rate was 59.2%. Slightly (...) fewer than half [47.1% (95% CI 43.7–50.5)] of the respondents from the six specialties accepted PAS, which is significantly more than accepted PAS in the 2007 study [34.9% (95% CI 31.5–38.3)]. Thirty-three percent of respondents were prepared to prescribe the needed drugs. When asked what would happen to the respondent’s own trust in healthcare, a majority [67.1% (95% CI 63.9–70.3)] stated that legalizing PAS would either not influence their own trust in healthcare, or that their trust would increase. This number is an increase compared to the 2007 survey, when just over half [51.9% (95% CI 48.0–55.2)] indicated that their own trust would either not be influenced, or would increase.ConclusionsThe study reveals a shift towards a more accepting attitude concerning PAS among physicians in Sweden. Only a minority of the respondents stated that they were against PAS, and a considerable proportion reported being prepared to prescribe the needed drugs for patient self-administration if PAS were legalized. (shrink)

This chapter discusses some concerns regarding the effects of enhancement technologies on autonomy and authenticity, insofar as authenticity relates to autonomy. As a preliminary, it describes how enhancement and autonomy should be understood in this context along with some examples of enhancement. The chapter moves on to explain why enhancement can promote autonomy. Three types of concerns regarding the effect of enhancement technologies on autonomy are raised: (i) that medical technologies should not be used to enhance autonomy, since this is (...) not the proper use of such technologies; (ii) that some enhancement technologies are inimical to our authenticity; and (iii) that the widespread use of some enhancement technologies have negative overall consequences on people's autonomy. Different kinds of enhancements typically arouse different kinds of concerns as regards autonomy. These include cognitive, mood, physical, and aesthetic enhancement. (shrink)

BackgroundIn paediatric oncology, healthcare professionals face moral challenges. Clinical ethics support services, such as moral case deliberation, aim to assist them in dealing with these challenges. Yet, healthcare professionals can have different expectations and goals related to clinical ethics support services.MethodsIn this study, the perceptions held by healthcare professionals regarding the importance of possible outcomes of MCDs, prior to implementation of MCDs, were investigated. A multisite, cross-sectional, quantitative study was performed at all six Paediatric Oncology Centres in Sweden. Healthcare professionals (...) answered the Euro-MCD instrument with 26 potential MCD outcomes using a scale from Not important to Very important. Descriptive and comparative statistical analyses were carried out.ResultsAll outcomes were rated high, i.e., between 3.12 and 3.78. More open communication, developing skills to analyse ethically difficult situations, better mutual understanding, and deciding on concrete actions were rated as most important. Understanding of ethical theories and critical examination of policies were rated less important. Most often nursing assistants rated higher and physicians lower than the other professions did. Women and participants without previous experience of MCDs perceived outcomes as more important. There were differences between centres as one centre had significantly higher, and one centre had significantly lower ratings compared to the others.ConclusionIt is clear that healthcare professionals want MCDs to improve teamwork and skills in order to analyse and manage ethically difficult situations. When comparing to previous research about important MCD outcomes, there were similarities in what healthcare professionals consider to be important when handling moral challenges regardless of country and potential differences in healthcare settings and systems, such as paediatric vs. adult care. (shrink)

Sustainability discourse offers a plethora of perspectives on the type of change needed to ensure a just development within planetary boundaries, and how that change could come about. Calls for radical transformations nonetheless underline the need to examine prevalent discursive structures in society, including challenging the ‘ideology of growth’, in order to formulate new and transformative policy approaches. Based on empirical insights as to how different actors – including grassroots, planners, officials and politicians – in Sweden perceive the transformations needed (...) to reach sustainability goals, this paper explores how narratives of change reproduce, make use of or show cracks in the eco-modern sustainability paradigm. (shrink)

Background: Providing oncological care to children is demanding and ethical issues concerning what is best for the child can contribute to moral distress. Objectives: To explore healthcare professionals’ experiences of situations that generate moral distress in Swedish paediatric oncology. Research design: In this national study, data collection was conducted using the Swedish Moral Distress Scale-Revised. The data analysis included descriptive statistics and non-parametric analysis of differences between groups. Participants and research context: Healthcare professionals at all paediatric oncology centres in Sweden (...) were invited to participate. A total of 278 healthcare professionals participated. The response rate was 89%. Ethical considerations: In its advisory statement, the Regional Ethical Review Board decided that the study was of such a nature that the legislation concerning ethical reviews was not applicable. All participants received written information about the aim of the study and confidentiality. Participants demonstrated their consent by returning the survey. Findings: The two situations with the highest moral distress scores concerned lack of competence and continuity of personnel. All professional groups reported high levels of disturbance. Nurses rated significantly higher frequencies and higher total Moral Distress Scale scores compared to medical doctors and nursing assistants. Discussion: Lack of competence and continuity, as the two most morally distressing situations, confirms the findings of studies from other countries, where inadequate staffing was reported as being among the top five morally distressing situations. The levels of total Moral Distress Scale scores were more similar to those reported in intensive care units than in other paediatric care settings. Conclusion: The two most morally distressing situations, lack of competence and continuity, are both organisational in nature. Thus, clinical ethics support services need to be combined with organisational improvements in order to reduce moral distress, thereby maintaining job satisfaction, preventing a high turnover of staff and ensuring the quality of care. (shrink)

Truth-telling in healthcare practice can be regarded as a universal communicative virtue; however, there are different views on what consequence it has for giving or diminishing hope. The aim of this article is to explore the relationship between the concepts of truth-telling and hope from a relational ethics approach in the context of healthcare practice. Healthcare staff protect themselves and others to preserve hope in the care of seriously sick patients and in end-of-life care. This is done by balancing truth-telling (...) guided by different conditions such as the cultural norms of patients, family and staff. Our main conclusion is that the balancing of truth-telling needs to be decided in a mutual understanding in the caring relationship, but hope must always be inspired. Instead of focusing on autonomy as the only guiding principle, we would like to propose that relational ethics can serve as a meaningful perspective in balancing truth-telling. (shrink)

Caring for children with cancer involves complex ethical challenges. Ethics Case Reflection (ECR) rounds can be offered to support teams to reflect on challenges and what should be done in patient care. A training course, for facilitators of ECR rounds, has been offered to healthcare professionals (HCPs) in childhood cancer care by a Nordic working group on ethics. During/after the course, the trainees implemented and facilitated ECR rounds in their clinical setting. The aim was to explore the trainees’ experiences of (...) implementing ECR rounds in childhood cancer care. HCPs, who participated as trainees in the course, participated in 3 focus group interviews (n = 22) and 27 individual interviews (n = 17). Interview data were analysed concurrently with data collection following classic grounded theory. Positioning ethics is the core category in this study, used to resolve the main concern of doing ethics in a context where direct patient care is prioritized. Being able to take time for ethics reflections, not perceived as the key priority, was considered a luxury in the clinical setting. Strategies for positioning ethics include allying, promoting ethics reflection, scheduling ethics reflection, and identifying ethical dilemmas. These strategies can be more or less successful and vary in intensity. The prioritisation of direct patient care is not surprising, but polarisation between care and ethics needs to be questioned and ethics reflection need to be integrated in standard care. Ethical competence seems to be central in doing ethics and more knowledge on the promotion of ethical competence in practice and education is needed. (shrink)

The Hospital Ethical Climate Survey was developed in the USA and later shortened. HECS has previously been translated into Swedish and the aim of this study was to describe a process of translating and culturally adapting HECS-S and to develop a Swedish multi-professional version, relevant for paediatrics. Another aim was to describe decisions about retaining versus modifying the questionnaire in order to keep the Swedish version as close as possible to the original while achieving a good functional level and trustworthiness. (...) In HECS-S, the respondents are asked to indicate the veracity of statements. In HECS and HECS-S the labels of the scale range from ‘almost never true’ to ‘almost always true’; while the Swedish HECS labels range from ‘never’ to ‘always’. The procedure of translating and culturally adapting the Swedish version followed the scientific structure of guidelines. Three focus group interviews and three cognitive interviews were conducted with healthcare professionals. Furthermore, descriptive data were used from a previous study with healthcare professionals, employing a modified Swedish HECS. Decisions on retaining or modifying items were made in a review group. The Swedish HECS-S consists of 21 items including all 14 items from HECS-S and items added to develop a multi-professional version, relevant for paediatrics. The descriptive data showed that few respondents selected ‘never’ and ‘always’. To obtain a more even distribution of responses and keep Swedish HECS-S close to HECS-S, the original labels were retained. Linguistic adjustments were made to retain the intended meaning of the original items. The word ‘respect’ was used in HECS-S with two different meanings and was replaced in one of these because participants were concerned that respecting patients’ wishes implied always complying with them. The process of developing a Swedish HECS-S included decisions on whether to retain or modify. Only minor adjustments were needed to achieve a good functional level and trustworthiness although some items needed to be added. Adjustments made could be used to also improve the English HECS-S. The results shed further light on the need to continuously evaluate even validated instruments and adapt them before use. (shrink)

ABSTRACT: In this essay I characterize arguments by analogy, which have an impor- tant role both in philosophical and everyday reasoning. Arguments by analogy are dif- ferent from ordinary inductive or deductive arguments and have their own distinct features. I try to characterize the structure and function of these arguments. It is further discussed that some arguments, which are not explicit arguments by analogy, nevertheless should be interpreted as such and not as inductive or deductive arguments. The result is that (...) a presumed outcome of a philosophical dispute will have to be reconsidered. (shrink)

This book involves an in-depth analysis of the ethical, political and philosophical issues related to health-oriented screening programs.

What challenges must a principle of need for prioritisations in health care meet in order to be plausible and practically useful? Some progress in answering this question has recently been made by Hope, Østerdal and Hasman. This article continue their work by suggesting that the characteristic feature of principles of needs is that they are sufficientarian, saying that we have a right to a minimally acceptable or good life or health, but nothing more. Accordingly, principles of needs must answer two (...) distributive questions: when do we have sufficient and how should we prioritise among those who do not yet have a sufficiency? Furthermore, it is argued that Roger Crisp’s theory of need, which combines sufficientarianism with prioritarianism below the threshold of need, is better equipped than alternatives to answer these questions as well as meeting the challenges formulated by Hope, Østerdal and Hasman. However, Crisp’s theory faces two major challenges. First, it has to say something about the currency of distribution: a principle of need must be complemented either with a theory on the human good or a theory about the proper goals of health care. Second, it has to say something about where the threshold should be set. However, any attempt to set a threshold seems morally arbitrary in the light of the sufficientarian idea that those just above the threshold never should be given priority over those just below the threshold. (shrink)

BackgroundWe aim to further develop an index for detecting disguised paternalism, which might influence physicians’ evaluations of whether or not a patient is decision-competent at the end of life. Disguised paternalism can be actualized when physicians transform hard paternalism into soft paternalism by questioning the patient’s decision-making competence. MethodsA previously presented index, based on a cross-sectional study, was further developed to make it possible to distinguish between high and low degrees of disguised paternalism using the average index of the whole (...) sample. We recalculated the results from a 2007 study for comparison to a new study conducted in 2020. Both studies are about physicians’ attitudes towards, and arguments for or against, physician-assisted suicide. ResultsThe 2020 study showed that geriatricians, palliativists, and middle-aged physicians (46–60 years old) had indices indicating disguised paternalism, in contrast with the results from the 2007 study, which showed that all specialties (apart from GPs and surgeons) had indices indicating high degrees of disguised paternalism.ConclusionsThe proposed index for identifying disguised paternalism reflects the attitude of a group towards physician assisted suicide. The indices make it possible to compare the various medical specialties and age groups from the 2007 study with the 2020 study. Because disguised paternalism might have clinical consequences for the rights of competent patients to participate in decision-making, it is important to reveal disguised hard paternalism, which could masquerade as soft paternalism and thereby manifest in practice. Methods for improving measures of disguised paternalism are worthy of further development. (shrink)

Hymen reconstruction is a controversial measure performed to help young females under threat of honour-related violence. Official guidelines often reject offering hymen reconstructions. On the other hand, extraordinary measures in order to enable operations of Jehovah’s Witnesses who want a bloodless operation in order to avoid religiously related sanctions are often considered praiseworthy. The aim is thus to examine whether or not there are relevant differences between these two measures.

BackgroundIn childhood cancer care, healthcare professionals must deal with several difficult moral situations in clinical practice. Previous studies show that morally difficult challenges are related to decisions on treatment limitations, infringing on the child's integrity and growing autonomy, and interprofessional conflicts. Research also shows that healthcare professionals have expressed a need for clinical ethics support to help them deal with morally difficult situations. Moral case deliberations (MCDs) are one example of ethics support. The aim of this study was to describe (...) the MCD-related outcomes that healthcare professionals in childhood cancer care considered important, before MCDs were implemented, in order to facilitate the implementation of MCDs in childhood cancer care in Sweden.MethodsThis study is based on qualitative data. Healthcare professionals, mostly representing registered nurses, nursing assistants and physicians, working at childhood cancer care centres in Sweden, were invited to respond to the translated and content validated European MCD Outcomes Instrument, before participating in regular MCDs. Answers to the main open-ended question, included in the questionnaire, was analysed according to systematic text condensation.ResultsData was collected from 161 responses from the healthcare professionals. The responses included healthcare professionals’ perceptions of which MCD-related outcomes they found important for handling moral challenges. Three different themes of important outcomes from the analysis of the data are presented as follows:Interprofessional well-being in team interactionson a team level;Professional comfort when dealing with moral challengeson a personal level; andImproved quality of care for the child and the familyon a care level.ConclusionsHealthcare professionals in childhood cancer care considered it important that ethics support could enhance the well-being of interprofessional teams, support healthcare professionals on an individual level and improve quality of care. The results of this study can be used in current and future training for MCD-facilitators. When knowing the context specific important MCD-outcomes, the sessions could be adapted. Managers in childhood cancer care would benefit from knowing about the specific important outcomes for their target group because they could then create relevant working conditions for clinical ethics support. (shrink)

This article is about the justifiability of accepting worse cost effectiveness for orphan drugs, that is, treatments for rare diseases, in a publicly financed health care system. Recently, three arguments have been presented that may be used in favour of exceptionally advantageous economic terms for orphan drugs. These arguments share the common feature of all referring to considerations of justice or fairness: the argument of the irrelevance of group size, the argument from the principle of need, and the argument of (...) identifiability. It is argued that all of these arguments fail to support the conclusion that orphan drugs should be subsidized to a larger extent than treatments for common diseases. The argument of the irrelevance fails to distinguish between directly and indirectly relevant considerations of fairness or justice. The recent attempt to revive the moral relevance of identifiability has provided no novel reasons to think that identifiability is morally relevant in itself or due to considerations of fairness and justice. The argument from the principle of need does not fail due to any inherent flaw in the principle as such. Rather, this principle can be interpreted in different ways, and none of these interpretations support exceptionally advantageous terms economically for treating rare diseases specifically. It is concluded that we are awaiting justice based reasons for the preferential treatment of orphan drugs. (shrink)

The first purpose of this article is to present a new theory of libertarian free will—the boundary theory of libertarian free will—which provides a new framework by means of employing boundaries as a “conceptual scheme” for understanding libertarian free will. This theory consists of two parts. One part suggests that the agent’s will should be viewed as the intermediate boundary between an agent’s reasons and his alternative choices. The second part is a model where the agent’s will is a faculty (...) that solely operates by permitting or resisting reasons (that are potential causes) to become actual causes for the agent’s choices. The second purpose of the paper is to argue that the boundary theory of libertarian free will has several advantages, the most important of which are: (a) it defeats the charge that libertarian free will is a mystery; (b) it defeats the standard objections against the compatibility of libertarian free will and indeterminism (that is, the luck argument, the roll-back argument, the difference argument, the assimilation argument, etc.); and (c) it is simultaneously an argument for indeterminism as such (that is, that determinism is false). (shrink)

Childhood cancers are life-threatening diseases that affect the whole family. During the treatment moral situations might arise. Research on how parents perceive moral challenges in childhood cancer care is sparse. The aim was to explore parents’ main concern, and how they deal with their main concern, when facing moral challenges in childhood cancer care. Data collection included focus group interviews with parents. The data analysis was carried out according to a classical theory and revealed the core category “Sheltering in chaos”. (...) The strategies to handle the main concern included “To bring the child through a life-saving trajectory” by “Balancing control” and “Deliberating of suffering. The consequences included feelings of being “Torn between roles”. “Familiarity” emerged as a facilitating factor to handle moral challenges. The results indicate that parents are torn between different roles, and that the care experience is improved through familiarity with the healthcare professionals. The following findings may inspire new ways of offering moral support to families in childhood cancer care. (shrink)

Wellman identified three types of conductive arguments, the third of which contains both pro and counter-considerations in the same piece of reasoning. This paper provides a pragma-dialectical analysis of this type of argumentation, with special focus on argumentation reconstruction. It argues that the account of pro/con argumentation in the framework of argument-as-product has problems solvable by a pragma-dialectical approach. The paper asserts that pro/con argumentation should be analyzed as a dialectical strategy of a protagonist, where acknowledgement of counter-considerations shows that (...) the antagonist’s reasons have been taken into consideration, although the pro-considerations override them. Thus, the pro-considerations of pro/con argumentation should be interpreted as the protagonist’s overriding defeaters of the antagonist’s counter-arguments, the protagonist incorporating the latter as counter-considerations. The paper further argues that the pragma-dialectical framework needs an additional conceptual tool to properly reconstruct complex forms of pro/con argumentation. Finally, the pragma-dialectical approach to reconstruct pro/con argumentation has several advantages, especially to a more logical-structural approach to complex pro/con argumentation. (shrink)

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 (...) of substantial equality, formal equality, and opportunity cost. We argue that considerations of substantial equality do not support higher costs per health improvement orphan drugs, even if such considerations are considered valid. On the contrary, arguments of formal equality may support accepting a higher cost per health improvement for orphan drugs. However, in order to do so, a number of both normative and empirical issues must be resolved; these issues are identified in the article. For instance, it must be settled to what extent the opportunity cost in terms of foregone health for other patients is acceptable in order to uphold formal equality. We conclude that certain arguments can be set aside, and future focus should be put on the unresolved normative and empirical issues related to formal equality and opportunity cost. (shrink)

The aim of this pilot study was to develop a realistic clinical case for identifying Knobe's asymmetric effect, ie, the tendency to ascribe intentions to a larger extent when an act is considered wrong, as well as to compare medical students at the beginning and end of their curriculum. A vignette about a critically ill 72-year-old patient in need of an operation was used, with two different outcomes: the patient dies or the patient recovers. Approximately half of the students received (...) the ‘recovery case’ and half the ‘death case’. The questions asked were whether it was right to perform the risky operation and whether the head of the clinic brought about the patient's death/recovery intentionally. Among students in their first term an asymmetry in response pattern was identified. This asymmetry was not found among students in their final term. The difference between term 1 and term 11 students is believed to be due to the socialisation of medical students towards clinical reasoning regarding the moral role of intentions. Although no Knobe effect could be detected among term 11 students, a related adaptation effect was detected, indicating that students at the end of their medical school also tend to adapt their ascription of intentions to their moral evaluation of the act. By using clinically relevant cases a new effect has thus been identified that might be useful when investigating experienced clinicians and their views on intentions. The cases and effect merit further investigation. (shrink)

This paper discusses the method when an argument is refuted by a parallel argument since the flaw of the parallel argument is clearly displayed. The method is explicated, examined and compared with two other general methods.

Accounts of analogical inference are usually categorized into four broad groups: abductive, deductive, inductive and sui generis. The purpose of this paper is to defend a sui generis model of analogical inference. It focuses on the sui generis account, as developed by Juthe [2005, 2009, 2015, 2016] and Botting’s [2017] criticism of it. This paper uses the pragmadialectical theory of argumentation as the methodological framework for analyzing and reconstructing argumentation. The paper has two main points. First, that Juthe’s arguments against (...) a deductive interpretation of prima facie analogy argumentation remain unaffected by Botting’s criticism, which means that many of the reasons against deductive reformulation of analogy argumentation still stand. The additional argument, which Botting himself brings up, that a deductive interpretation cannot account for the cumulative effect of analogies, just provides further reason to reject deductivism. The second main point of this paper is that an inductive interpretation of analogical inference also fails. There are constitutional differences between inductive and analogical inference that cannot be bridged. The result is a firm defense of the sui generis view of analogical inference. (shrink)

The result of two key social developments in recent years are examined here: the partial dismantling of the welfare state and the progress of genetics. Genetic insights are increasingly valuable for risk assessment, and insurers would like to use these insights to help determine premiums. Combined with the fact that social welfare is being curtailed, this could potentially create an uninsured high-risk population. Along with considerations of autonomy and privacy, this is the basis for an ethical critique of insurer's access (...) to information. The result has often been regulation of such information; but the authors argues that due to adverse selection, regulation will not solve these problems, and this may jeopardize the survival of private personal insurance. Instead, we should look towards the resurrection of social insurance, a key component of the welfare state. This will interest academic researchers as well as professionals involved with genetics and insurance. (shrink)

The purpose of the present study was to examine whether or not strong values might influence physicians' estimations of future events. In an empirical study about physicians' attitudes towards physician assisted suicide (PAS) we asked about the physicians' main reasons for being pro, doubtful or contra PAS and also asked them to estimate what would happen with patients' trust if PAS were to be legally accepted in Swedish society. Finally we asked the physicians about their own trust in healthcare in (...) the event of PAS being legally accepted. We found that in contrast to those who were pro PAS and doubtful, the group who were against PAS did not discriminate between their own opinion and their estimation of what they thought might happen with patients' trust in the future. Against the backdrop of the present study, we present a hypothesis maintaining that feeling strongly against controversial medical procedures is associated with being inclined to let one's own beliefs influence our capacity to interpret and estimate empirical results. We think this hypothesis merits closer examination. (shrink)

Principles of need are constantly referred to in health care priority setting. The common denominator for any principle of need is that it will ascribe some kind of special normative weight to people being worse off. However, this common ground does not answer the question how a plausible principle of need should relate to the aggregation of benefits across individuals. Principles of need are sometimes stated as being incompatible with aggregation and sometimes characterized as accepting aggregation in much the same (...) way as utilitarians do. In this paper we argue that if one wants to take principles of need seriously both of these positions have unreasonable implications. We then characterize and defend a principle of need consisting of sufficientarian elements as well as prioritarian which avoids these unreasonable implications. (shrink)

Illness severity is a priority setting criterion in several countries. Age seems to matter when considering severity, but perhaps not small age differences. In the following article we consider Small Differences : small differences in age are not relevant when considering differential illness severity. We show that SD cannot be accommodated within utilitarian, prioritarian or egalitarian theories. Attempting to accommodate SD by postulating a threshold model becomes exceedingly complex and self-defeating. The only way to accommodate SD seems to be to (...) accept some form of relevance view, where some age differences are irrelevant. This view can accommodate SD, but at the expense of consistent priority orderings. Severity thus becomes unsuitable for systematic decision-making. We argue that SD should be dismissed and that we should accept a continuous relationship between severity of illness and age. (shrink)

Analogously to Kuhn’s and Hanson’s understanding of observation as theory-impregnated, we try to test the hypothesis that observation and interpretation might also be value-impregnated. We use a written examination task for medical students who were asked to read and interpret a text where the authors provide arguments pro et contra euthanasia. Afterwards the students were asked to provide their own reflected opinion on the issue. We found that medical students who were against and indecisive provided interpretations of the text which (...) accorded with their own reflected opinions (P = 0.02), indicating that their interpretations were influenced by their own values. When including those who were pro euthanasia, the association was no longer significant. Although the present investigation was a small pilot-study, we obtained partial support for our hypothesis and have adjusted it to read as follows: observations and interpretations might be value-impregnated for respondents who have rather strong value-based attitudes. We think the adjusted hypothesis deserves to be further examined. (shrink)

This paper addresses several issues in argumentation theory. The over-arching goal is to discuss how a theory of analogical argument schemes fits the pragma-dialectical theory of argument schemes and argument structures, and how one should properly reconstruct both single and complex argumentation by analogy. I also propose a unified model that explains how formal valid deductive argumentation relates to argument schemes in general and to analogical argument schemes in particular. The model suggests “scheme-specific-validity” i.e. that there are contrasting species of (...) validity for each type of argument scheme that derive from one generic conception of validity. (shrink)

This text is about obtaining and sharing genetic information when there is a potential conflict of interests between patients and their families and relatives. The patient or, in this text, the “index-person,” is someone who is considering obtaining or already has obtained genetic information about herself through genetic testing.The index-person can have several reasons to take an interest in obtaining her genetic information. She may want to know if she has a genetic predisposition for a disorder in order to take (...) measures for preventing its development. Even if there are no preventive measures, as is the case with Huntington's disease, for instance, she may still want to know whether she has the mutation, in order to adjust her future plans. These interests that an individual may have in obtaining genetic information have been used to argue in favour of a right to know. (shrink)

In a recent paper, Peter Singer suggests that some interesting new findings in experimental moral psychology support what he has contended all along—namely that intuitions should play little or no role in adequate justifications of normative ethical positions. Not only this but, according to Singer, these findings point to a central flaw in the method (or epistemological theory) of reflective equilibrium used by many contemporary moral philosophers. In this paper, we try to defend reflective equilibrium from Singer’s attack and, in (...) part, we do this by discussing Singer’s own favoured moral methodology as outlined in his Practical Ethics . Although basing ethics solely on (certain kinds of) intuitions certainly is problematic, we argue, basing it solely on ‘reason’ gives rise to similar problems. The best solution would arguably be one which could strike a balance between the two—but, we suggest, this is precisely what reflective equilibrium is all about. (shrink)

It has become increasingly common to conduct research on popular views on ethical questions. In this paper, we discuss when and to what extent popular views should be included in a reflective equilibrium process, thereby influencing normative theory. We argue that popular views are suitable for inclusion in a reflective equilibrium if they approximate considered judgments and examine some factors that plausibly contribute to the consideredness of popular views. We conclude that deliberation and familiarity contribute to the consideredness of popular (...) views, whereas prevalence does not. Furthermore, we raise the “fair trial” objection: that expert deliberation on popular views might fail to respect the consideredness of these views. Eliciting views approximating considered judgments directly from participants is therefore preferable to refining popular views or treating them as “bare” intuitions in the reflective process. These conclusions have important implications for which research methods will likely elicit popular views suitable for a reflective equilibrium process. Research focusing on the prevalence of views is unlikely to yield popular views suitable for a reflective equilibrium, whereas deliberative and in-depth work is more promising. (shrink)

Priority setting of scarce resources in healthcare is high on the agenda of most healthcare systems implying a need to develop robust foundations for making fair allocation decisions. One central factor for such decisions in needs-based systems, following both empirical studies and theoretical analyses, is severity. However, it has been noted that severity is an under-theorized concept. One such aspect is how severity should relate to temporality. There is a rich discussion on temporality and distributive justice, however, this discussion needs (...) to be adapted to the practical and ethical requirements of healthcare priority setting principles at mid-level. In this article, we analyze how temporal aspects should be taken into account when assessing severity as a modifier for cost-effectiveness. We argue that when assessing the severity of a condition, we have reason to look at complete conditions from a time-neutral perspective, meaning that we take the full affectable stretch of the condition into account without modifying severity as patients move through the temporal stretch and without discounting the future. We do not find support for taking the ‘shape’ of a condition into account per se, e.g. whether the severity has a declining or inclining curve, or that severity is intermittent rather than continuous. In order to take severity seriously, we argue that we have reason to apply a quantified approach where every difference in severity should impact on priority setting. In conclusion, we find that this approach is practically useful in actual priority setting. (shrink)

Background Childhood cancers affect about 350 children every year in Sweden and are life-threatening diseases. During the treatment period, situations arise that can become morally challenging for the child. When knowing children’s values and morally challenging situations in childhood cancer care, targeted ethics support could be developed and used in care. Aim To explore children’s values and moral dilemmas ​​when undergoing cancer treatment. Methods This is a qualitative study based on empirical data. The data collection was conducted through three focus (...) group interviews and six individual interviews with children between 10 and 18 years (n = 16). A content analysis methodology was used to generate themes. Children who were/have been treated for cancer at three childhood cancer centres in Sweden were invited to participate. The study was approved by the Swedish Ethical Review Authority. The children’s participation was based on voluntariness and consent/assent. Findings During the analysis, five themes of values emerged: Personal relationships, Bodily ease and identity, Feeling in control and being involved, Positive distractions and Right care that is needed. Their moral dilemmas were thematized into: Should I consider others or not? Should I rest or not? and Should I refuse treatment or not? Conclusion Children undergoing cancer treatment want to have personal relationships with healthcare professionals. Their moral dilemmas were about questioning their own physical and psychological well-being against their expectations, the values of others and the treatment required. Further research is needed to understand how to deal with moral dilemmas in children undergoing cancer treatment. (shrink)

The aim of the present study was to corroborate or undermine a previously presented conjecture that physicians’ estimations of others’ opinions are influenced by their own opinions. We used questionnaire based cross-sectional design and described a situation where an imminently dying patient was provided with alleviating drugs which also shortened life and, additionally, were intended to do so. We asked what would happen to physicians’ own trust if they took the action described, and also what the physician estimated would happen (...) to the general publics’ trust in health services. Decrease of trust was used as surrogate for an undesirable action. The results are presented as proportions with a 95 % Confidence Interval. Statistical analysis was based on inter-rater agreement -test as well as χ2 test and Odds Ratio with 95 % CI. We found a moderate inter-rater agreement between what would happen with the physicians’ own trust in healthcare and their estimations of what would happen with the general population’s trust. We identified a significant difference between being pro et contra the treatment with double intentions and the estimation of the general population’s trust. Focusing on either decreasing or increasing own trust and being pro or contra the action we identified a strong association [OR 79 ]. Although the inter-rater agreement in the present study was somewhat weaker compared to a study about the explicit use of the term ‘physicians assisted suicide’ we found that our hypothesis—physicians’ estimations of others’ opinions are influenced by their own opinions—was corroborated. This might have implications in research as well as in clinical decision-making. We suggest that Merton’s ideal of disinterestedness should be highlighted. (shrink)

BackgroundIn the initial phase of the Covid-19 pandemic, difficult decisions had to be made on the allocation of testing resources. Similar situations can arise in future pandemics. Therefore, careful consideration of who should be tested is an important part of pandemic preparedness. We focus on four ethical aspects of that problem: how to prioritize scarce testing resources, the regulation of commercial direct-to-consumer test services, testing of unauthorized immigrants, and obligatory testing.Main textThe distribution of scarce resources for testing: We emphasize the (...) use of needs-based criteria, but also acknowledge the importance of choosing a testing strategy that contributes efficiently to stopping the overall spread of the disease. Commercial direct-to-consumer test services: Except in cases of acute scarcity, such services will in practice have to be allowed. We propose that they should be subject to regulation that ensures test quality and adequate information to users. Testing of unauthorized immigrants, their children and other people with unclear legal status: Like everyone else, these individuals may be in need of testing, and it is in society’s interest to reach them with testing in order to stop the spread of the disease. A society that offers comprehensive medical services to unauthorized immigrants is in a much better position to reach them in a pandemic than a society that previously excluded them from healthcare. Obligatory testing: While there are often strong reasons for universal testing in residential areas or on workplaces, there are in most cases better ways to achieve testing coverage than to make testing mandatory.ConclusionIn summary, we propose (1) decision-making primarily based on needs-based criteria, (2) strict regulation but not prohibition of direct-to-consumer test services, (3) test services offered to unauthorized immigrants, preferably as part of comprehensive medical services, and (4) broad outreach of testing services whenever possible, but in general not obligatory testing. (shrink)

During the last two decades, neonatal screening in Europe and North America has expanded substantially. This article examines two recent suggestions for expanding neonatal screening: severe combined immunodeficiency and X-linked adrenoleukodystrophy. With reference to well-established risk-benefit based rationales for screening, it is argued that the case for introducing SCID in neonatal screening is considerably stronger than for introducing X-ALD. For instance, the majority of those screened for X-ALD most likely have a negative risk-benefit ratio of screening: they develop milder symptoms (...) or perhaps no symptoms at all, while still being monitored for a long time. This argument is used as a vehicle for making some general points regarding justified expansions of neonatal screening. First, when considering the expansion of neonatal screening, we should look at a condition specific case-by-case basis. Moreover, future expansions of neonatal screening should stick to the well-established rationales for screening while avoiding risk-benefit slippage. Otherwise, more strict procedures of informed consent are warranted in neonatal screening, procedures that, in the end, risk undermining the benefits of current neonatal screening programmes. (shrink)

In this article we argue that the principle of need, on some interpretations, could be used to justify the spending of publically funded health care resources on cognitive enhancement and that this also holds true for individuals whose cognitive capacities are considered normal.The increased, and to an extent, novel demands that the modern technology and information society places on the cognitive capacities of agents, e.g., regarding good and responsible decision-making, have blurred the line between treatment and enhancement. More specifically, it (...) has shifted upwards. As a consequence, principles of need on their most reasonable interpretations can be used to support publically funded cognitive enhancement. At least this is so, if broader aims than curing and ameliorating diseases are included in the goals of health care. We suggest that it would be plausible to see health care as accepting such broader goals already today. (shrink)

BackgroundOrganizations worldwide increasingly adopt inclusive talent management, and this approach appears to rhyme particularly well with the Nordic welfare model. Questions about its value remain understudied, however. The inclusive approach is rooted in positive psychology and focuses on recognizing each employee's individual talents and assessing whether they fit the long-term needs of the organization, since a fit is assumed to be associated with employees' wellbeing. In the present study, we test this assumption focusing specifically on a key talent management practice, (...) talent identification, and the social dimension of employee wellbeing.MethodData were collected through an employee survey conducted within the Finnish units of four international manufacturing organizations and analyzed using logistic regression.ResultsWe found that the recognition of individual talents for long-term deployment by the organization is positively associated with social wellbeing in terms of supervisor support and social climate in the work unit, as perceived by the employees.ConclusionOur results tentatively suggest that inclusive talent management creates value through the identification of employees' individual talents as this practice can be associated with their enhanced wellbeing. (shrink)

This book reflects the growing influence of corpus linguistics in a variety of areas such as lexicography, translation studies, genre analysis, and language ...

Background Genetic testing is moving from targeted investigations of monogenetic diseases to broader testing that may provide more information. For example, recent health economic studies of genetic testing for an increased risk of breast cancer suggest that it is associated with higher cost-effectiveness to screen for pathogenic variants in a seven gene panel rather than the usual two gene test for variants in BRCA1 and BRCA2. However, irrespective of the extent to which the screening of the panel is cost-effective, there (...) may be ethical reasons to not screen for pathogenic variants in a panel, or to revise the way in which testing and disclosing of results are carried out. Main text In this paper we discuss the ethical aspects of genetic testing for an increased risk of breast cancer with a special focus on the ethical differences between screening for pathogenic variants in BRCA1/2 and a seven gene panel. The paper identifies that the panel increases the number of secondary findings as well as the number of variants of uncertain significance as two specific issues that call for ethical reflection. Conclusions We conclude that while the problem of handling secondary findings should not be overstated with regard to the panel, the fact that the panel also generate more variants of uncertain significance, give rise to a more complex set of problems that relate to the value of health as well as the value of autonomy. Therefore, it is insufficient to claim that the seven gene panel is preferable by only referring to the higher cost effectiveness of the panel. (shrink)

In an interesting article, Dr Zuzana Parusniková claimed: (i) that Semmelweis’ colleagues did not recognise the importance of his animal experiments, (ii) that the resistance to Semmelweis’ hypothesis and results was due mainly to applying mono-causality and (iii) Semmelweis inability to communicate, (iv) that the New Vienna Medical School applied evidence-based medicine, and (v) that the philosophy of Karl Popper is the best interpretation of Semmelweis’ scientific approach. Here, we present some factual aspects of Semmelweis’ text from 1861 and discuss (...) Dr Parusniková’s claims against this backdrop. We conclude that Semmelweis might intentionally have abstained from communicating his hypothesis and results between 1847 and 1849 – including the results from his animal experiments – as he thought that they would eventually be understood and accepted. Semmelweis’ hypothesis was that cadaveric matters and decaying particles were the cause of childbed fever and increased maternal mortality. This hypothesis might have been controversial, but we claim that the major reason for the resistance was eminence-based and induced by the publication of preliminary and suboptimal results, based on a premature version of his hypothesis. If the New Vienna Medical School had been influenced by evidence-based medicine, we believe that Semmelweis’ empirical results would have been accepted - as they were based on an almost randomised controlled trial - and if the results had not been associated with his hypothesis but instead had focused on a black box procedure. We agree that the philosophy of Popper might be appropriate when analysing Semmelweis’ scientific approach when abandoning low-level theories. However, to understand the resistance against Semmelweis’ hypothesis and results, it is not sufficient to refer to a Pickwickian discussion; a Kuhnian framework is more adequate. (shrink)

Different ideas of the normative relevance of autonomy can give rise to profoundly different action-guiding principles in healthcare. If autonomy is seen as a value rather than as a right, it can be argued that patients’ decisions should sometimes be overruled in order to protect or promote their own autonomy. We refer to this as paternalism in the name of autonomy. In this paper, we discuss different elements of autonomy (decision-making capacity, efficiency, and authenticity) and arguments in favor of paternalism (...) for the sake of autonomy that have been proposed in the bioethical debate. We argue that if autonomy is valuable, then paternalism for the sake of autonomy may be justified. However, policies allowing paternalism in the name of autonomy may be self-defeating. (shrink)