This paper presents the results of an empirical study of attitudes towards ethical questions in business life among managing directors. They study covers more than 240 Swedish firms of all sizes, from different lines of business, and it is based on a solid theoretical framework. It should be seen as a part of the author''s effort to develop a model explaining ethical organizational behaviour. Among the most important conclusions of the study is the concept of corporate moral view. It seems (...) possible to distinguish between the humanitarian morality versus the organizational morality, depending on who''s interests the decision maker prefers to take in a moral dilemma. (shrink)

There is an increased focus on, and evidence of, children's capability to both understand and make decisions about issues relating to participation in medical research. At the same time there are divergent ideas of when, how and to what extent children should be allowed to decide for themselves. Furthermore, little is known about parents' views on these matters, an important issue since they often provide the formal consent. In this questionnaire study of 2500 families in south-east Sweden (with and without (...) research experience) we explored parents' views on issues relating to information, consent and research data. We found that parents are generally positive about supplying their child with individual information (93.3%; median age 7) and assuring the child's consent/assent to participation (74.3%; median age 12). However, parents' views vary regarding the extent to which children should influence research data: as many as 47–61% of our sample were opposed to children's rights to decide about the use and storage of biological samples and natural history data. Parents who are opposed to child consent and a wider influence on their research participation argue that parental authority and research quality are two important factors opposing enhanced child influence. Drawing on this, we underline the need to discuss how to balance children's rights against parental autonomy and research interests before implementing any standardized protocols granting children the right to consent and revoke data in long-term research. (shrink)

Caring science that has a foundation in ‘lived experience’ may be viewed as a ‘patient science’, in other words nursing has its starting point in the patient’s perspective. To support in learning caring science, the learning situation has to embrace the students’ lived experience in relation to the substance of caring science. One of the challenges in education involves making theoretical meanings vivid in the absence of actual patients. Written patient narratives and fiction like novels in combination with scientific literature (...) are often used in order to obtain lived experiences as the foundation for teaching. Questions concerning how film can be used in this context to support the learning of caring science have recently emerged. The aim of this study is to describe how film as learning-support may boost reflection when learning caring science. The data was collected through audio-taped seminars, written reflections and group-interviews with students on basic, advanced, and doctoral levels. The analysis is based on the Reflective Lifeworld Research (RLR) approach which is founded in phenomenology. The results show how film as a learning-support enhances the understanding of the caring science theory, and provides a deeper understanding of the subject. Film can be very touching and provides support for the students’ embodied reflections. Hence, it is important that the students are encouraged to watch films from a caring science perspective. This requires a structure for learning-support related to the film, such as having a focus and purpose for watching the film, as well as support for follow-ups. The film itself does not create such support and guidance; instead, it must be combined with well-considered pedagogic thoughts on what learning is and how learning can be supported. The results are highlighted with the help of Maurice Merleau-Ponty’s philosophy of ‘the lived body’, and ‘the flesh of the world’. Indo-Pacific Journal of Phenomenology , Volume 12, Special Edition July 2012. (shrink)

There is an increased focus on, and evidence of, children's capability to both understand and make decisions about issues relating to participation in medical research. At the same time there are divergent ideas of when, how and to what extent children should be allowed to decide for themselves. Furthermore, little is known about parents' views on these matters, an important issue since they often provide the formal consent. In this questionnaire study of 2500 families in south-east Sweden we explored parents' (...) views on issues relating to information, consent and research data. We found that parents are generally positive about supplying their child with individual information and assuring the child's consent/assent to participation. However, parents' views vary regarding the extent to which children should influence research data: as many as 47–61% of our sample were opposed to children's rights to decide about the use and storage of biological samples and natural history data. Parents who are opposed to child consent and a wider influence on their research participation argue that parental authority and research quality are two important factors opposing enhanced child influence. Drawing on this, we underline the need to discuss how to balance children's rights against parental autonomy and research interests before implementing any standardized protocols granting children the right to consent and revoke data in long-term research. (shrink)

Background Traditionally, palliative care has focused on patients suffering from life-threatening somatic diseases such as cancer or progressive neurological disorders. In contrast, despite the often chronic, severely disabling, and potentially life-threatening nature of psychiatric disorders, there are neither palliative care units nor clinical guidelines on palliative measures for patients in psychiatry. Main text This paper contributes to the growing literature on a palliative approach in psychiatry and is based on the assumption that a change of perspective from a curative to (...) a palliative approach could help promote patient-centeredness and increase quality of life for severely ill patients in psychiatry as well as in somatic medicine. To exemplify this, we offer three different clinical scenarios: severe and enduring anorexia nervosa, treatment-refractory schizophrenia, and chronic suicidality and persistent self-injury in borderline personality disorder. Conclusion We emphasize that many typical interventions for treatment-refractory psychiatric disorders may indeed be of a palliative nature. Furthermore, introducing traditional features of palliative care, e.g. so-called goals of care conversations, could aid even further in ensuring that caregivers, patients, and families agree on which treatment goals are to be prioritized in order to optimize quality of life in spite of severe, persistent mental disorder. (shrink)

Objectives To explore attitudes and reasoning among Swedish physicians and the general public regarding the withdrawal of life-sustaining treatment at a competent patient's request. Design A vignette-based postal questionnaire including 1202 randomly selected individuals in the county of Stockholm and 1200 randomly selected Swedish physicians with various specialities. The vignettes described patients requesting withdrawal of their life-sustaining treatment: (1) a 77-year-old woman on dialysis; (2) a 36-year-old man on dialysis; (3) a 34-year-old ventilator-dependent tetraplegic man. Responders were asked to classify (...) the act of terminating treatment and to prioritise arguments for/against. Results A majority in both groups prioritised arguments in favour of terminating treatment and classified the act as defensible in all vignettes. However, among the general public, 16% classified the act as euthanasia in all vignettes; among physicians this view was most expressed regarding ventilator treatment (26%). Some who classified the act as euthanasia prioritised arguments in favour of terminating treatment: among physicians 18% in vignette 1, 19% in vignette 2 and 34% in vignette 3; among the general public 35% in vignette 1, 20% in vignette 2 and 48% in vignette 3. Conclusion There is a widespread consensus regarding competent patients' right to abstain from life-sustaining treatment. An association between the hastening of death, caused by the withdrawal of life-sustaining treatment and the concept of euthanasia is proposed. The results also suggest that classifying the withdrawal of life-sustaining treatment as ‘euthanasia’ does not necessarily mean that the act is interpreted as ethically unacceptable. (shrink)

Psychiatry today is mainly practised within a curative framework. However, many mental disorders are persistent and negatively affect quality of life as well as life expectancy. This tension between treatment goals and the actual illness trajectory has evoked a growing academic interest in ‘palliative psychiatry’, namely the application of a palliative care approach in patients with severe persistent mental illness. Recently, Trachsel et al presented a working definition of palliative psychiatry. This first official attempt to capture the concept is based (...) on WHO’s widely accepted definition of palliative care but modified and limited to include only severe persistent psychiatric illness. While this is a welcome step in the discussion on palliative care approaches in psychiatry, it also opens up for new questions. One of the most evident is whether psychiatry actually needs its own definition of palliative care or, put differently, whether there is something about mental disorders that differs so radically from other medical conditions that it calls for a separate definition. We acknowledge the need to discuss the goals of psychiatric care in patients with severe persistent psychiatric illness. However, we question whether a separate definition of palliative care exclusive to psychiatry is the right way to go. In this paper, we discuss why. (shrink)

The Rule of Double Effect (RDE) holds that it may be permissible to harm an individual while acting for the sake of a proportionate good, given that the harm is not an intended means to the good but merely a foreseen side-effect. Although frequently used in medical ethical reasoning, the rule has been repeatedly questioned in the past few decades. However, Daniel Sulmasy, a proponent who has done a lot of work lately defending the RDE, has recently presented a reformulated (...) and more detailed version of the rule. Thanks to its greater precision, this reinvented RDE avoids several problems thought to plague the traditional RDE. Although an improvement compared with the traditional version, we argue that Sulmasy's reinvented RDE will not stand closer scrutiny. Not only has the range of proper applicability narrowed significantly, but, more importantly, Sulmasy fails to establish that there is a morally relevant distinction between intended and foreseen effects. In particular, he fails to establish that there is any distinction that can account for the alleged moral difference between sedation therapy and euthanasia. (shrink)

Many enveloped viruses are released from infected cells by maturing and budding at the plasma membrane. During this process, viral core components are incorporated into membrane vesicles that contain viral transmembrane proteins, termed ‘spike’ proteins. For many years these spike proteins, which are required for infectivity, were believed to be incorporated into virions via a direct interaction between their cytoplasmic domains and viral core components. More recent evidence shows that, while such direct interactions drive budding of alphaviruses, this may not (...) be the case for negative strand RNA viruses and retroviruses. These viruses can bud particles in the absence of spike proteins, using only viral core components to drive the process. In some cases the spike proteins, without the viral core, can be released as virus‐like particles. Optimal budding and release may, therefore, depend on a ‘push‐and‐pull’ concerted action of core and spike, where oligomerization of both components plays a crucial role. (shrink)

Background Physician-assisted suicide is a controversial issue and has sometimes raised emotion-laden reactions. Against this backdrop, we have analyzed how Swedish physicians are reasoning about physician-assisted suicide if it were to be legalized. Methods and participants We conducted a cross-sectional study and analyzed 819 randomly selected physicians’ responses from general practitioners, geriatricians, internists, oncologists, psychiatrists, surgeons, and all palliativists. Apart from the main questions about their attitude toward physician-assisted suicide, we also asked what would happen with the respondents’ own trust (...) in healthcare if physician-assisted suicide were legalized. Response options were that trust would decrease, not be influenced, or would increase. Results We identified a strong statistical association between on the one hand those whose own trust would increase and who were pro physician-assisted suicide, and on the other hand those who were against physician-assisted suicide and whose own trust would decrease [relative risk: 16.7 (95% confidence interval: 10.2–27.2)]. Among those whose own trust would not be influenced (n = 456), 60% were pro pysician-assisted suicide, 16% were against, and 24% were undecided. Of those whose trust would increase or not be influenced, a large majority supported autonomy-based arguments, whereas those whose trust would decrease supported non-maleficence-based arguments. Conclusion Analyzing the answers after having divided respondents into those whose own trust in healthcare would decrease or increase and not be influenced brings about interesting results such as how the three groups prioritize arguments for and against physician-assisted suicide. This way of analyzing the data seems to be a promising strategy when identifying value-impregnated factual claims. (shrink)

Two questionnaires directed to Swedish physicians and a sample of the Swedish population investigated attitudes towards physician-assisted suicide (PAS). The aim of the present work was to analyse qualitative data from these questionnaires in order to explore how respondents reason about PAS. Data were analysed in two steps. First, we categorized different kinds of responses and identified pro and con arguments. Second, we identified general conclusions from the responses. The data reflect the differences in attitudes towards PAS among the public (...) and physicians, with the former mainly in favour of PAS and the latter mainly against. There was, however, considerable agreement about what requirements must be met before PAS could be considered ethical. Many arguments against PAS concerned the professional role of physicians, which indicates that it may not be assisted suicide as such that many PAS opponents disagree with, but rather that it is handled by physicians in the regular health-care system. (shrink)

Previous studies support the link of parental acculturation to their children’s academic achievement, identity, and family relations. Prior research also suggests that parental language proficiency is associated with children’s vocabulary knowledge. However, few studies have examined the links of parental acculturation to young children’s oral language abilities. As preschool oral language skills have been shown to predict future academic achievement, it is critical to understand the relations between parental acculturation and bilingual abilities with young immigrant children. Furthermore, few studies have (...) examined the links between parental acculturation and children’s bilingual ability among different immigrant groups who live in the same areas to understand possible similarities and differences. To address these gaps, this study examines these relations in two of the largest and fastest-growing immigrant populations in the United States, Chinese American and Mexican American families. A total of 119 dual language learners enrolled in Head Start programs in Northern California were recruited. DLLs were assessed on oral language measures in both their heritage language and English. Parental interviews were conducted to obtain parental acculturation and language proficiency. Results showed no significant group differences between Chinese American and Mexican American parents on the majority of their acculturation dimensions. Furthermore, there were no significant group differences in the bilingual abilities between Chinese American and Mexican American DLLs. Cluster analysis identified four groups of DLLs based on their bilingual ability: high language ability in both English and HL, low language ability in both, English-dominant, and HL-dominant. Results suggest that parental acculturation levels are more similar than different among the four groups. On average, parents in all four groups had stronger ties to their heritage culture and HL than to the American culture. Results also showed links between parental cultural identities and children’s language dominance. Parents of English-dominant children had significantly higher levels of American identity than the parents of children with high ability in both languages. Implications are discussed. (shrink)

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)

RATIONALE, AIM AND OBJECTIVE: Factors influencing doctors in prescribing of drugs have mostly been studied in primary care. Studies performed in hospital care have primarily focused on new drugs, not prescribing in general. An in-depth understanding of the prescribing process in the more specialized secondary care is not only important for secondary care itself, but because it also influences prescribing in primary care. The aim of this study is therefore to identify factors that secondary care doctors believe influence them in (...) prescribing drugs, using a qualitative approach. (shrink)

Background Despite its negative impact on patients and nurses, the use of restraint in somatic health care continues in many settings. Understanding the reasons and justifications for the use of restraint among nurses is crucial in order to manage this challenge. Aim To understand nurses’ justifications for restraint use in neurosurgical care. Research design A qualitative, descriptive design was used. Data were analysed with inductive qualitative content analysis. Participants and research context Semi-structured interviews with 15 nurses working in three neurosurgical (...) departments in Sweden. Ethical considerations Approved by The Regional Ethics Committee, Stockholm, Sweden. Findings The analysis resulted in three categories. The category Patient factors influencing restraint use describes patient factors that trigger restraint, such as a diminished decision-making competence, restlessness, and need for invasive devices. The category Specific reasons for justifying restraint describes reasons for restraining patients, such as restraint being used for the sake of the patient or for the sake of others. The category General reasoning in justifying restraint describes how nurses reason when using restraint, and the decision to use restraint was often based on a consequentialist approach where the nurses’ weighed the pros and cons of different alternatives. Discussion Nurses with experience of restraint use were engaged in a constant process of justifying and balancing different options and actions. Restraint was considered legitimate if the benefit exceeded the suffering, but decisions on which restraint measures to use and when to use them depended on the values of the individual nurse. Conclusion How nurses reason when justifying restraint, why they use restraint, and who they use restraint on must be considered when creating programs and guidelines to reduce the use of restraint and to ensure that when it is used it is used carefully, appropriately, and with respect. (shrink)

Aim To examine the hypothesis that knowledge about physician-assisted suicide (PAS) and euthanasia is associated with a more restrictive attitude towards PAS. Design A questionnaire about attitudes towards PAS, including prioritisation of arguments pro and contra, was sent to Swedish veterinary surgeons. The results were compared with those from similar surveys of attitudes among the general public and physicians. Participants All veterinary surgeons who were members of the Swedish Veterinary Association and had provided an email address (n=2421). Main outcome measures (...) Similarities or differences in response pattern between veterinary surgeons, physicians and the general public. Results The response pattern among veterinary surgeons and the general public was almost similar in all relevant aspects. Of the veterinarians 75% (95% CI 72% to 78%) were in favour of PAS, compared with 73% (95% CI 69% to 77%) among the general public. Only 10% (95% CI 5% to 15%) of the veterinary surgeons were against PAS, compared with 12% (95% CI 5% to 19%) among the general public. Finally, 15% (95% CI 10% to 21%) of veterinarians were undecided, compared with 15% (95% CI 8% to 22%) among the general public. Physicians had a more restrictive attitude to PAS than the general public. Conclusions Since veterinary surgeons have frequent practical experience of euthanasia in animals, they do have knowledge about what euthanasia really is. Veterinary surgeons and the general public had an almost similar response pattern. Accordingly it seems difficult to maintain that knowledge about euthanasia is unambiguously associated with a restrictive attitude towards PAS. (shrink)

The objective of the present paper is to explore parents' views on safety and confidentiality, information and consent, the importance of different kinds of research, and their responsibilities regarding children's participation. A questionnaire was distributed to 2500 families in south-east Sweden with children born during the years 1997–1999; 1302 responded. The sample was chosen to include views of families with and without earlier research experience. A clear majority of responding parents stated that parents have a moral responsibility to let their (...) children participate in research that is considered important, safe and moderately time-consuming. Respondents stressed the importance of thorough review and control of research involving children. Respondents also found it important that parents are guaranteed the right to decide about their children's participation and that they are thoroughly informed on central aspects of the study. (shrink)

We present a perspective of the national transplant program based on organizational theory and complexity theory, framing the system’s allocation of donor organs as an interorganizational directed multiplex of agents with diverse belief formation in a cooperative-competitive environment. Simulation and analysis of this macroscale complexity may help explain known behavioural variations across member organizations. However, the transplant community still relies on system-scale simulations since effective macroscale methodologies are not well established. Therefore, we offer this perspective of the national transplant program (...) as a means to stimulate new methods that capture macroscale impacts of policy development for deceased donor organ allocation. (shrink)

Restraint is regularly used in somatic healthcare settings, and countries have chosen different paths to regulate restraint in somatic healthcare. One overarching problem when regulating restraint is to ensure that patients with reduced decision-making capacity receive the care they need and at the same time ensure that patients with a sufficient degree of decision-making capacity are not forced into care that they do not want. Here, arguments of justice, trust in the healthcare system, minimising harm and respecting autonomy are contrasted (...) with different national regulations. We conclude that a regulation that incorporates an assessment of patients’ decision-making capacity and considers the patient’s best interests is preferable, in contrast to regulations based on psychiatric diagnoses or regulations where there are no legal possibilities to exercise restraint at all in somatic care. (shrink)

Quantum theory of Lorentz invariant local scalar fields without restrictions on 4-momentum spectrum is considered. The mass spectrum may be both discrete and continues and the square of mass as well as the energy may be positive or negative. One may assume the existence of such fields only if they interact with ordinary fields very weakly. Generalization of Kallen-Lehmann representation for propagators of these fields is found. The considered generalized fields may violate CPT-invariance. Restrictions on mass-spectrum of CPT-violating fields are (...) found. Local fields that annihilate vacuum state and violate CPT-invariance are constructed in this scope. Correct local relativistic generalization of Lindblad equation for density matrix is written for such fields. This generalization is particularly needed to describe the evolution of quantum system and measurement process in a unique way. Difficulties arising when the field annihilating the vacuum interacts with ordinary fields are discussed. (shrink)

We consider the problem of measurement using the Lindblad equation, which allows the introduction of time in the interaction between the measured system and the measurement apparatus. We use analytic results, valid for weak system-environment coupling, obtained for a two-level system in contact with a measurer (Markovian interaction) and a thermal bath (non-Markovian interaction), where the measured observable may or may not commute with the system-environment interaction. Analysing the behavior of the coherence, which tends to a value asymptotically close (...) to zero, we obtain an expression for the time of measurement which depends only on the system-measurer coupling, and which does not depend on whether the observable commutes with the system-bath interaction. The behavior of the coherences in the case of strong system-environment coupling, found numerically, indicates that an increase in this coupling decreases the measurement time, thus allowing our expression to be considered the upper limit for the duration of the process. (shrink)

Standard quantum theory is inadequate to explain the mechanisms by which potential becomes actual. It is inadequate and therefore unable to describe generation of events. Niels Bohr emphasized long ago that the classical part of the world is necessary. John Bell stressed the same point: that “measurement≓ cannot even be defined within the standard quantum theory, and he sought a solution within hidden variable theories and his concept of “beables.≓Today it is customary to try to explain emergence of the classical (...) world through a decoherence mechanism due to “environment.≓ But, we believe, as it was with the concept of measurement, “environment≓ itself cannot be defined within the standard quantum theory.We have proposed a semiphenomenological solution to this problem by introducing explicitly, from the very beginning, classical degrees of freedom, and by coupling these degrees of freedom, through a Lindblad type coupling, to the quantum world. The resulting theory, we call “event-enhanced quantum theory.≓ EEQT allows us to describe an event-generating mechanism for individual quantum systems under continuous observation. The objections of John Bell are met and precise definitions of an “experiment≓ and of a “measurement≓ have been given within EEQT. However EEQT is, essentially, a nonrelativistic theory.In the present paper we extend the ideas of L. P. Horwitz and C. Piron and we propose a relativistic version of EEQT, with an event-generating algorithm for spin one-half particle detectors. The algorithm is based on proper time formulation of the relalivistic quantum theory. Although we use indefinite metric, all the probabilities controlling the random process of the detector clicks are nonnegative. (shrink)