- Box 200
SE-40530 Gothenburg
Sweden
- Applied Ethics, Bioethics, Medical Ethics, Public Health Ethics, Ethics of Risk, Ethics, and 19 morePhilosophy of risk, Moral Philosophy, Philosophy, Philosophy Of Law, Philosophy of Psychiatry, Philosophy Of Religion, Political Philosophy, Philosophy of Technology, Applied Philosophy, Law and Ethics in Forensic Science, Risk Management, Environmental Policy and Governance, Health Care Ethics, Reproductive Ethics, Bioethics Reproductive Technology, Public Health Policy, Research Ethics, Medical Ethics & Law, and Shared decision makingedit
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2. https://www.researchgate.net/profile/Christian_Muntheedit
This volume outlines and analyses ethical issues actualized by applying a precautionary approach to the regulation of new biotechnologies. It presents a novel way of categorizing and comparing biotechnologies from a precautionary... more
This volume outlines and analyses ethical issues actualized by applying a precautionary approach to the regulation of new biotechnologies. It presents a novel way of categorizing and comparing biotechnologies from a precautionary standpoint. Based on this, it addresses underlying philosophical problems regarding the ethical assessment of decision-making under uncertainty and ignorance, and discusses how risks and possible benefits of such technologies should be balanced from an ethical standpoint. It argues on conceptual and ethical grounds for a technology neutral regulation as well as for a regulation that not only checks new technologies but also requires old, inferior ones to be phased out. It demonstrates how difficult ethical issues regarding the extent and ambition of precautionary policies need to be handled by such a regulation, and presents an overarching framwork for doing so.
Research Interests: Agricultural Engineering, Applied Ethics, Bioethics, Policy Analysis and Decision Making, Sustainable agriculture, and 15 moreBiotechnology, Environmental Ethics, Agriculture, Risk Management, Industrial Biotechnology, Decision Making Under Uncertainty, Nanotechnology, Plant biotechnology, Plant breeding and genetics, Precautionary Principle, Environmental Biotechnology, Bionanotechnology, GMO Biosafety, Plant Biotechnology and Molecular Biology, and Genetically modified organisms
"The aim of this first part of The Philosophy of Hate Crime Anthology is to introduce the topic of its accompanying, second part, the annotated bibliography of the philosophy of hate crime authored and compiled by David Brax.2 Together,... more
"The aim of this first part of The Philosophy of Hate Crime Anthology is to introduce the topic of its accompanying, second part, the annotated bibliography of the philosophy of hate crime authored and compiled by David Brax.2 Together, these documents provide a provides a guide to the philosophical and theoretical issues underlying hate crime legislation and policy. These issues are rarely at the top of the news agenda, but are important to the assessment of various more concrete and readily debated questions. They are, as we shall attempt to demonstrate, crucial in order to achieve well-founded hate crime policies. In effect, this bibliography purports to explain such connections and to present briefly the debates about the philosophical issues as they are conducted within different fields of expertise, with pointers to relevant reading materials and what these contribute to the discussion.
The realisation of this aim is an outcome of the project When Law and Hate Collide, coordinated by the law school of the University of Central Lancashire, UK, and involving researchers from the Göthe University of Frankfurt, Germany and the University of Gothenburg, Sweden. This project was funded by the European Commission's Daphne III program (contract no. 2009-DAP3- AG-1221), which aims at providing the European Union with a strengthened basis for designing hate crime policies at the European level, as well as support member state initiatives of this nature."
The realisation of this aim is an outcome of the project When Law and Hate Collide, coordinated by the law school of the University of Central Lancashire, UK, and involving researchers from the Göthe University of Frankfurt, Germany and the University of Gothenburg, Sweden. This project was funded by the European Commission's Daphne III program (contract no. 2009-DAP3- AG-1221), which aims at providing the European Union with a strengthened basis for designing hate crime policies at the European level, as well as support member state initiatives of this nature."
Research Interests: Criminology, European Studies, Law, Criminal Law, Criminal Justice, and 19 moreJurisprudence, Political Philosophy, Ethics, Applied Ethics, European Law, Political Theory, Social Philosophy, Philosophy Of Law, Hate Speech, Hate Crimes, European Politics, European Union, European/EU Politics, Moral Philosophy, EU Law, Crime Prevention, Moral and Political Philosophy, Hate Crime Law, and Crime
REVIEWS: In Medicine, Health Care and Philosophy: http://www.springerlink.com/content/44275q410286r7q1/ ABSTRACT Medical or health-oriented screening programs are amongst the most debated aspects of health care and public health... more
REVIEWS:
In Medicine, Health Care and Philosophy: http://www.springerlink.com/content/44275q410286r7q1/
ABSTRACT
Medical or health-oriented screening programs are amongst the most debated aspects of health care and public health practices in health care and public health ethics, as well as health policy discussions. In spite of this, most treatments of screening in the research literature restrict themselves to isolated scientific aspects, sometimes complemented by economic analyses or loose speculations regarding policy aspects. At the same time, recent advances in medical genetics and technology, as well as a rapidly growing societal focus on public health concerns, inspires an increase in suggested or recently started screening programs.
This book involves an in-depth analysis of the ethical, political and philosophical issues related to health-oriented screening programs. It explores the considerations that arise when heath care interacts with other societal institutions on a large scale, as is the case with screening: What values may be promoted or compromised by screening programs? What conflicts of values do typically arise – both internally and in relation to the goals of health care, on the one hand, and the goals of public health and the general society, on the other? What aspects of screening are relevant for determining whether it should be undertaken or not and how it should be organised in order to remain defensible? What implications does the ethics of screening have for health care ethics as a whole?
These questions are addressed by applying philosophical methods of conceptual analysis, as well as models and theories from moral and political philosophy, medical ethics, and public health ethics, to a large number of ongoing and proposed screening programs which makes this book the first comprehensive work on the ethics of screening. Analyses and suggestions are made that are of potential interest to health care staff, medical researchers, policy makers and the general public.
CONTENTS
Acknowledgements
Chapter 1: Introduction
1.1 The Wilson and Jungner Criteria
1.2 Point and Plan
1.3 The Concept of Screening
Chapter 2: Why Screening?
2.1 Screening, Treatment and Prevention: Preliminary Remarks
2.2 Health: Life and Well-being
2.2.1 Health and Counselling
2.2.2 The Good of People and of the Population
2.3 Autonomy
2.3.1 Respecting and Promoting Autonomy
2.3.2 Promoting Autonomy through Screening
2.4 Justice
2.5 Summary
Chapter 3: Screening – What, When and Whom?
3.1 Diseases and Groups
3.1.1 Prenatal Screening
3.1.2 Neonatal Screening
3.1.2.1 Reasons for Screening in the Neonatal Period
3.1.2.2 Neonatal Screening and Parental Informed Consent
3.1.2.3 Expanding Neonatal Screening – How Far?
3.1.3 Child and Adolescent Screening
3.1.3.1 Stigmatisation
3.1.3.2 The Child as Decision Maker
3.1.4 Adult Screening
3.2 Testing and Analysis
3.2.1 Safety
3.2.2 Validity
3.2.3 Predictive Value
3.3 Treatments
3.3.1 Abortion as Treatment
3.3.2 Counselling as Treatment
3.4 Summary
Chapter 4: Screening – How?
4.1 Informed Consent
4.2 Counselling
4.2.1 Genetic Counselling as a Template
4.2.2 Expansion: Shared Decision Making
4.3 Funding and Participation
4.4 Summary
Chapter 5: Case Studies
5.1 Non-Invasive Prenatal Diagnosis
5.2 Neonatal Screening for Fragile X
5.3 Mammography Screening
5.4 PSA Screening for Prostate Cancer
Chapter 6: Serving Society or Serving the Patient?
6.1 Summary of the Analysis So far
6.2 The Public Health – Health Care Tension Area
6.3 The Relevance of a Social Science Perspective
6.4 An Institutional Approach to health-related Ethics: A Sketch
6.5 Applying the Institutional Approach: Three Cases
6.5.1 Institutions, Functions and Ethics: Reproductive Care vs. Communicable Disease
6.5.2 Direct to Consumer Genetic Testing: The Limits of Context Relativity
6.5.3 Screening and Justice: The Case Against Allocating Health Care Resources to Screening
6.6 Revisiting the Wilson and Jungner Criteria for Screening
6.7 Closing
Refrences
Index
In Medicine, Health Care and Philosophy: http://www.springerlink.com/content/44275q410286r7q1/
ABSTRACT
Medical or health-oriented screening programs are amongst the most debated aspects of health care and public health practices in health care and public health ethics, as well as health policy discussions. In spite of this, most treatments of screening in the research literature restrict themselves to isolated scientific aspects, sometimes complemented by economic analyses or loose speculations regarding policy aspects. At the same time, recent advances in medical genetics and technology, as well as a rapidly growing societal focus on public health concerns, inspires an increase in suggested or recently started screening programs.
This book involves an in-depth analysis of the ethical, political and philosophical issues related to health-oriented screening programs. It explores the considerations that arise when heath care interacts with other societal institutions on a large scale, as is the case with screening: What values may be promoted or compromised by screening programs? What conflicts of values do typically arise – both internally and in relation to the goals of health care, on the one hand, and the goals of public health and the general society, on the other? What aspects of screening are relevant for determining whether it should be undertaken or not and how it should be organised in order to remain defensible? What implications does the ethics of screening have for health care ethics as a whole?
These questions are addressed by applying philosophical methods of conceptual analysis, as well as models and theories from moral and political philosophy, medical ethics, and public health ethics, to a large number of ongoing and proposed screening programs which makes this book the first comprehensive work on the ethics of screening. Analyses and suggestions are made that are of potential interest to health care staff, medical researchers, policy makers and the general public.
CONTENTS
Acknowledgements
Chapter 1: Introduction
1.1 The Wilson and Jungner Criteria
1.2 Point and Plan
1.3 The Concept of Screening
Chapter 2: Why Screening?
2.1 Screening, Treatment and Prevention: Preliminary Remarks
2.2 Health: Life and Well-being
2.2.1 Health and Counselling
2.2.2 The Good of People and of the Population
2.3 Autonomy
2.3.1 Respecting and Promoting Autonomy
2.3.2 Promoting Autonomy through Screening
2.4 Justice
2.5 Summary
Chapter 3: Screening – What, When and Whom?
3.1 Diseases and Groups
3.1.1 Prenatal Screening
3.1.2 Neonatal Screening
3.1.2.1 Reasons for Screening in the Neonatal Period
3.1.2.2 Neonatal Screening and Parental Informed Consent
3.1.2.3 Expanding Neonatal Screening – How Far?
3.1.3 Child and Adolescent Screening
3.1.3.1 Stigmatisation
3.1.3.2 The Child as Decision Maker
3.1.4 Adult Screening
3.2 Testing and Analysis
3.2.1 Safety
3.2.2 Validity
3.2.3 Predictive Value
3.3 Treatments
3.3.1 Abortion as Treatment
3.3.2 Counselling as Treatment
3.4 Summary
Chapter 4: Screening – How?
4.1 Informed Consent
4.2 Counselling
4.2.1 Genetic Counselling as a Template
4.2.2 Expansion: Shared Decision Making
4.3 Funding and Participation
4.4 Summary
Chapter 5: Case Studies
5.1 Non-Invasive Prenatal Diagnosis
5.2 Neonatal Screening for Fragile X
5.3 Mammography Screening
5.4 PSA Screening for Prostate Cancer
Chapter 6: Serving Society or Serving the Patient?
6.1 Summary of the Analysis So far
6.2 The Public Health – Health Care Tension Area
6.3 The Relevance of a Social Science Perspective
6.4 An Institutional Approach to health-related Ethics: A Sketch
6.5 Applying the Institutional Approach: Three Cases
6.5.1 Institutions, Functions and Ethics: Reproductive Care vs. Communicable Disease
6.5.2 Direct to Consumer Genetic Testing: The Limits of Context Relativity
6.5.3 Screening and Justice: The Case Against Allocating Health Care Resources to Screening
6.6 Revisiting the Wilson and Jungner Criteria for Screening
6.7 Closing
Refrences
Index
Research Interests: Health Sciences, Applied Philosophy, Ethics, Applied Ethics, Bioethics, and 20 morePreventive Health, Public Health Ethics, Medical Ethics, Critical Bioethics, Prostate Cancer, Preventive medicine, Health, Health Care Ethics, Public Health, Cancer Prevention, Health Policy, Maternal, neonatal and child healthcare, Genetic Testing, Cancer Screening, Prenat Diagnosis Fetal Medicine Genetics, Non Invasive Prenatal Diagnosis, Newborn Screening, Neonatal medicine, Paediatric Endocrinology and General Paediatrics and Child Health, Mammography, and Prenatal screening
Since a couple of decades, the notion of a precautionary principle plays a central and increasingly influential role in international as well as national policy and regulation regarding the environment and the use of technology. Urging... more
Since a couple of decades, the notion of a precautionary principle plays a central and increasingly influential role in international as well as national policy and regulation regarding the environment and the use of technology. Urging society to take action in the face of potential risks of human activities in these areas, the recent focus on climate change has further sharpened the importance of this idea. However, the idea of a precautionary principle has also been problematised and criticised by scientists, scholars and policy activists, and been accused of almost every intellectual sin imaginable: unclarity, impracticality, arbitrariness and moral as well as political unsoundness. In that light, the very idea of precaution as an ideal for policy making rather comes out as a dead end. On the basis of these contrasting starting points, Christian Munthe undertakes an innovative, in-depth philosophical analysis of what the idea of a precautionary principle is and should be about. A novel theory of the ethics of imposing risks is developed and used as a foundation for defending the idea of precaution in environmental and technological policy making against its critics, while at the same time avoiding a number of identified flaws. The theory is shown to have far-reaching consequences for areas such as bio-, information- and nuclear technology, and global environmental policy in areas such as climate change. The author argues that, while the price we pay for precaution must not be too high, we have to be prepared to pay it in order to act ethically defensible. A number of practical suggestions for precautionary regulation and policy making are made on the basis of this, and some challenges to basic ethical theory as well as consumerist societies, the global political order and liberal democracy are identified.
Research Interests: Ethics, Philosophy of Technology, Communication, Environmental Philosophy, Applied Ethics, and 39 moreBioethics, Climate Change, Climate Change Adaptation, Environmental Studies, Philosophy Of Climate Change, Climate change policy, Disaster risk management, Risk Governance, Risk regulation, Sociology of Risk, Technology Management, Environmental Ethics, Environmental Political Theory, Risk, Informed Consent, Philosophy of risk, Environmental Policy and Governance, Environmental Politics, Risk Management, Science and Technology Policy, Policy Studies of Technology, Technology and Society, Risk communication, Politics And Sociology Of Risk, Risk assessment, Precautionary Principle, Climate Change and Philosophy, Decision Theory, Risk Assessment & Risk Management, Technology Ethics, Global Warming, Ethics of Risk, Disaster risk reduction, Engineering Ethics, Technology Law, Climate Change Policy Analyis, Bayesian Epistemology, Probabilistic Causality, Precautionary Principle, Pharmaceutical Law, and Adaptation Policy Framework
Research Interests:
Preimplantation genetic diagnosis (PGD) is taken to mark the starting-point of a new phase in human reproduction, where the possibility of choosing children on genetic grounds without having to resort to dangerous or ethically... more
Preimplantation genetic diagnosis (PGD) is taken to mark the starting-point of a new phase in human reproduction, where the possibility of choosing children on genetic grounds without having to resort to dangerous or ethically controversial procedures (such as abortion) will gradually increase. Ethical and political issues actualised by this development are addressed.
The discussion touches upon issues regarding the moral status of embryos and gametes, the moral import of respecting individual autonomy and its implications for the requirement of informed consent in health-care, the connection between disease, disability and the value of life, the moral status of possible future people, and the connection between choosing children and eugenic policies of the past. Practical policy issues are addressed on the basis of this, as well as an empirical case-study of the introduction of PGD in Sweden.
The book ends up in a set of recommendations regarding the management of research on, introduction and routine use of pure selection, both within health care and from the point of view of society as a whole. It is argued that research on such procedures should be allowed and supported by society. However, tight restrictions regarding the clinical introduction of new procedures in this area is highly desirable. A rough model for implementing such restrictions is also presented. It is further asserted that, although reasons of economy and safety should limit the access to pure selection, society should not apply any explicit restrictions based on ideas regarding how different traits affect a person's quality of life. It is stressed that, in order to avoid a resurrection of eugenic policies of the past, the development in this field underlines the need for continued and strengthened public support to the sick, disabled and mentally retarded.
Keywords: assisted procreation, bioethics, embryo experimentation, eugenics, genetic testing, in vitro fertilisation, medical ethics, medical genetics, polar body biopsy, preconception diagnosis, preimplantation genetic diagnosis, prenatal diagnosis, public policy, reproductive medicine, research ethics, sex preselection.
The discussion touches upon issues regarding the moral status of embryos and gametes, the moral import of respecting individual autonomy and its implications for the requirement of informed consent in health-care, the connection between disease, disability and the value of life, the moral status of possible future people, and the connection between choosing children and eugenic policies of the past. Practical policy issues are addressed on the basis of this, as well as an empirical case-study of the introduction of PGD in Sweden.
The book ends up in a set of recommendations regarding the management of research on, introduction and routine use of pure selection, both within health care and from the point of view of society as a whole. It is argued that research on such procedures should be allowed and supported by society. However, tight restrictions regarding the clinical introduction of new procedures in this area is highly desirable. A rough model for implementing such restrictions is also presented. It is further asserted that, although reasons of economy and safety should limit the access to pure selection, society should not apply any explicit restrictions based on ideas regarding how different traits affect a person's quality of life. It is stressed that, in order to avoid a resurrection of eugenic policies of the past, the development in this field underlines the need for continued and strengthened public support to the sick, disabled and mentally retarded.
Keywords: assisted procreation, bioethics, embryo experimentation, eugenics, genetic testing, in vitro fertilisation, medical ethics, medical genetics, polar body biopsy, preconception diagnosis, preimplantation genetic diagnosis, prenatal diagnosis, public policy, reproductive medicine, research ethics, sex preselection.
Research Interests:
"Motives put forward by specialists on prenatal diagnosis in support of this procedure when it was introduced in Swedish health care during the 1970's are described and analysed. The motives are set in relation later criticism of prenatal... more
"Motives put forward by specialists on prenatal diagnosis in support of this procedure when it was introduced in Swedish health care during the 1970's are described and analysed. The motives are set in relation later criticism of prenatal diagnosis as well as general bioethical issues.
Three motives are described: 1) Prenatal diagnosis is a tool for improving genetic counselling, thereby promoting the autonomy and reducing the anxieties of pregnant women who fear having children with some disorder or disease. 2) The point of prenatal diagnosis is to effect medical prevention by reducing the number of children born with diseases or disorders. 3) Prenatal diagnosis has an economic advantage in that it may save society from some of the costs involved in the care for disabled or retarded people.
These motives are found to communicate an unclear and partly inconsistent body of ethical values. First, complex ethical issues in connection with abortion were not addressed. Secondly, it is highly unclear how considerations of autonomy was balanced against considerations of well-being and economic aims. This unclear picture of the support of the autonomy of patients is also relevant when the economic motive is set in relation to accusations that prenatal diagnosis springs from similar moral values as eugenic policies of the past. Three interpretations of this motive are distinguished of which only one may actually support eugenic policies. However, even if the economic motive is interpreted in a very defensive way, it still expresses a tolerance of policymakers setting aside the autonomy of individual patients in order to achieve economic aims. It is argued that the expression of such tolerance can only be blocked by a clear willingness to actively fight any threat against the autonomy of patients, and that the expression of such an attitude is incompatible with the use of the economic motive. "
Three motives are described: 1) Prenatal diagnosis is a tool for improving genetic counselling, thereby promoting the autonomy and reducing the anxieties of pregnant women who fear having children with some disorder or disease. 2) The point of prenatal diagnosis is to effect medical prevention by reducing the number of children born with diseases or disorders. 3) Prenatal diagnosis has an economic advantage in that it may save society from some of the costs involved in the care for disabled or retarded people.
These motives are found to communicate an unclear and partly inconsistent body of ethical values. First, complex ethical issues in connection with abortion were not addressed. Secondly, it is highly unclear how considerations of autonomy was balanced against considerations of well-being and economic aims. This unclear picture of the support of the autonomy of patients is also relevant when the economic motive is set in relation to accusations that prenatal diagnosis springs from similar moral values as eugenic policies of the past. Three interpretations of this motive are distinguished of which only one may actually support eugenic policies. However, even if the economic motive is interpreted in a very defensive way, it still expresses a tolerance of policymakers setting aside the autonomy of individual patients in order to achieve economic aims. It is argued that the expression of such tolerance can only be blocked by a clear willingness to actively fight any threat against the autonomy of patients, and that the expression of such an attitude is incompatible with the use of the economic motive. "
Research Interests:
Arguments put forward for five positions on the moral status of abortion are discussed. The positions range from the view that abortion may be right only if it is necessary to save the woman's life, to the claim that while most safe... more
Arguments put forward for five positions on the moral status of abortion are discussed. The positions range from the view that abortion may be right only if it is necessary to save the woman's life, to the claim that while most safe abortions requested by the woman are right, some abortions would be wrong not to perform and there are cases where it is right to perform abortion even if the woman does not want it. The arguments are found invalid and/or irrelevant. It is argued that a tenable position on the moral status of abortion has to be supported by an act-utilitarian moral theory dubbed BHU.
Application of BHU yields that it is impossible to obtain good reasons for any of the positions. However, this is also true of most other moral theories. Four tentative conclusions seem plausible: 1) Abortion is seldom right in countries where most women lack opportunities to have cheap, safe legal abortions. In other countries, however, many abortions can be right. 2) In many of the justifiable cases of abortion, the woman faces a moral dilemma where she cannot avoid acting wrongly even if she acts rightly. 3) It is in general wrong to omit abortion if the foetus is so severly deformed that it would develop into a person with a life worth not living. It is also in general wrong to omit abortion if this results in abortion being performed at a later time. 4) In very rare cases it may be right to perform abortion even if the woman does not want it, but in practice we lack all means of identifying these cases.
Application of BHU yields that it is impossible to obtain good reasons for any of the positions. However, this is also true of most other moral theories. Four tentative conclusions seem plausible: 1) Abortion is seldom right in countries where most women lack opportunities to have cheap, safe legal abortions. In other countries, however, many abortions can be right. 2) In many of the justifiable cases of abortion, the woman faces a moral dilemma where she cannot avoid acting wrongly even if she acts rightly. 3) It is in general wrong to omit abortion if the foetus is so severly deformed that it would develop into a person with a life worth not living. It is also in general wrong to omit abortion if this results in abortion being performed at a later time. 4) In very rare cases it may be right to perform abortion even if the woman does not want it, but in practice we lack all means of identifying these cases.
Research Interests:
In response to Koplin and Wilkinson, I argue, first, that the uncertain clinical prospects of human-pig chimera based transplantation makes the reason to spend resources for clarifying whether or not such practice might imply serious... more
In response to Koplin and Wilkinson, I argue, first, that the uncertain clinical prospects of human-pig chimera based transplantation makes the reason to spend resources for clarifying whether or not such practice might imply serious ethical breach due to enhanced cognitive capacities of the chimeras rather weak. This as the benefits of further pursuing this avenue of research is so uncertain, so that taking even very unclear risks of serious ethical breach (thus in need of clarification for justification of the research) is not worth the price in terms of spent resources. Secondly, I argue that, as there are some reason to pursue this avenue further (and thus investigate the risk in question), the analogy to the notion of halting all farming of larger animals for food does not hold up. The reason is that we do not need to probe any further any comparable risk to know that such farming practices should be halted.
Research Interests:
Background Emissions of high concentrations of antibiotics from manufacturing sites select for resistant bacteria and may contribute to the emergence of new forms of resistance in pathogens. Many scientists, industry, policy makers and... more
Background Emissions of high concentrations of antibiotics from manufacturing sites select for resistant bacteria and may contribute to the emergence of new forms of resistance in pathogens. Many scientists, industry, policy makers and other stakeholders recognize such pollution as an unnecessary and unacceptable risk to global public health. An attempt to assess and reduce such discharges, however, quickly meets with complex realities that need to be understood to identify effective ways to move forward. This paper charts relevant key actor-types, their stakes and interests, incentives that can motivate them to act to improve the situation, as well as counterincentives that may undermine such motivation. Methods The actor types and their respective interests have been identified using research literature, publicly available documents, websites, and the knowledge of the authors. Results Thirty-three different types of actor-types were identified, representing e.g. commercial actors, public agencies, states and international institutions. These are in complex ways connected by differing and partly similar interests that sometimes may conflict, sometimes pull in the same direction. Some actor types can act to create incentives and counterincentives for others in this area. Conclusions The analysis demonstrates and clarifies the challenges in addressing industrial emissions of antibiotics, notably the complexity of the relations between different types of actors, their international dependency and the need for transparency. The analysis however also suggests possible ways of initiating incentive-chains to eventually improve the prospects of motivating industry to reduce emissions. High resource consumer states, especially in multinational cooperation, hold a key position to initiate such chains.
Research Interests: Bioethics, Sustainable Development, Global Health, Public Health Ethics, Public Health Policy, and 14 moreEnvironmental Health, Health Policy, Environmental Sustainability, Water Pollution, Global Health Policy, Environmental Pollution, Antibiotic Resistance, Antimicrobial drug resistance, Pharmaceuticals, Global Public Health, Drug Resistance, Antibiotics, Pharmaceutical Law, and Pollution Control in Pharmaceutical Industries
Objective: Foster family care is associated with adverse short- and long-term consequences for the child. A systematic review was conducted on interventions for foster children and foster careers. Method: A comprehensive search... more
Objective:
Foster family care is associated with adverse short- and long-term consequences for the child. A systematic review was conducted on interventions for foster children and foster careers.
Method:
A comprehensive search process was used to find eligible interventions evaluated in randomized controlled trials or quasi-experimental studies. The quality of studies was assessed with GRADE, and effects were synthesized using meta-analytic methods.
Results:
In all, 28 publications of 18 interventions, including 5,357 children, were identified. Only three specific interventions had sufficient confidence of evidence. No study had examined tools for foster parent selection nor had evaluated preservice programs related to outcomes.
Discussion:
These analyses provide new insights and hope into the field of systematic interventions in foster care. The overall results indicate that it is possible to improve eight outcomes but cannot point out which programs are superior. Ethically, social care organizations should systematically collect knowledge about effects and side effects.
Keywords foster care, field of practice, systematic review, literature review, adolescents, population, children
Foster family care is associated with adverse short- and long-term consequences for the child. A systematic review was conducted on interventions for foster children and foster careers.
Method:
A comprehensive search process was used to find eligible interventions evaluated in randomized controlled trials or quasi-experimental studies. The quality of studies was assessed with GRADE, and effects were synthesized using meta-analytic methods.
Results:
In all, 28 publications of 18 interventions, including 5,357 children, were identified. Only three specific interventions had sufficient confidence of evidence. No study had examined tools for foster parent selection nor had evaluated preservice programs related to outcomes.
Discussion:
These analyses provide new insights and hope into the field of systematic interventions in foster care. The overall results indicate that it is possible to improve eight outcomes but cannot point out which programs are superior. Ethically, social care organizations should systematically collect knowledge about effects and side effects.
Keywords foster care, field of practice, systematic review, literature review, adolescents, population, children
Research Interests: Applied Ethics, Social Work, Family studies, Research Ethics, Children and Families, and 11 moreFoster Care, Social Care, Family Caregivers/Carers, Children's Rights, Child Protection Social Work, Human Services & Social Work, Health and Social Care, Children in Foster Care, Social Work Ethics, Economics of Health and Social Care, and Social Work Education and Practice
The daring vision of using big data technology to substantially advance the scientific understanding of human nature, individually and socially, and possibly solve age-old challenges of bridging the subjective and objective sides of human... more
The daring vision of using big data technology to substantially advance the scientific understanding of human nature, individually and socially, and possibly solve age-old challenges of bridging the subjective and objective sides of human nature, rests on substantial assumptions about the concept of a human being. The daring big data vision may at the same time, in itself, serve to change the very concept of a human, regardless of how well the vision’s assumptions and prospects hold up to scrutiny. This issue of the European Review presents an attempt to critically engage with the question of how this complex situation affects the content and prospects of the vision of reconsidering humanity with the help of big data. In this introduction, the land scape of the issue is sketched and some general remarks of where the emerging map might take future research are made. In general, even if the assumptions of the daring big data vision turn out wanting, pragmatic factors may very well transform our own image of ourselves to fit it.
Research Interests: Neuroscience, Psychology, Cognitive Science, Computer Science, Anthropology, and 15 morePhilosophy, Philosophy of Mind, Philosophy of Science, Humanities, Digital Humanities, Social Sciences, Philosophy of Social Science, Philosophy of perception, Artistic Research, Cognitive Neuroscience, Fine Arts, Big Data, Humanities and Social Sciences, Big Data Analytics, and Big Data / Analytics / Data Mining
Antibiotic resistance, arising when bacteria develop defences against antibiotics, creates a public health threat of massive proportions. This raises challenging questions for standard notions in bioethics when suitable policy is to be... more
Antibiotic resistance, arising when bacteria develop defences against antibiotics, creates a public health threat of massive proportions. This raises challenging questions for standard notions in bioethics when suitable policy is to be characterised and justified. We examine the particular proposal of expediting innovation of new antibiotics by cutting various forms of regulatory “red tape” in the standard system for the clinical introduction of new drugs. We find strong principled reasons in favour of such lowering of the ethical standards of research and clinical introduction of new antibiotic formulas. However, this support is undermined by pragmatic challenges due to expected responses from stakeholders, creating uncertainty about what policy could actually be effectively implemented. We describe an underlying dilemma on how to rationally justify compromises between ideal ethical justification and pragmatic risks that needs to be further addressed in this light. We suggest a solution to this dilemma related to proposals of expediting antibiotic drug innovation.
Research Interests: Bioethics, Medical Law, Research Ethics, Public Health Ethics, Public Health Policy, and 14 moreMedical Ethics, Technological Innovation, Health Policy, New Antibiotics Discovery, Medical and Research ethics, Antibiotic Resistance, Antimicrobial drug resistance, Research Policy, Medical Ethics & Law, Medical Law and Ethics, Pharmacology Antibiotics, Pharmaceutical Innovation, Antibiotics, and Healthcare Ethics
This article explores ethical aspects of using open argumentation in person centered care (PCC), where health professionals (HPs) openly criticize or contradict factual claims, assumptions, preferences or value commitments of patients. We... more
This article explores ethical aspects of using open argumentation in person centered care (PCC), where health professionals (HPs) openly criticize or contradict factual claims, assumptions, preferences or value commitments of patients. We argue that such disputing may be claimed to have an important place in advanced versions of PCC, but that it actualizes important clinical ethical aspects of doing such disputation well. This may prompt caution in the implementation of PCC, but also inspire educational and organizational reform. We also probe the notion of openly disputing with patients when PCC is applied in less standard settings (where it is nevertheless advocated), using the cases of children, psychiatry and public health interventions, such as antibiotic stewardship programs, as examples. These contexts both offer new reasons for why PCC may or should include open disputing with patients, but also to introduce new ethical complications. Some of these may transform either to arguments against PCC implementation in these areas, or to a more open view of to what extent an HP may seek to dominate patients in a PCC setting. We are especially skeptical about the meaningfulness of applying advanced PCC in areas of psychiatry with high levels of compulsory elements, such as forensic psychiatric detention.
Research Interests: Pediatrics, Psychiatry, Bioethics, Person-centred Therapy, Narrative Medicine, and 17 morePublic Health Ethics, Forensic psychiatry, Health Care Ethics, Doctor-patient communication, Argumentation Theory, Clinical Ethics, Antibiotic Resistance, Patient-Centered Care, Antimicrobial drug resistance, Person Centered Therapy, Drug Resistance, Vaccination, Person Centred Counselling, Healthcare Ethics, Pediatric ethics, Antibiotic stewardship, control of Health care associated infections, and History and Ethics of Psychiatry
We consider the implications for the ethical evaluation of research programs of two fundamental changes in the revised research ethical guideline of the Council for International Organizations of Medical Sciences. The first is the... more
We consider the implications for the ethical evaluation of research programs of two fundamental changes in the revised research ethical guideline of the Council for International Organizations of Medical Sciences. The first is the extension of scope that follows from exchanging “biomedical” for “health-related” research, and the second is the new evaluative basis of “social value,” which implies new ethical requirements of research. We use the example of antibiotic resistance interventions to explore the need to consider what we term the pragmatic risks of such interventions to evaluate the so- cial value of certain kinds of health-related research. These (pragmatic) risks severely threaten the social value of interventions in every area where human and social re- sponses significantly impact on their effectiveness. Thus, the social value of health-re- lated research needed to demonstrate its effectiveness depends on the successful management of such risks. Research designed to take into account pragmatic risks also gives rise to similar types of risks, and the potential for social value in light of those risks needs to be considered in ethical reviews based on the new guidelines. We argue that, to handle this new expanded task, the international system of research ethical review addressed by the guidelines needs institutional development. In particular, we consider lifting research ethical review to a level closer to actual health policy making..
Research Interests: Bioethics, Bioemdical research ethics and policy, Research Ethics, Evidence Based Medicine, Evidence Based Practice, and 16 morePublic Health Ethics, Public Health Policy, Medical Ethics, Public Health, Evidence based Practice (Health Sciences), Health Policy, Global Health Policy, New Antibiotics Discovery, Biomedical research ethics and policy, Medical and Research ethics, Antibiotic Resistance, Antimicrobial drug resistance, Biomedical Ethics, Drug Resistance, Antimicrobial resistance, and Environmental Microbiology - antibiotic resistance
This chapter explores disability-based criticism against what is here called selective reproductive technology (SRT), such as prenatal screening programmes, in light of recent calls for disability theory, as well as political activism... more
This chapter explores disability-based criticism against what is here called selective reproductive technology (SRT), such as prenatal screening programmes, in light of recent calls for disability theory, as well as political activism based on that, to accommodate for an intersectional turn across all types of critical social identity studies (class, disability, gender, lgbt, queer, race, etc.). Applying intersectionality to the disability SRT critique generates complex and provoking implications; not invalidating it, but radically transforming its shape and direction. Most notably, it inserts a wedge between the identity-based experience that SRT unjustly discriminates and oppresses disabled people, and the identity political call for SRT programmes to be shut down or, at least, not publicly supported. Intersectionality steers the justification towards politically addressing structural factors explaining injustice independently of identity-based experience, and SRT programmes may have to be allowed for such action to be sustainable also from a disability identity standpoint.
Research Interests: Bioethics, Disability Studies, Critical Disability Studies, Intersectionality Theory, Medical Ethics, and 15 moreReproductive Ethics, Critical Bioethics, Health Care Ethics, Biopolitics, Bioethics Reproductive Technology, Intersectionality, Disability, Reproductive health, Medical Ethics & Law, Assisted Reproductive Technologies, Bioética, Medical Law and Ethics, Prenatal screening, Preimplantation genetic diagnosis, and Reproductive politics
This article explores the relationship between parental authority, adolescent autonomy, and their respective responsibility. Adolescence is a transitional phase in which the child reaches maturity and takes on the full rights and... more
This article explores the relationship between parental authority, adolescent autonomy, and their respective responsibility. Adolescence is a transitional phase in which the child reaches maturity and takes on the full rights and responsibilities of an adult. During this phase several capacities related to decision-making and moral agency are in drastic flux. We analyse the moral relationship between parents and adolescents in light of recent findings concerning adolescent decision-making in developmental psychology. By combining the mentioned psychological research with standard ideas pertaining to what is required to have a right to self-determination and being responsible we argue that there is reason to believe that adolescents sometimes have a right to make decision that they are not responsible for. If our argument is correct then we face an hithertho unexplored quadrilemma concerning the limits of parental discretion and the distribution of responsibility between parents and child. We present a suggestion for how this quadrilemma may plausibly be resolved.
Research Interests: Applied Philosophy, Ethics, Applied Ethics, Bioethics, Family studies, and 11 moreChildren and Families, Parenting, Moral Development, Moral Philosophy, Parent Child Relationships, Children's Rights, Adolescent, Free Will and Moral Responsibility, Teenagers, Child and Adolescent Psychology, and Adolescents
We address the moral importance of fish, invertebrates such as crustaceans, snails and insects, and other animals about which there is qualified scientific uncertainty about their sentience. We argue that, on a sentientist basis, one can... more
We address the moral importance of fish, invertebrates such as crustaceans, snails and insects, and other animals about which there is qualified scientific uncertainty about their sentience. We argue that, on a sentientist basis, one can at least say that how such animals fare make ethically significant claims on our character. It is a requirement of a morally decent (or virtuous) person that she at least pays attention to and is cautious regarding the possibly morally relevant aspects of such animals. This involves having a moral stance, in the sense of patterns of perception, such that one notices such animals as being morally relevant in various situations. For the person who does not already consider these animals in this way, this could be a big change in moral psychology, and can be assumed to have behavioural consequences, albeit indeterminate. Character has been largely neglected in the literature, which focuses on act-centred approaches (i.e. that the evidence on sentience supports, or does not support, taking some specific action). We see our character-centred approach as complementary to, not superior to, act-centred approaches. Our approach has the advantage of allowing us to make ethically interesting and practically relevant claims about a wider range of cases, but it has the drawback of providing less specific action guidance.
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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... more
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 or if they conflict at fundamental or pragmatic levels. This paper reviews existing literature in both medicine and related philosophy to analyze closer the meaning of the two notions, and to explore the extent to which they overlap or oppose each other, in theory or in practice, in particular regarding ethical assumptions and their respective practical implications.
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The pediatric diabetes team aims to support health, quality of life, and normal growth and development among adolescents with Type 1 Diabetes Mellitus (T1DM). Adolescents with an immigrant background have been found less successful in... more
The pediatric diabetes team aims to support health, quality of life, and normal growth and development among adolescents with Type 1 Diabetes Mellitus (T1DM). Adolescents with an immigrant background have been found less successful in self-care. Previous research indicated that adolescents who had integrated the disease as a part of their self-image reasoned differently about their self-care, to those who had not.
Objective: The aim of the present study was to identify elements in the patient-pediatrician consultations that might influence such integration of the disease among adolescents with T1DM.
Methods: Twelve pediatrician –adolescent consultations were video-recorded and analyzed. The adolescents all had an immigrant background.
Results: Integration of the disease appeared enabled when responsibility was shared, when hope, autonomy and emotions were confirmed, and the pediatrician asked probing questions. Letting objective data dominate the adolescent’s experiences, using risk as a motivator, neutralizing emotions in relation to having diabetes, and confirming forgetfulness may instead inhibit disease integration.
Conclusion: An extended person-centered approach with focus on the adolescent’s experiences of everyday-life with a chronic disease and less attention on physical parameters in the pediatrician-adolescent consultations, may increase integration of the disease.
Objective: The aim of the present study was to identify elements in the patient-pediatrician consultations that might influence such integration of the disease among adolescents with T1DM.
Methods: Twelve pediatrician –adolescent consultations were video-recorded and analyzed. The adolescents all had an immigrant background.
Results: Integration of the disease appeared enabled when responsibility was shared, when hope, autonomy and emotions were confirmed, and the pediatrician asked probing questions. Letting objective data dominate the adolescent’s experiences, using risk as a motivator, neutralizing emotions in relation to having diabetes, and confirming forgetfulness may instead inhibit disease integration.
Conclusion: An extended person-centered approach with focus on the adolescent’s experiences of everyday-life with a chronic disease and less attention on physical parameters in the pediatrician-adolescent consultations, may increase integration of the disease.
Research Interests: Health Psychology, Person-centred Therapy, Diabetes, Self Care, Adolescent Health, and 10 moreMigration And Health, Diabetes Mellitus and Its Complications, Adolescent, Immigrants, Person Centered Therapy, Diabetes mellitus, Self-Care, Child and Adolescent Psychology, Adolescents, and Person Centred Counselling
The field of "machine ethics" has raised the issue of the moral agency and responsibility of artificial entities, like computers and robots under the heading of "artificial moral agents" (AMA). In this article, we work through... more
The field of "machine ethics" has raised the issue of the moral agency and responsibility of artificial entities, like computers and robots under the heading of "artificial moral agents" (AMA). In this article, we work through philosophical assumptions, conceptual and logical variations, and identify methodological as well as conceptual problems based on an analysis of all sides in this debate. A main conclusion is that many of these problems can be better handled by moving the discussion into a more outright normative ethical territory. Rather than locking the issue to be about AMA, a more fruitfull way forward is to address to what extent both machines and human beings should be in different ways included in different (sometimes shared) practices of ascribing moral agency and responsibility.
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Research Interests: Forensic Psychology, Criminal Law, Criminal Justice, Jurisprudence, Applied Philosophy, and 15 moreApplied Ethics, Moral Psychology, Mental Health, Law and Society, Accountability, Legal Theory, Law and Politics, Philosophy Of Law, Forensic psychiatry, Hate Crimes, Legal Philosophy, Responsibility, Hate Crime Law, Hate crime, and Hate Crime Legislation
This article critically assesses recent proposals that an ethics of risk developed independently of standard "factualistic" ethical theory should be based on the assumption of a basic moral right of individuals against being exposed to... more
This article critically assesses recent proposals that an ethics of risk developed independently of standard "factualistic" ethical theory should be based on the assumption of a basic moral right of individuals against being exposed to risks. I argue that core elements that have to be present if the notion of a moral right is to uphold the classic Rawlsian requirement of "taking sertiously the distinction between persons" and of preserving the notion of waiving rights means that an ethics of risk based on this axiom will fail to address its most paramount issues. This, in turn, is due to the nature of the most ethically important risks to be collectively produced, and the subsequent consequence that an ethics of risk needs to be able to acknowledge the moral importance of security against risks as a public good. The article ends by charting three broad theoretical strategies that an ethics of risk may take to face up to this challenge, and discusses the place for rights within these respective theoretical landscapes with mostly skeptocal results.
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So-called ‘existential risks’ present virtually unlimited reasons for probing them and responses to them further. The ensuing normative pull to respond to such risks thus seems to present us with reasons to abandon all other projects and... more
So-called ‘existential risks’ present virtually unlimited reasons for probing them and responses to them further. The ensuing normative pull to respond to such risks thus seems to present us with reasons to abandon all other projects and commit all time, efforts and resources to the management of each existential risk scenario. Advocates of the urgency of attending to existential risk use arguments that seem to lead to this paradoxical result, while they often hold out a wish to avoid it. This creates the ‘black hole challenge’: how may an ethical theory that recognizes the urgency of existential risks justify a limit to how much time and resources are committed to addressing them? This article presents two pathways to this effect by appealing to reasons for limiting the ‘price of precaution’ paid in order to manage risks. The suggestions are different in that one presents ideal theoretical reasons based on an ethical theory of risk, while the other employs pragmatic reasons to modify the application of ideal theoretical ideas. The latter of these ideas is found to be slightly more promising than the first.
Research Interests: Philosophy, Political Philosophy, Ethics, Philosophy of Technology, Applied Ethics, and 16 moreDecision Making, Policy Analysis and Decision Making, Research Ethics, Disaster risk management, Environmental Ethics, Decision And Game Theory, Philosophy of risk, Risk Management, Decision Making Under Uncertainty, Moral Philosophy, Precautionary Principle, Emerging Technologies, Technology Ethics, Uncertainty, Ethics of Emerging Technologies, and Uncertainty analysis
The Swedish solution to the legal handling of professional conscientious refusal in health care is described. No legal right to conscientious refusal for any profession or class of professional tasks exist in Sweden, regardless of the... more
The Swedish solution to the legal handling of professional conscientious refusal in health care is described. No legal right to conscientious refusal for any profession or class of professional tasks exist in Sweden, regardless of the religious or moral background of the objection. The background of this can be found in strong convictions about the importance of public service provision and related civic duties, and ideals about rule of law, equality and non-discrimination. Employee requests to change work tasks are handled case by case within the frames of labour law, ensuring full voluntariness, but also employer privilege regarding the organisations and direction of work, and duties of public institutions to provide services. Two complicating aspects of this solution related to the inclusion of "alternative medical" service providers in a national health service, and professional insistence on conscientious refusal rights to accept legalised assisted dying are discussed. The latter is found to undermine the pragmatic reasons behind recent attempts by pro-life groups to challenge the Swedish solution related to legal abortion in courts.
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Given health care resource constraints, voices are raised to hold patients responsible for their health-choices. In parallel, there is a growing trend towards shared decision-making, aiming to empower patients and give them more control... more
Given health care resource constraints, voices are raised to hold patients responsible for their health-choices. In parallel, there is a growing trend towards shared decision-making, aiming to empower patients and give them more control over health care decisions. More power and control over decisions is usually taken to mean more responsibility for these. The trend of shared decision-making would therefore seem to strengthen the case for invoking individual responsibility in health care priority setting.
Objective and Design
The objective was to analyze whether the implementation of shared decision-making would strengthen the argumentative support for invoking individual responsibility in health-care priority setting, using normative analysis.
Results and Conclusions
Shared decision-making does not constitute an independent argument in favor of employing individual responsibility since these notions rest on different underlying values. However, these theoretical tensions do not constitute a problem for combining these phenomena in practice. If a health system employs shared decision-making, individual responsibility may be used to limit resource implications of accommodating patient preferences outside of professional standards and goals. If a health care system employs individual responsibility, high level dynamic shared decision-making may disarm common objections to the applicability of individual responsibility, in virtue of making them more likely to exercise adequate control of their own actions. However, if communication strategies applied in the shared decision-making are misaligned to the patient's initial capacities, the result may be the opposite. Non high-level dynamic types of shared decision-making would not seem to affect the applicability of individual responsibility at all.
Objective and Design
The objective was to analyze whether the implementation of shared decision-making would strengthen the argumentative support for invoking individual responsibility in health-care priority setting, using normative analysis.
Results and Conclusions
Shared decision-making does not constitute an independent argument in favor of employing individual responsibility since these notions rest on different underlying values. However, these theoretical tensions do not constitute a problem for combining these phenomena in practice. If a health system employs shared decision-making, individual responsibility may be used to limit resource implications of accommodating patient preferences outside of professional standards and goals. If a health care system employs individual responsibility, high level dynamic shared decision-making may disarm common objections to the applicability of individual responsibility, in virtue of making them more likely to exercise adequate control of their own actions. However, if communication strategies applied in the shared decision-making are misaligned to the patient's initial capacities, the result may be the opposite. Non high-level dynamic types of shared decision-making would not seem to affect the applicability of individual responsibility at all.
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In this article we discuss how health professionals should monitor and safeguard patients' abilities to take part in clinical decisions and their implementation. Such a task is essential e.g. in self-care situation where patient is... more
In this article we discuss how health professionals should monitor and safeguard patients' abilities to take part in clinical decisions and their implementation. Such a task is essential e.g. in self-care situation where patient is responsible for most regular care. Here, argue that a common fact-oriented strategy of patient education in practice tends to take the form of what we call errorthrawling. Illustrated by empirical findings from a video study of consultation meetings in adolescent diabetes care, we argue that this strategy both tends to miss significant capacity weaknesses, and even undermine capacities. In effect, this strategy for clinically monitoring and addressing the decision capacities of patients where these are fragile seems to be incomplete and actually hazardous. We close by suggesting complementary and alternative strategies, and comment on how these may actualise a need of a broadened competence of clinical health professionals.
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Redan fosterdiagnostikens historia ger anledning till reflektion över hur värderingarna bakom denna verksamhet förhåller sig till de motiv som låg bakom den svenska tvångssteriliseringspolitiken. Både steriliseringspolitiken och... more
Redan fosterdiagnostikens historia ger anledning till reflektion över hur värderingarna bakom denna verksamhet förhåller sig till de motiv som låg bakom den svenska tvångssteriliseringspolitiken. Både steriliseringspolitiken och fosterdiagnostiken springer ur samma vetenskapliga grunddisciplin (genetiken) och tiden då fosterdiagnostiken introducerades i den svenska vården sammanfaller med steriliseringserans sista år (första hälften av 1970-talet). Det finns också personella kopplingar mellan det medicinska ...
Med etiska principer avses här grundläggande uppfattningar om vad som är önskvärt respektive icke önskvärt med avseende på mänskliga handlingar och deras effekter. Sådana uppfattningar kan formuleras som generella normer eller värderingar... more
Med etiska principer avses här grundläggande uppfattningar om vad som är önskvärt respektive icke önskvärt med avseende på mänskliga handlingar och deras effekter. Sådana uppfattningar kan formuleras som generella normer eller värderingar vilka anger vad som ytterst avgör om ett visst handlingssätt är moraliskt förbjudet, acceptabelt eller påbjudet. Inom såväl grundläggande moralfilosofi som den mer specialinriktade medicinska etiken finns en rad sinsemellan oförenliga förslag på sådana principer. I det fall dessa ger ...
The debate on the ethics of screening programmes in recent years has developed into one of the largest and most complex fields within public health ethics. This chapter unravels and discusses some of the basic themes within this debate,... more
The debate on the ethics of screening programmes in recent years has developed into one of the largest and most complex fields within public health ethics. This chapter unravels and discusses some of the basic themes within this debate, such as the criteria of screening, the role of consent and the public dimension of screening activities, as well as considerations that are specific to the different types of screening programmes, that is, prenatal, newborn, children and adolescent, cancer, genetic, communicable disease, and forensic screening.
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This article analyses the idea of a legal right to conscientious refusal (CR) for health care professionals (HCP) from a basic legal ethical standpoint, using refusal to perform tasks related to legal abortion in cases of voluntary... more
This article analyses the idea of a legal right to conscientious refusal (CR) for health care professionals (HCP) from a basic legal ethical standpoint, using refusal to perform tasks related to legal abortion in cases of voluntary employment as a case in point. Th idea of a legal right to CR is distinguished from ideas regarding moral rights or reasons related to CR, and none of the latter are found to support the notion of a legal right. Reasons for allowing some sort of room for CR for HCPs based on the importance of cultural identity and the fostering of a critical atmosphere might provide some support, if no countervailing factors apply. One such factor is that a legal right to HCP’s CR must comply with basic legal ethical tenets regarding the rule of law and equal treatment, and this requirement is found to create serious problems for defending the idea under consideration. We conclude that the notion of a legal right to CR for any profession is either fundamentally incompatible with elementary legal ethical requirements, or implausible due to undermining the functionality of the related professional sector (e.g., helath care) or even society as a whole.
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This article argues that standard models of person-centred care (PCC) and shared decision-making (SDM) rely on simplistic, often unrealistic assumptions of patient capacities which entail that PCC/SDM might have detrimental effects in... more
This article argues that standard models of person-centred care (PCC) and shared decision-making (SDM) rely on simplistic, often unrealistic assumptions of patient capacities which entail that PCC/SDM might have detrimental effects in many applications. We suggest a complementary PCC/SDM approach to ensure that patients are able to execute rational decisions taken jointly with care professionals when performing self-care. Illustrated by concrete examples from a study of adolescent diabetes care, we suggest a combination of moral and psychological considerations to support the claim that standard PCC/SDM threatens to systematically undermine its own goals. This threat is due to a tension between the ethical requirements of SDM in ideal circumstances and more long-term needs actualized by the context of self-care handled by patients with limited capacities for taking responsibility and adhere to their own rational decisions. To improve this situation, we suggest a counseling, self-care, adherence approach to PCC/SDM, where more attention is given to how treatment goals are internalized by patients, how patients perceive choice-situations, and what emotional feedback patients are given. This focus may involve less of a concentration on autonomous and rational clinical decision-making otherwise stressed in standard PCC/SDM advocacy.
Research Interests: Health Psychology, Pediatrics, Moral Psychology, Bioethics, Decision Making, and 10 morePerson-centred Therapy, Diabetes, Medical Ethics, Diabetes Mellitus and Its Complications, Shared decision making, Adolescence (Psychology), Person Centered Therapy, Adolescence, Pediatrics and Child Health, and Person Centred Counselling
Daniel Steel’s new book on the precautionary principle illustrates the need to work ahead to fuse perspectives of epistemology and philosophy of science with those of ethics to accomplish progress in the debate on the proper role of... more
Daniel Steel’s new book on the precautionary principle illustrates the need to work ahead to fuse perspectives of epistemology and philosophy of science with those of ethics to accomplish progress in the debate on the proper role of precaution in a broad selection of bioethical areas. Steel advances the territory greatly with regard to conceptual clarity and epistemology, but from a bioethics standpoint he is mistaken in discounting the need for ethical underpinnings of a sound theory of the precautionary principle.
Research Interests: Philosophy of Science, Philosophy of Technology, Applied Ethics, Bioethics, Decision Making, and 8 morePolicy Analysis and Decision Making, Environmental Ethics, Philosophy of risk, Environmental Policy and Governance, Risk Management, Science and Technology Policy, Precautionary Principle, and Ethics of Risk
Objectives: Assessment of ethical aspects of a technology is an important component of health technology assessment (HTA). Nevertheless, how the implementation of ethical assessment in HTA is to be organized and adapted to specific... more
Objectives: Assessment of ethical aspects of a technology is an important component of health technology assessment (HTA). Nevertheless, how the implementation of ethical assessment in HTA is to be organized and adapted to specific regulatory and organizational settings remains unclear. The objective of this study is to present a framework for systematic identification of ethical aspects of health technologies. Furthermore, the process of developing and adapting the framework to a specific setting is described.
Methods: The framework was developed based on an inventory of existing approaches to identification and assessment of ethical aspects in HTA. In addition, the framework was adapted to the Swedish legal and organizational healthcare context, to the role of the HTA agency and to the use of non-ethicists. The framework was reviewed by a group of ethicists working in the field as well as by a wider set of interested parties including industry, interest groups, and other potential users.
Results: The framework consists of twelve items with sub-questions, short explanations, and a concluding overall summary. The items are organized into four different themes: the effects of the intervention on health, its compatibility with ethical norms, structural factors with ethical implications, and long term ethical consequences of using the intervention.
Conclusions: In this study, a framework for identifying ethical aspects of health technologies is proposed. The general considerations and methodological approach to this venture will hopefully inspire and present important insights to organizations in other national contexts interested in making similar adaptations.
Methods: The framework was developed based on an inventory of existing approaches to identification and assessment of ethical aspects in HTA. In addition, the framework was adapted to the Swedish legal and organizational healthcare context, to the role of the HTA agency and to the use of non-ethicists. The framework was reviewed by a group of ethicists working in the field as well as by a wider set of interested parties including industry, interest groups, and other potential users.
Results: The framework consists of twelve items with sub-questions, short explanations, and a concluding overall summary. The items are organized into four different themes: the effects of the intervention on health, its compatibility with ethical norms, structural factors with ethical implications, and long term ethical consequences of using the intervention.
Conclusions: In this study, a framework for identifying ethical aspects of health technologies is proposed. The general considerations and methodological approach to this venture will hopefully inspire and present important insights to organizations in other national contexts interested in making similar adaptations.
Research Interests:
Precautionary reasoning has deep historical and wide cross-cultural roots in the ethics of health, health care and medical research. As in general ethics, however, this side of bioethical thinking has not been the subject of focused... more
Precautionary reasoning has deep historical and wide cross-cultural roots in the ethics of health, health care and medical research. As in general ethics, however, this side of bioethical thinking has not been the subject of focused critical analysis until recently. The emergence of the precautionary principle (PP) in general environmental and technology policy debate has, after an initial period of confusion, resulted in a range of possible ideas about the value of precaution and what sacrifices it may be worth. This has indicated some need for developments in ethical as well as decision theory. In bioethical debates, this process has left only vague traces, however. Although many issues exist where precautionary reasoning has a place, this is either often left unnoticed, or arguments developed suffer from elementary flaws. Environmental and general public health ethics, the ethics of evidence-based practice in research as well as clinical decision-making, management of normative or factual uncertainty and the nature of clinical ethical virtues are all areas where precautionary ideas seem to have a place. Such reasoning moreover has specific relevance for global approaches to bioethics and health policy issues in a number of ways.
Research Interests: Bioethics, Research Ethics, Disaster risk management, Global Health, Risk and Vulnerability, and 11 moreMedical Ethics, Risk Management, Decision Making Under Uncertainty, Bioethics Reproductive Technology, Precautionary Principle, Risk Assessment & Risk Management, Medical and Research ethics, Emerging Technologies, Medical Ethics & Law, Medical Law and Ethics, and Global Bioethics
In this introduction to the special symposium on the philosophy of hate crime, we provide an overview of the main philosophical aspects of hate crime and hate crime legislation. We point out that there are two overarching philosophical... more
In this introduction to the special symposium on the philosophy of hate crime, we provide an overview of the main philosophical aspects of hate crime and hate crime legislation. We point out that there are two overarching philosophical issues that span over the literature: the Conceptual Question—concerning what hate crime is—and the Normative Question—concerning the status of hate crimes and the justification of hate crime legislation. We also provide brief summaries of the articles in the special section and point to their relations to the broader themes.
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Comment from a medical ethics research perspective on a debate on whether and how to involve patients in decisions between options with differentrisk-benefit profiles in high-stakes neurosurgery between Hugues Duffau and Jannick Brennum... more
Comment from a medical ethics research perspective on a debate on whether and how to involve patients in decisions between options with differentrisk-benefit profiles in high-stakes neurosurgery between Hugues Duffau and Jannick Brennum and colleagues.
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The vision of legendary criminologist Cesare Lombroso to use scientific theories of individual causes of crime as a basis for screening and prevention programmes targeting forensic risk-individuals has resurfaced, following advances in... more
The vision of legendary criminologist Cesare Lombroso to use scientific theories of individual causes of crime as a basis for screening and prevention programmes targeting forensic risk-individuals has resurfaced, following advances in genetics, neuroscience and psychiatric epidemiology. This article analyses this idea and maps its ethical implications from a public health ethical standpoint. Twenty-seven variants of the new Lombrosian vision of forensic screening and prevention are distinguished, and some scientific and technical limitations are noted. Some lures, biases and structural factors, making the application of the Lombrosian idea likely in spite of weak evidence are pointed out and noted as a specific type of ethical aspect. Many classic and complex ethical challenges for health screening programmes are shown to apply to the identified variants and the choice between them, albeit with peculiar and often provoking variations. These variations are shown to actualise an underlying theoretical conundrum in need of further study, pertaining to the relationship between public health ethics and the ethics and values of criminal law policy.
Research Interests: Neuroscience, Criminology, Neuropsychology, Forensic Psychology, Criminal Law, and 21 moreCriminal Justice, Jurisprudence, Forensic Anthropology, Bioethics, Violence, Forensic Genetics, Legal Theory, Public Health Ethics, Public Health Policy, Forensic psychiatry, Violence Prevention, Neuroethics, Philosophy of Criminal Law, Legal Ethics, Public Health, Legal Philosophy, Crime Prevention, Neurolaw, Screening, Crime, and Neurocriminology
A new landscape of prenatal testing (PNT) is presently developing, including new techniques for risk-reducing, non-invasive sampling of foetal DNA and drastically enhanced possibilities of what may be rapidly and precisely analysed,... more
A new landscape of prenatal testing (PNT) is presently developing, including new techniques for risk-reducing, non-invasive sampling of foetal DNA and drastically enhanced possibilities of what may be rapidly and precisely analysed, surrounded by a growing commercial genetic testing industry and a general trend of individualisation in health care policies. This article applies a set of established ethical notions from debates on PNT of the past for analysing PNT screening-programs in this new situation. While some basic challenges of PNT stay untouched, the new development supports a radical individualisation of how PNT screening is organised. This reformation is, at the same time, difficult to reconcile with responsible spending of resources in a publicly funded health care context. Thus, while the ethical imperative of individualisation holds and applies to PNT, the new landscape of PNT provides reasons to start rolling back the type of mass-screening programs currently established in many countries. Instead, more limited offers, based on considerations of severity of conditions and optimised to simultaneously serve reproductive autonomy and public health within an acceptable frame of priorities, is suggested. The new landscape of PNT furthermore underscores the ethical importance of supporting and including people with disabilities. For the very same reason, no ban on what may be analysed using PNT in the new landscape should be applied, albeit private offers must, of course, conform to strict requirements of respecting reproductive autonomy and what that means in terms of counselling.
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Research Interests:
Following the statement in the United Nations' Rio Declaration of 1992 that countries should apply a “precautionary approach” in policymaking on environmental and technological issues, the notion of a precautionary principle (PP) has... more
Following the statement in the United Nations' Rio Declaration of 1992 that countries should apply a “precautionary approach” in policymaking on environmental and technological issues, the notion of a precautionary principle (PP) has gained ground in worldwide policymaking and regulation, thus catching the interest of ethics scholars. Although seldom explained in much detail, and resulting in quite different policy results in different countries and areas (O'Riordan et al. 2001; Sandin 1999; Trouwborst 2002; Zander 2010), PP is generally understood as a norm urging or permitting policymakers to take preventive action in the face of unknown, uncertain, or probable dangers, motivated by the experience of how seemingly valuable and promising practices may lead to seriously adverse consequences in spite of lack of solid evidence to this effect (Sandin 1999). In ethics debate, this idea has been applied not only to matters regarding the large-scale introduction and use of technology (e.g., regarding energy production, transport and communication, nano- or biotechnology, and so on) (see Biotechnology; Nanotechnology, Ethics of) with possible ensuing impact on the natural environment connecting to the notion of sustainability (see Sustainability), but also, for example, to abortion (see Abortion), medical genetics, embryo experimentation (see Embryo Research), the treatment of animals (see Animal Experimentation), terrorism (see Terrorism), and general research ethics (see Research Ethics) (Munthe 2011). Many of these applications advocate strong conclusions in spite of the fact that PP or its normative justification have not been made very clear. At the same time, PP has been the subject of criticism, much of which boils down to three points: lack of clarity, lack of practicality, and/or ethical implausibility. Curiously, these critical points have often been made in conjunction, in spite of the fact that a clear sense of what PP means seems necessary for backing up the other two objections.
Research Interests: Emotion, Applied Philosophy, Political Philosophy, Ethics, Environmental Philosophy, and 17 moreApplied Ethics, Bioethics, Disaster risk management, Environmental Ethics, Risk, Philosophy of risk, Risk Management, Risk communication, Decision Making Under Uncertainty, Risk assessment, Environmental ethics (Philosophy) (Philosophy), Precautionary Principle, Decision Theory, Risk Assessment & Risk Management, Ethics of Risk, Risk Ethics, and Risk Politics
The notion of the best interest of children figures prominently in family and reproductive policy discussions and there is a considerable body of empirical research attempting to connect the interests of children to how families and... more
The notion of the best interest of children figures prominently in family and reproductive policy discussions and there is a considerable body of empirical research attempting to connect the interests of children to how families and society interact. Most of this research regards the effects of societal responses to perceived problems in families, thus underlying policy on interventions such as adoption, foster care and temporary assumption of custodianship, but also support structures that help families cope with various challenges. However, reference to the best interest of children can also be applied to a more basic issue in family policy, namely that of what is to be considered a family in the first place. This issue does not raise any questions regarding the proper conditions for when society should intervene in or change the family context of a child. Rather, it is about what social configurations should be recognized as a potentially fitting context for children to enter into and (if all goes well) eventually develop into adulthood within /.../ such that society’s default institutional arrangements allow it to have (by sexual and artificial reproduction, adoption, and combinations of these), care for and/or guard children. [This] will frame any further discussion of /.../ policies having further implications for, for example, the practices of adoption and reproductive technology, as well as regulation of custody in the event of separation or parental disagreement.
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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... more
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 this implies in terms of the importance that we have reason to attach to (non-)adherence and how has, however, not been explained. In this article, we explore the relationship between different forms of shared decision-making, patient autonomy and adherence. Distinguishing between dynamically and statically framed adherence we show how the version of shared decision-making advocated will have consequences for whether one should be interested in a dynamically or statically framed adherence and in what way patient adherence should be assessed. In contrast to the former compliance paradigm (where non-compliance was necessarily seen as a problem), using observations about (non-)adherence to assess the success of health care decision making and professional-patient interaction turns out to be a much less straightforward matter.
Key words: Adherence, Compliance, Patient Autonomy, Patient Best Interest, Shared Decision-Making
Key words: Adherence, Compliance, Patient Autonomy, Patient Best Interest, Shared Decision-Making
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The debate on Coleman's study has moved into ethics, as commentators claim it to support conclusions about the organisation of abortion services (AS). In her reply, Coleman sides with these voices. However, closer scrutiny puts these... more
The debate on Coleman's study has moved into ethics, as commentators claim it to support conclusions about the organisation of abortion services (AS). In her reply, Coleman sides with these voices. However, closer scrutiny puts these suggestion into question.
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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... more
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 of broad advancements towards PCC/SDM, need to be considered by health care ethics researchers. Given a PCC/SDM-based reorientation of health care practice, such ethics research is essential from a quality assurance perspective.
Research Interests: Nursing, Philosophy, Applied Philosophy, Ethics, Bioethics, and 17 morePhilosophy of Medicine, Health Care Policy, Caring Science, Patient Provider Communication, Medication Adherence, Medical Ethics, Concepts of Value in Health Care, Health Care Education, Health Care Ethics, Linguistics, Clinical Decision-Making, Health Policy, Medicine And Health Care, Shared decision making, Ethics in Nursing, Ethics in Health Care, and Person centered care
Countries worldwide have very different national regulations on human embryonic stem (ES) cell research, informed by a range of ethical values. Some countries find reason to extend the applicability of their regulations on such research... more
Countries worldwide have very different national regulations on human embryonic stem (ES) cell research, informed by a range of ethical values. Some countries find reason to extend the applicability of their regulations on such research to its citizens when they visit other countries. Extraterritorial jurisdiction has recently been identified as a potential challenge towards global regulation of ES cell research. This chapter explores the implications and impact of extraterritorial jurisdiction and global regulation of ES cell research on researchers, clinicians and national health systems, and how this may affect patients. The authors argue that it would make ethical sense for ES cell restrictive countries to extend its regulations on ES cell research beyond its borders, because, if these countries really consider embryo destruction to be objectionable on the basis on the status of the embryo, then they ought to count it morally on par with murder (and thus have a moral imperative to protect embryos from the actions of its own citizens). However, doing so could lead to a legal situation that would result in substantial harm to central values in areas besides research, such as health care, the job market, basic freedom of movement, and strategic international finance and politics. Thus, it seems that restrictive extraterritorial jurisdiction in respect to ES cell research would be deeply problematic, given that the ethical permissibility of ES cell research is characterised by deep and wide disagreement.
Read More: http://www.worldscientific.com/doi/abs/10.1142/9781848164383_0004
Read More: http://www.worldscientific.com/doi/abs/10.1142/9781848164383_0004
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This paper analyses ethical issues in forensic psychiatric research on mentally disordered offenders, especially those detained in the psychiatric treatment system. The idea of a ‘dual role’ dilemma afflicting forensic psychiatry is more... more
This paper analyses ethical issues in forensic psychiatric research on mentally disordered offenders, especially those detained in the psychiatric treatment system. The idea of a ‘dual role’ dilemma afflicting forensic psychiatry is more complicated than acknowledged. Our suggestion acknowledges the good of criminal law and crime prevention as a part that should be balanced against familiar research ethical considerations. Risks of research subjects being burdened by improvements of criminal justice due to research should not be seen as weighty reasons. Direct substantial risks must be balanced by health benefits, and normal informed consent requirements apply. When direct risks are slight, as in register-based epidemiology, lack of consent may be counter-balanced by special measures to protect integrity and the general benefit of better understanding of treatment and prevention. Special requirements on consent procedures in the forensic psychiatric context are suggested, and the issue of the relation between decision competence and legal accountability is found to be in need of further study. The major ethical hazard in forensic psychiatric research connects to the role of researchers as assessors and consultants in a society entertaining strong prejudices against mentally disordered offenders.
Keywords: dual role dilemma, ethics, forensic psychiatry, informed consent, mentally disordered offenders, public good, research ethics
Keywords: dual role dilemma, ethics, forensic psychiatry, informed consent, mentally disordered offenders, public good, research ethics
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The development of forensic psychiatric risk assessments is discussed from a clinical point of view using the example of Sweden. A central task in forensic psychiatry has traditionally been to identify dangerous, mentally disordered... more
The development of forensic psychiatric risk assessments is discussed from a clinical point of view using the example of Sweden. A central task in forensic psychiatry has traditionally been to identify dangerous, mentally disordered subjects considered to be prone to commit violent acts. Over time, “dangerousness” has been reworded into “risk”. Nevertheless, such assessments have generally been based on the psychiatric factors characterising the individual patient, while group interaction, situational factors, or social and cultural circumstances, such as the availability of alcohol and drugs, have been largely overlooked. That risk assessments have a focused on people with a diagnosis of “mental disorder” and been used as grounds for coercive measures and integrity violations has somehow been accepted as a matter of course in the public and political debate. Even the basic question whether offenders with a mental disorder are really more prone to criminal recidivism than other offenders seems to have been treated light-handedly and dealt with merely by epidemiological comparisons between groups of persons with broad ranges of psychosocial vulnerability and the general population. Legal texts, instructions and guidelines from the authorities in charge are often vague and general, while actors in the judicial system seem to put their trust in psychiatric opinions. The exchange of professional opinions, general public expectations, and judicial decision processes poses a huge risk for misunderstandings based on divergent expectations and uses of terminology.
Research Interests:
Research Interests:
The recently revised CIOMS guidelines radically broaden both that scope of the guidelines from medical to all kinds of health research), and the basis on which such research may be assessed ethically, not least what is called ”social... more
The recently revised CIOMS guidelines radically broaden both that scope of the guidelines from medical to all kinds of health research), and the basis on which such research may be assessed ethically, not least what is called ”social value” of research. This makes these guidelines less on a par with the WMA’s Declaration of Helsinki principles for biomedical research, e.g. with regard to what kind of benefits may justify risks to research subjects and others, and ethical requirements regarding the management of such risks. While DoH still mostly expresses an orthodox individualist research ethical perspective of a sort that has enjoys traditional support in bioethics, but has attracted some criticism from a public health ethical perspective, the new CIOMS guidelines seem to open up for more consideration of collective, institutional and public goods, and possibility of having these traded off against risks to individuals. This paper uses interventions meant to prevent or mitigate problems due to antibiotic resistance as a case in point, to discuss how a sound research ethical regulation should position itself with regard to research regarding health interventions of great importance for (global) public health. A particular focus will be the balancing of individual and collective goods/bads in face of threats of having core institutions and central public goods undermined.
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Shared decision-making and person centred care (PCC/SDM) are increasingly embraced framework conceptions on how to organise health care's interaction with patients. Although underlying ethical motivation may vary, PCC/SDM holds ideals of... more
Shared decision-making and person centred care (PCC/SDM) are increasingly embraced framework conceptions on how to organise health care's interaction with patients. Although underlying ethical motivation may vary, PCC/SDM holds ideals of a greater adaption of health care to individual circumstances, and of recognising patients as collaborators in clinical decision-making. The PCC/SDM notion has migrated quickly across many areas where it is less clear how it applies, due to patients being in non-standard conditions with regard to personal capacities or care context, and detected to offer a number of peculiar ethical and practical challenges. But the migration has also reached areas with even less similarity to the original PCC/SDM landscape of somatic hospital care. In this presentation, we describe – based on comissioned and work in a Swedish context and ongoing research studies – three examples of this expansion and survey these for extra ethical complications: forensic care, social services and public health (outside of health care institutions). Each area offers peculiar extra ethical challenges for PCC/SDM, as they depart extensively from standard assumptions by, in various ways, embracing goals not built on the standard individualist assumptions of health care ethics. It is possible to implement adapted forms of PCC/SDM to these areas, but these cannot be assumed to serve ideals of emancipating, empowering or recognising individuals as persons. Rather, they have to be viewed though a lens of public goods aimed for in the respective areas. Clients and patients are entitled to be made aware of this fact, but regardless of this, the mentioned perspective-shift will pose particular challenges for health professionals. At the same time, PCC/SDM strategies may also open up for approaches to resolving these tensions and meet typical challenges that would otherwise have remained out of reach.
Research Interests: Forensic Psychology, Applied Ethics, Social Work, Bioethics, Person-centred Therapy, and 11 morePublic Health Ethics, Social Care, Forensic psychiatry, Medical Ethics, Public Health, Shared decision making, Antibiotic Resistance, Antimicrobial drug resistance, Person Centered Therapy, Health and Social Care, and Person Centred Counselling
Reproductive bioethics has almost entirely proceeded within an individualist paradigm, where rights of parties are set against each other or societal interests. This paper takes some steps to analyse what happens if the ethical analysis... more
Reproductive bioethics has almost entirely proceeded within an individualist paradigm, where rights of parties are set against each other or societal interests. This paper takes some steps to analyse what happens if the ethical analysis of reproductive medicine and policy is instead approached based on public health ethical assumptions. That is, the general issues are about how society should organise itself with regard to the procreation of its population, and particular issues regarding, e.g., abortion, ART, contraception, pregnancy care, prenatal testing, etc. are analysed from that standpoint. Albeit there has been some public health ethical attention to sexual health issues, this way of approaching reproductive ethics has been ignored almost entirely, with a handful of exceptions the last few years taking account of, e.g., public expenditure on ART and environmental concerns linked to population policy. This presentation aims to sketch a preliminary theoretical framework for a general theory of reproductive public health ethics, within which such and further attempts may be placed and critically analysed, and to compare it to the traditional formats of reproductive bioethics. A general theory of reproductive public health ethics will view reproductition as a social rather than biological process, taking place at a collective level, and its values will hence be public goods and aggregates, while notions of individual rights and interests will not be primary. This view also means that there is no basic relevant distinction to be made between procreating a population through migration and through biological reproduction. The presentation will also make some work at preparing further analysis of the obvious conflicts and tensions bound to arise between this perspective on reproduction and that of standard reproductive bioethics.
Research Interests: Applied Ethics, Bioethics, Sexual and Reproductive Health, Migration, Public Health Ethics, and 15 morePublic Health Policy, Environmental Health, Reproductive Ethics, International Migration, Migration Studies, Transnational migration, Health Policy, Bioethics Reproductive Technology, Population Ethics, International Migration and Immigration Policy, Reproductive health, Assisted Reproductive Technologies, Sexual and reproductive health and rights, Population Policy, and Ethics of Migration
TOPIC AND PROBLEM Shared decision-making and person centred care (PCC/SDM) are increasingly embraced frameworks for how to organise health care's continuous interaction with patients based on a personal narrative about their general... more
TOPIC AND PROBLEM Shared decision-making and person centred care (PCC/SDM) are increasingly embraced frameworks for how to organise health care's continuous interaction with patients based on a personal narrative about their general life-situation facilitating greater adaption to individual circumstances and recognition of patients as collaborators in clinical decision-making as main ingredients. PCC/SDM has migrated into areas where patients are in non-standard conditions (e.g., dementia care and pediatrics), actualising peculiar problems to achieve PCC/SDM core values of combining enhanced adherence to promote individual health outcomes, and empowered capabilities to boost patient autonomy. More recently, the migration has reached areas even farther removed from the PCC/SDM context of patient focused somatic hospital care with individual health and autonomy as core values, aiming rather for conformity to external norms, collective outcomes and achievement of public goods, such as social order, cohesion and prosperity. We contrast the standard ethical basis of PCC/SDM with the three areas of (compulsory) forensic psychiatric care, social services, and public health exemplified by antibiotic resistance prevention programmes, with the respective core values and main objectives marked in a red colour, and examples to illustrate concrete areas of ethical tension and conflict to standard PCC/SDM assumptions.
Research Interests:
Reproductive bioethics has almost entirely proceeded within an individualist paradigm, where rights of parties are set against each other or societal interests. This paper takes some steps to analyse what happens if the ethical analysis... more
Reproductive bioethics has almost entirely proceeded within an individualist paradigm, where rights of parties are set against each other or societal interests. This paper takes some steps to analyse what happens if the ethical analysis of reproductive medicine and policy is instead approached based on public health ethical assumptions. That is, the general issues are about how society should organise itself with regard to the procreation of its population, and particular issues regarding, e.g., abortion, ART, contraception, pregnancy care, prenatal testing, etc. are analysed from that standpoint. Albeit there has been some public health ethical attention to sexual health issues, this way of approaching reproductive ethics has been ignored almost entirely, with a handful of exceptions the last few years taking account of, e.g., public expenditure on ART and environmental concerns linked to population policy. This presentation aims to sketch a preliminary theoretical framework for a general theory of reproductive public health ethics, within which such and further attempts may be placed and critically analysed, and to compare it to the traditional formats of reproductive bioethics.
A general theory of reproductive public health ethics will view reproductition as a social rather than biological process, taking place at a collective level, and its values will hence be public goods and aggregates, while notions of individual rights will not be primary. This view also means that there is no basic relevant distinction to be made between procreating a population through migration and through biological reproduction.
A general theory of reproductive public health ethics will view reproductition as a social rather than biological process, taking place at a collective level, and its values will hence be public goods and aggregates, while notions of individual rights will not be primary. This view also means that there is no basic relevant distinction to be made between procreating a population through migration and through biological reproduction.
Research Interests:
Research Interests:
Invited keynote lecture at the kickoff meeting of the Centre for Antibiotic Resistance research (CARe), University of Gothenburg
Research Interests: Bioethics, Health Care Policy, Global Health, Public Health Ethics, Public Health Policy, and 13 moreEnvironmental Ethics, Medical Ethics, Health Care Ethics, Public Health, Health Policy, Global Health Policy, New Antibiotics Discovery, Antibiotic Resistance, Antimicrobial drug resistance, Drug Resistance, One Health, Antibiotics, and Environmental Microbiology - antibiotic resistance
Research Interests: Applied Ethics, Bioethics, Public Health Law, Sexual and Reproductive Health, Migration, and 12 morePublic Health Ethics, Public Health Policy, Environmental Health, Medical Ethics, Population Health, Migration Studies, Public Health, Health Policy, Bioethics Reproductive Technology, Reproductive health, Assisted Reproductive Technologies, and Population Studies
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Research Interests:
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This paper analyses, from a normative and taxonomical standpoint, the apparent fact that what forensic psychiatry (FP) as a science or a branch of medicine focus on is necessarily socially constructed in a specific way relating to... more
This paper analyses, from a normative and taxonomical standpoint, the apparent fact that what forensic psychiatry (FP) as a science or a branch of medicine focus on is necessarily socially constructed in a specific way relating to positive law. FP busies itself with conditions which are (a) mental health problems (in itself partly socially determined) and (b) linked to criminality – especially severe criminality – in turn a concept determined by actual legal statutes in a given society. This notion of what FP ”is about" has to be held distinct from the idea of FP researching the possible causal connection between mental health factors and specific crimes of behaviour
types, or that of FP employing mental health care interventions to influence the tendency of criminal or other sort of behaviour. While FP may certainly (attempt to) do these things (implying an interest in specific parts of nature, specific expertise, etc), the issue of how to characterize its generic object of study, interest or action is more profoundly conceptual in that it may inform us about what FP is and what object may or may not be properly studied or intervened upon based on FP. This, in turn, will also provide an answer to what exactly the expertise of an FP specialist is supposed to be about, as well as pertain to disputes over the proper social authority and impact of knowledge coming out of the FP area. The paper will
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explore and compare three distinct strategies for providing an answer to this question, which are both criticised from a normative and philosophical perspective. First, FP might try to characterise its object of interest by embracing the socio-political relativity implied by the fact that criminal law, implying that the object of FP changes with every difference between jurisdiction across countries as well as over time. This seems to imply that there is no such thing as one object of FP, no specific FP expertise, and so on and thus undermines the idea of FP as a science, specific health care speciality or expertise. Second, FP may adopt a very abstract definition of its object, possible to include all jurisdictional variations one might imagine. This, however, seems to imply a problematic boundlessness: the idea that practically any behaviour or human condition is a proper concern of FP (since any such may be criminalized in some jurisdiction). This, in turn implies normative problems both with regard to the claims about a particular FP expertise and with regard to the ethical integrity of FP as a scientific and medical field.
types, or that of FP employing mental health care interventions to influence the tendency of criminal or other sort of behaviour. While FP may certainly (attempt to) do these things (implying an interest in specific parts of nature, specific expertise, etc), the issue of how to characterize its generic object of study, interest or action is more profoundly conceptual in that it may inform us about what FP is and what object may or may not be properly studied or intervened upon based on FP. This, in turn, will also provide an answer to what exactly the expertise of an FP specialist is supposed to be about, as well as pertain to disputes over the proper social authority and impact of knowledge coming out of the FP area. The paper will
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explore and compare three distinct strategies for providing an answer to this question, which are both criticised from a normative and philosophical perspective. First, FP might try to characterise its object of interest by embracing the socio-political relativity implied by the fact that criminal law, implying that the object of FP changes with every difference between jurisdiction across countries as well as over time. This seems to imply that there is no such thing as one object of FP, no specific FP expertise, and so on and thus undermines the idea of FP as a science, specific health care speciality or expertise. Second, FP may adopt a very abstract definition of its object, possible to include all jurisdictional variations one might imagine. This, however, seems to imply a problematic boundlessness: the idea that practically any behaviour or human condition is a proper concern of FP (since any such may be criminalized in some jurisdiction). This, in turn implies normative problems both with regard to the claims about a particular FP expertise and with regard to the ethical integrity of FP as a scientific and medical field.
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Study question: What are the ethical prospects and challenges of using time-lapse (TL) for different purposes in research, clinical service, care and commercial marketing in the assisted reproductive context? What possible professional or... more
Study question: What are the ethical prospects and challenges of using time-lapse (TL) for different purposes in research, clinical service, care and commercial marketing in the assisted reproductive context? What possible professional or public policy implications follow from these? Summary answer: The ethics of TL depends on its more exact use. Current knowledge indicates possible clinical benefits, but premature clinical application should be resisted. TL opens for, e.g., patient demands regarding embryo selection and implementation of TL involving display to patients mandates extra caution regarding care, counseling and marketing exploits. What is known already: Using TL to capture the process of in vitro embryo development has quickly entered reproductive medicine, with prospective uses in research and clinical service. It has also been picked up as a possible marketing tool by commercial providers, and as an add-on of patient care and counseling. Assessment of the effects and efficiency of TL is ongoing and, as yet, displaying complex and partly unclear or contradictory results. care and counseling aspects remain uncharted. Study design, size, duration: Explorative theoretical analytical applied ethics study. Participants/materials, setting, methods: Systematic analysis of ethical aspects using literature on TL and relevant aspects of the ethics of assisted reproduction and reproductive medicine. Main results and the role of chance: TL is valuable for research, but trials of TL-interventions aiming at improved IVF should not be launched prematurely or allowed to sneak into routine practice. Offering display of TL documentation of embryo development to patients during ongoing treatment has unclear benefits and risks from a care and counseling perspective and arises the issue of what to display. It may be a vehicle for increasing patient involvement, but may also create conflict between patients and clinicians regarding embryo selection, and will introduce care and counselling challenges as patients form their own reactions. Retrospective offers appear less risky, but may fuel into uncertainty about the outcome. Marketing services with such offers risks biasing patients towards an “entertainment” view and away from more important considerations counseling wise. Limitations, reason for caution: There are many unknowns regarding the more detailed effects on patient experience of incorporating TL display as part of assisted reproductive services. Such additions also have unknown cultural dimensions by making the living in vitro embryo more widely and intimately visible and acquaintable. Wider implications of the findings: Besides the need to structure, monitor and limit attempts at using TL to boost IVF results, the idea of displaying TL output to patients is in need of much probing, not least regarding patient experience and structural effects on the perception of assisted reproductive services, but also clinical policy and counseling requirements. Professional and scientific organizations should act to prevent premature and reckless clinical use.
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The ethical assessment of extreme risk, or uncertainty scenarios present peculiar and important decision problems from both a theoretical, a practical and a pragmatic policy making standpoint. As human beings get better and better at... more
The ethical assessment of extreme risk, or uncertainty scenarios present peculiar and important decision problems from both a theoretical, a practical and a pragmatic policy making standpoint. As human beings get better and better at systematically imagining what might occur given some actions or policies, more and more such assessments are actualised, e.g. with regard to environmental, computer, bio-, military and nano-technology, as well as “natural” hazards, where as yet non-existent technology might provide mitigation of otherwise unavoidable massive harms. At the same time, resources are limited, human time is scarce and ethical theory basically impotent of guiding tenets as to how the management of uncertain outcomes and actions are to be assessed in normative terms.
For instance, as I write this, the Large Hadron Collider team at the CERN lab outside Geneva are making last preparation for the “beam injection” experiment, for which at least two prominent physicists have issued stern #end of the world” warnings. How should this be managed, and why? Depending on the answer, what does that imply for the implementation of, e.g. uncertain actions to counter the potential harms of climate change, the eventuality that a meteorite might hit Earth, or that our own technology shaped to manage this dangerous world of our’s pulls the rug out from under our feet? (here we have everything from antimicrobial resistance to rebelling synbio AI’s on the menu). Especially if we consider less distant needs, for which there exist quite workable solutions, if only the funds for their implementation are released – such as the quarter of a million children dying of starvation every month. At the same time, some of the futurustic fears may not themselves be worthy our dread – at least not if we think disciplined and ethically ablout it. The talk will dig into this mass of issues, with a particular concentration on the ethics of exploring distant (albeit potent) dangers and salvation, using the concept of the price of precaution, developed by myself in some recent writings.
References:
Munthe, C (2011). The Price of Precaution and the Ethics of Risk. Springer SBM.
For instance, as I write this, the Large Hadron Collider team at the CERN lab outside Geneva are making last preparation for the “beam injection” experiment, for which at least two prominent physicists have issued stern #end of the world” warnings. How should this be managed, and why? Depending on the answer, what does that imply for the implementation of, e.g. uncertain actions to counter the potential harms of climate change, the eventuality that a meteorite might hit Earth, or that our own technology shaped to manage this dangerous world of our’s pulls the rug out from under our feet? (here we have everything from antimicrobial resistance to rebelling synbio AI’s on the menu). Especially if we consider less distant needs, for which there exist quite workable solutions, if only the funds for their implementation are released – such as the quarter of a million children dying of starvation every month. At the same time, some of the futurustic fears may not themselves be worthy our dread – at least not if we think disciplined and ethically ablout it. The talk will dig into this mass of issues, with a particular concentration on the ethics of exploring distant (albeit potent) dangers and salvation, using the concept of the price of precaution, developed by myself in some recent writings.
References:
Munthe, C (2011). The Price of Precaution and the Ethics of Risk. Springer SBM.
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Invited presentation to the special symposium Food choices, responsibility and bioethics
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This talk builds on earlier discussion by myself (2008), Coggon (2010), Dawson (2011), Verweij & Dawson (2007), Wilson (2009) et al regarding the basic (normative) goal(s) of public health (PH). It addresses a fundamental issue regarding... more
This talk builds on earlier discussion by myself (2008), Coggon (2010), Dawson (2011), Verweij & Dawson (2007), Wilson (2009) et al regarding the basic (normative) goal(s) of public health (PH). It addresses a fundamental issue regarding the foundations of PH ethics of particular interest to the ethics of global health. Regardless of exact proposal on what values are important, there is consensus that the goal of PH must be phrased in terms of a population. However, when that general notion is to be applied (e.g. the classic idea of promoting population health), the issue of what polulation is the relevant one arises, possible to phrase in terms of how wide/restricted the scope of the beneficiaries of an ethically justifiable PH policy should be. That query turns into a conundrum, as no possibly underlying ethical theoretical stance that might otherwise readily serve to answer it seems to fit as a PH ethical foundational assumption. This goes, e.g., for the argument for expanding national health concerns into global ones built on the notion of rights (Pogge 2008). Neither does any existing idea about the goals of PH imply anything specific, but seems rather to be compatible with any possible framing of the scope of ethical PH work. E.g. national PH policy may just as well contribute to realising the PH goals for a small minority population, as for the entire global community. The paper works out the details of this basic framing problem and sketches two alternative suggested routes for approaching its solution, based on Derek Parfit's (1984) notion of "aims" of ethical theories, and pragmatic metaethical ideas in the spirit of Hume, Mackie, Wong, Rawls and others. A provisional argument is made to the benefit of the second route.
Research Interests:
Research Interests: Bioethics, Family studies, Children and Families, Parenting, Family, and 9 moreMedical Ethics, Reproductive Ethics, Health Care Ethics, Care Ethics, Bioethics Reproductive Technology, Ethics in Reproductive medicine and women's health, Medical Ethics & Law, The Ethics of Care, and Medical Law and Ethics
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Hate crimes are ordinary crimes committed in connection with a negatively prejudiced, biased, disparaging, or antagonistic attitude towards the victim in terms of a perceived membership of a social group. Some hate crimes are elaborate... more
Hate crimes are ordinary crimes committed in connection with a negatively prejudiced, biased, disparaging, or antagonistic attitude towards the victim in terms of a perceived membership of a social group. Some hate crimes are elaborate political acts of terror or elaborate persecution, some are so-called “hate speech”, but the overwhelming majority are instances of mundane criminality, involving everything from murder to theft and harassment. Hate crime policies rest on the idea that the bias or “hate”feature make such crimes worse, and that offenders for this reason should be held more firmly responsible. At the same time, the attitude of making a crime into a hate crime involves more or less distorted ideas about reality, together with a willingness to transgress social norms on that basis. In some cases, these views amount to major delusions, resistant to rational scrutiny. In other cases, we may move closer to a point where the belief-desire cluster can be seen as ordinary negligence. Thus, many hate crimes have features that may be argued acting to diminish responsibility according to standard ideas in the philosophy of punishment. The presentation maps underlying value conflicts, tensions, and incoherence in legal practice connected to this complexity of criminal law.
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"Italian nineteenth century criminologist Cesare Lombroso is notorious for his seminal ideas about criminality and anti-social behaviour resulting from physiological anomalies that should be detected by society and used for forensic... more
"Italian nineteenth century criminologist Cesare Lombroso is notorious for his seminal ideas about criminality and anti-social behaviour resulting from physiological anomalies that should be
detected by society and used for forensic preventive purposes. After an extended period of disrepute following World War II, similar ideas have been resurrected in psychiatry, genetics, neurology and criminology in the past decade or two. In particular, there is a growing focus on early detection and application of preventive measures. This development actualizes a complex
web of ethics and policy issues having to do with the well-known fact that screening and prevention in the health area are
far from ethically clear-cut activities and actualize vivid
prospects of doing extensive harm to individuals as well as society. Also, taken to its extreme, it actualizes the idea of using prenatal or preimplantation testing to preselect against children with
a predisposition for criminal or antisocial behaviour. In the forensic case, such screening-prevention strategies will connect further to a complicated issue about the proper use of risk-assessment models for societal decision-making for precautionary purposes. Based on former work in all of these areas, this presentation
will outline and analyze the basic issue of the defensibility of activities of this sort, with the perspective of forestalling unintentional harm to individuals and society."
detected by society and used for forensic preventive purposes. After an extended period of disrepute following World War II, similar ideas have been resurrected in psychiatry, genetics, neurology and criminology in the past decade or two. In particular, there is a growing focus on early detection and application of preventive measures. This development actualizes a complex
web of ethics and policy issues having to do with the well-known fact that screening and prevention in the health area are
far from ethically clear-cut activities and actualize vivid
prospects of doing extensive harm to individuals as well as society. Also, taken to its extreme, it actualizes the idea of using prenatal or preimplantation testing to preselect against children with
a predisposition for criminal or antisocial behaviour. In the forensic case, such screening-prevention strategies will connect further to a complicated issue about the proper use of risk-assessment models for societal decision-making for precautionary purposes. Based on former work in all of these areas, this presentation
will outline and analyze the basic issue of the defensibility of activities of this sort, with the perspective of forestalling unintentional harm to individuals and society."
Research Interests:
Research Interests:
Research Interests:
Empirical study of patient autonomy, self-determination and co-decision making is growing rapidly. Not only bioethicists are engaged, but also researchers in care science and health organisation as well as general clinical practice... more
Empirical study of patient autonomy, self-determination and co-decision making is growing rapidly. Not only bioethicists are engaged, but also researchers in care science and health organisation as well as general clinical practice research. The interest follows the impact of ideas of autonomy being central for not only ethics, but also general care quality. Recent trends of person centered care, clinician-patient partnership, shared decision making, etcetera, further fuel the development. Initially, bioethicists focused on the implementation of informed consent in particular settings (e.g. clinical research or prenatal diagnosis). Today's scope is much wider regarding both areas and autonomy-related aspects targeted; encompassing all sorts of patient-clinician interaction. However, much of this expanding research focus suffers from serious flaws. Articles claiming to present results about patient autonomy on closer inspection apply methods unfit to detect anything that determines the extent of autonomy or self-determination according to standard concepts in normative theory. Common mistakes are to characterise autonomy as an experiental notion, or conflate it with things thought to be conducive to autonomy. Since empirical bioethics is a rapidly growing field with potential for furthering the policy and public impact of normative bioethics research, the task of clearing out such problems is rather acute, not least since the field will soon face the challenge of producing meta-analyses.
Two strategies for overcoming these fundamental problems with regard to autonomy-oriented empirical bioethics are presented. One uses indicators possible to indirectly link to autonomy using conceptual analysis. Another aims for measuring components of autonomy directly. Both strategies require that normative bioethicists take on the task of producing valid operationalisations on the basis of normative ideals. Issues regarding validity, reliability, quantifiability and proper detection instruments are also addressed.
Ashcroft RE (2003). Constructing empirical bioethics: Foucauldian reflections on the empirical turn in bioethics research. Health Care Analysis, 11: 3-13.
Dunn M et al (2009). Methodology, epistemology and empirical bioethics research: A constructive/ist commentary, American Journal of Bioethics, 9: 93-95.
Kon AA (2009). The role of empirical research in bioethics. American Journal of Bioethics, 9: 59-65.
Munthe C et al (2011). Person Centred Care and Shared Decision Making: Implications for Ethics, Public Health and Research. Health Care Analysis, 19, online first, DOI: 10.1007/s10728-011-0183-y
Strech D et al (2011). Systematic Reviews of Empirical Bioethics. Journal of Medical Ethics, 34: 472-477
Two strategies for overcoming these fundamental problems with regard to autonomy-oriented empirical bioethics are presented. One uses indicators possible to indirectly link to autonomy using conceptual analysis. Another aims for measuring components of autonomy directly. Both strategies require that normative bioethicists take on the task of producing valid operationalisations on the basis of normative ideals. Issues regarding validity, reliability, quantifiability and proper detection instruments are also addressed.
Ashcroft RE (2003). Constructing empirical bioethics: Foucauldian reflections on the empirical turn in bioethics research. Health Care Analysis, 11: 3-13.
Dunn M et al (2009). Methodology, epistemology and empirical bioethics research: A constructive/ist commentary, American Journal of Bioethics, 9: 93-95.
Kon AA (2009). The role of empirical research in bioethics. American Journal of Bioethics, 9: 59-65.
Munthe C et al (2011). Person Centred Care and Shared Decision Making: Implications for Ethics, Public Health and Research. Health Care Analysis, 19, online first, DOI: 10.1007/s10728-011-0183-y
Strech D et al (2011). Systematic Reviews of Empirical Bioethics. Journal of Medical Ethics, 34: 472-477
The traditional goal of public health of promoting ”population health” contains many unclarities that imply underlying normative controversies. In addition, in recent decades, this goal has been supplemented by ideas to the effect that... more
The traditional goal of public health of promoting ”population health” contains many unclarities that imply underlying normative controversies. In addition, in recent decades, this goal has been supplemented by ideas to the effect that equality and autonomy are important values to consider in the public health context. These different suggestions express very different underlying perspectives, as well as suggest ultimate values to pursue, that are many times in severe conflict. For example, pursuing equality may severely undermine population health in various ways, and many public health professionals view the importation of the notion of autonomy from medical ethics to bring with it an individualistic focus unsuitable for public health. It is furthermore undecided how the more recent additions should be translated to the concrete reality of public health practice (monitoring, health promotion, safety management etc.). It is highly unclear, therefore, how a well-formed goal-structure for public health should be construed in order to be functional for public health practice, politically feasible, and normatively plausible. The paper aims at presenting a multi-dimensional model for formulating the goals of public health in a way that integrates the ideas mentioned, and meets the challenges just explained. It is argued that the model is compatible or even supported by most minimally plausible basic ethical theories. Doing this, I address a number of controversial public health areas, such as smoking and the prevention of communicable disease, as well as less discussed ones such as basic sanitation, and demonstrates how the model gives plenty of room for restricting individual autonomy while at the same time recognizing autonomy as a central value to pursue within public health. I also address the issue of whether different goals are suitable for public healthpolicies and practices in different regions or socio-economic contexts It is argued that the proposed model fits all such variations, by an in-built flexibility of giving different particular goals different priority depending on the surrounding circumstances. This feature of the model contribute to its political feasibility, but may also produce quite radical results – especially regarding the integration of the public health policies of different nations.
Försiktighetsprincipen (FP) har på kort tid blivit ett politiskt honörsord, ett återkommande slagträ i allehanda debatter och en standardingrediens i samhälleliga regleringar och policy-deklarationer världen över. Den filosofiska och... more
Försiktighetsprincipen (FP) har på kort tid blivit ett politiskt honörsord, ett återkommande slagträ i allehanda debatter och en standardingrediens i samhälleliga regleringar och policy-deklarationer världen över. Den filosofiska och akademiska diskussionen av den FP är numera omfattande, men samtidigt förvånansvärt enkelspårig. Tre återkommande teman är (1) att FP inte kan ges någon begriplig och praktiskt relevant tolkning, (2) att FP antingen måste tolkas som en absolut normativ princip som implicerar ohållbara rigida förbud mot vissa slags riskfyllda verksamheter, eller inte säger något mer än att risker bör balanseras av tillräckligt stora fördelar i linje med standardmodeller i beslutsteori och riskanalys, samt (3) att FP måste förstås som en normativ princip eller beslutsregel gällande enskilda riskfyllda beslut. Föredraget ämnar påvisa hur dessa teman vilar på tveksamma förutsättningar. En diskussion av försiktighetens moraliska och politiska betydelse behöver i högre utsträckning ta på allvar hur FP faktiskt hanteras politiskt, dels se FP som ett indirekt uttryck för en viss syn på det moraliskt försvarbara i själva skapandet/tagandet av risker (snarare än en teori om rationalitet eller en typisk ”faktualistisk” etisk position), dels betrakta själva FP som en härledd procedur-vägledande norm snarare än en regel för enskilda beslut. I samband med detta demonstreras dels hur de flesta standardargument mot FP som formulerats av filosofer och andra på sin höjd lägger vissa rimliga ramrestriktioner på hur en välgrundad etisk hållning till riskskapande/-tagande ska se ut, dels hur detta i minst två viktiga avseenden ger utrymme för till synes välmotiverade etiska tankegångar som kraftigt avviker från ovan nämnda standardmodeller, dels kan tillhandahålla praktisk vägledning för utformandet av adekvata beslutsprocedurer och i viss mån även för det beslutsfattande som sker inom ramen för dessa. Fokuseringen på etisk värdering av riskbeslut snarare än givna handlingar och utfall har dessutom intressanta implikationer för moralfilosofisk grundforskning och för tillämpade frågor gällande det allmänna synsättet på ett gott samhälle och ett önskvärt världssamfund. Mot bakgrund av detta beskrivs några önskvärda sätt som den normativa och tillämpade etiken behöver öka sin integration med såväl deskriptiv forskning som politisk praktik.
The attempt to make a morally relevant distinction between enhancing and therapeutic medical procedures (e.g. of a genetic kind) is as commonplace as it is criticised. Supporters hold out the need for such a distinction in terms of a need... more
The attempt to make a morally relevant distinction between enhancing and therapeutic medical procedures (e.g. of a genetic kind) is as commonplace as it is criticised. Supporters hold out the need for such a distinction in terms of a need to delimit what is required of health care to fulfill its obligations to do good, while critics attack the way in which the distinction is made. As a rule, the distinction is formulared in terms of some type of absolute limit of function, health, quality of life, well-being etc., and, likewise as a rule, the criticism attacks the theoretical and ethical basis for determining such a limit (it is indeterminate, morally irrelevant, or begs the question). However, acknowledging the force of the criticism does not imply a rejection of the need for some sort of theory that could provide the kind of limitation of the duties of medicine and health care that is the point of the therapy-enhancement distinction. On the basis of this, I sketch a theoretical context for moving the discussion further that identifies two basic features that need to be in place in an ethical theory for doing the job that the enhancement-therapy distinction has been aimed for, without being open to the typical criticism of this distinction: 1) it must lack any idea of an absolute limit of the type attacked by the criticism, 2) it must be able to provide a basis for risk evaluation where two procedures with equally serious risks and equal prospects for quantitatively equal gains in terms of length and/or quality of life may nevertheless be evaluated differently, 3) it must provide a basis for prioritarisation of health care resources such that two procedures with equal costs, equally serious risks and equal prospects for quantitatively equal gains in terms of length and/or quality of life may nevertheless be prioritised differently. Sketching very losely one way of accomplishing such a theory, I also demonstrate that how a theory incorporating (1) and (2) will automatically also provide (3).
The precautionary principle (PP) has been criticised for almost every intellectual sin one may imagine: unclarity, impracticality, rigidity, implausibility etc. Recognising the rather obvious fact that there is no such thing as one PP,... more
The precautionary principle (PP) has been criticised for almost every intellectual sin one may imagine: unclarity, impracticality, rigidity, implausibility etc. Recognising the rather obvious fact that there is no such thing as one PP, this paper attempts to address this criticism on a more constructive note than merely view it as forcing us to be "for or against" precaution. This is done by connecting an underlying ethical ideal regarding the imposition of risks present in most formulations of PP to the criticism and use the latter for discussing how such an idea may be plausibly designed and used for underpinning policies that may plausibly be said to express the spirit of PP. It is argued that the most important issue regarding this is to recognise that there is something to the idea that imposing risks on people has a morally significant price, but that we must also acknowledge that taking precautionary measures to avoid or decrease such risks has such a price. The critical issue in the ethics of risk of relevance for PP thus becomes what constitutes a proper price of precaution. It is demonstrated how two simple constraints on this makes it easy to meet many typical arguments against PP, but also how this issue must be further attacked by means transcending the traditional tools of normative ethics and decision theory, as well as how further reflection along such lines connects PP to issues of international justice.
While other parts of medicine and health care seems traditionally to be primarily directed at preventing losses of bodily functions, repairing said functions in the case of such losses, or at least to provide ailment for unpleasant... more
While other parts of medicine and health care seems traditionally to be primarily directed at preventing losses of bodily functions, repairing said functions in the case of such losses, or at least to provide ailment for unpleasant symptoms, sports medicine has allready from the beginning been involved with the project of enhancing bodily functions with regard to sports performance. First, when sports medicine involve itself in the traditional health care activity of prevention, therapy and ailment, the aim is often very different from ordinary medical activities in that it tries to secure bodily functions far beyond what is required to reach what would normally be seen as a non-pathological state of a person. Second, sports medicine actively involves itself in the project of extending and enhancing human performance capacities through medical knowledge and technology. This raises several issues both with regard to medical ethics and the ethics of sports. For example, how should the goals of sports medicine be viewed from the perspective of rationing scarce health care resources? Should sports medicine be restricted by rules from the sports community as to which performance enhancing activities are tolerated in that sector? Or should sports medicine rather direct what is to be accepted within the world of sports? Both lines of reasoning are to be found in debates about, e.g., doping, controversial training methods and the potential use of gene technology in sports. The paper will address these issues and analyse them from a philosophical point of view.
Research Interests: Environmental Law, Bioethics, Disaster risk management, Food Engineering, Biotechnology, and 21 moreEnvironmental Ethics, Agriculture, Risk Management, Decision Making Under Uncertainty, Environmental Sustainability, Plant breeding and genetics, Precautionary Principle, Risk Assessment & Risk Management, Food Science and Technology, Genetic Engineering, Ethics of Risk, Risk Analysis, Bionanotechnology, CRISPR, Disaster risk reduction, GMO Biosafety, Farming Systems and Cropping Systems, Risk and crisis management, Civil and Environmental Engineering, Sustainable Food & Farming, and Gene Editing
Free of charge symposium in Gothenburg, Nov. 15-16, 2017. Signup at: http://care.gu.se/conference-in-ethics--nov-2017 Speakers include: Otto Cars (Uppsala University) Michael J. Selgelid (Monash University and WHO) Marcel Verweij... more
Free of charge symposium in Gothenburg, Nov. 15-16, 2017.
Signup at: http://care.gu.se/conference-in-ethics--nov-2017
Speakers include:
Otto Cars (Uppsala University)
Michael J. Selgelid (Monash University and WHO)
Marcel Verweij (Wagenigen University)
Clare Chandler (London School of Hygiene & Tropical Medicine)
Michael Millar (Barts Health NHS Trust)
Jonathan Anomaly (UNC Chapel Hill & Duke University)
Julian Savulescu (University of Oxford)
Steven J. Hoffman (University of Ottawa)
Jasper Littmann (Robert Koch Institute)
Alena Buyx (University of Kiel)
Signup at: http://care.gu.se/conference-in-ethics--nov-2017
Speakers include:
Otto Cars (Uppsala University)
Michael J. Selgelid (Monash University and WHO)
Marcel Verweij (Wagenigen University)
Clare Chandler (London School of Hygiene & Tropical Medicine)
Michael Millar (Barts Health NHS Trust)
Jonathan Anomaly (UNC Chapel Hill & Duke University)
Julian Savulescu (University of Oxford)
Steven J. Hoffman (University of Ottawa)
Jasper Littmann (Robert Koch Institute)
Alena Buyx (University of Kiel)
Research Interests: Bioethics, Medical Law, Public Health Law, Global Health, Public Health Ethics, and 19 morePublic Health Policy, Environmental Health, Medical Ethics, Population Health, Public Health, Infectious Diseases, Health Policy, Global Health Policy, Healthcare, Medical and Research ethics, Antibiotic Resistance, Antimicrobial drug resistance, Medical Ethics & Law, Bioética, Medical Law and Ethics, One Health, Antibiotics, Antibiotic, and Philosophy and Sociology of Human/animal Relations
Sökning: onr:"swepub:oai:services.scigloo.org:42412" > Public policies, la... ... Shickle, Darren (författare) Richardson, Erica (författare) Munthe, Christian, 1962-(författare) Göteborgs universitet, Filosofiska... more
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Research Interests: Robotics, Neuroscience, Psychology, Cognitive Science, Computer Science, and 16 morePhilosophy, Philosophy of Mind, Philosophy of Science, Performing Arts, Humanities, Digital Humanities, Social Sciences, Visual Culture, Political Science, Humanoid Robotics, Cognitive Neuroscience, Visual Arts, Big Data, Big Data Analytics, Big Data / Analytics / Data Mining, and Big Data Visualisation
There is increasing interest in applying ideas from person centred care (PCC) in forensic psychiatry, including increased room for patients to collaborate in the care design. However, standard ethical assumptions in PCC about capacities... more
There is increasing interest in applying ideas from person centred care (PCC) in forensic psychiatry, including increased room for patients to collaborate in the care design. However, standard ethical assumptions in PCC about capacities of patients, as well as a traditional health care ethical context, departs significantly from the forensic psychiatric situation. Forensic psychiatric care is beset with restrictions of personal freedom and motivated partly by patients' incapacity to take responsibility brought by mental ill-health, usually within limits from criminal law, public safety and court orders. The care is supposed to change patients to become more autonomous and responsible in order for the restrictions on freedom to be justifiably relaxed or removed. Doing so may involve some room for independent decision-making by patients, using their responsibility capacities, but PCC opens up for much more far-reaching empowerment of patients, e.g., regarding the goals of care and the acceptance of applied methods. Therefore, there is a manifold increase of the ethical complexity creating tensions for PCC already in standard health care. This presentation provides a map of these ethical complexities, focusing especially on the issue of how the central notions of patient empowerment and shared decision-making should imply within forensic psychiatric care.
Research Interests:
Standard models of person- and family-centeredness tell us little about how to involve family members in care similar to that of diabetes. Typically, the models focus on trying to engage and educate patients and their family to decide... more
Standard models of person- and family-centeredness tell us little about how to involve family members in care similar to that of diabetes. Typically, the models focus on trying to engage and educate patients and their family to decide among and implement ready-made options, often in a hospital setting. These models are thus poorly equipped to address problems where, like diabetes, the illness requires large portions of self-care and life-style adjustment by patients with vulnerable decision-capacities in a mostly outpatient context. We have elsewhere proposed an alternative approach more attuned to such circumstances, aiming less for rational decision-making in consultation meetings, and more at empowering patients' long-term capacities to manage their condition domestically. This “counselling, self-care, adherence (CSA) approach” offers a look at the role that family can play to improve these types of care. We will illustrate how family members can assist in the care of teenagers with diabetes, but that there are also serious risks actualized by such involvement. In particular, we will highlight ethical complications that arise when the role of a family member is changed from “parent” to “care provider.”
Research Interests: Bioethics, Family studies, Person-centred Therapy, Family, Medical Ethics, and 8 moreFamily Caregivers/Carers, Shared decision making, Clinical Ethics, Patient-Centered Care, Person Centered Therapy, (1) Advanced nursing practice (2) Children's nursing (3) Neonatal and child health (4) Family centred care, Healthcare Ethics, and Patient centred Approaches to Diabetes Management
Health care decisions about investigation, diagnosis, and treatment (including decisions not to apply measures, or to stop applying ongoing ones) may involve, engage, or affect family relations and family members of a patient in a variety... more
Health care decisions about investigation, diagnosis, and treatment (including decisions not to apply measures, or to stop applying ongoing ones) may involve, engage, or affect family relations and family members of a patient in a variety of ways. This complicates the assessment of how options affect patients, and may furthermore elicit independent effect on professionals through expected actions of family members. Moreover, due to the close and intimate nature of family relationships, considerations about such aspects may be concern both clinical professionals, patients, and family members independently of how they actually manifest themselves in terms of effects on length and quality of life, autonomy and so on. In particular, decisions can be expected to both be influenced by and affect family members’ conceptions of mutual responsibilities making up the basic moral web of families, as pictured in the outset of this volume. Irrespective of how family responsibilities are allocated or what the legal requirements around medical decision-making are in place in different particular situations, health care professionals are almost always expected to play an important role in the decision-making process. The aim of this chapter is to outline how different relational aspects of families may ground obligations on behalf of health care professionals towards patients and their families in the processes of decision-making within health-care.
Research Interests: Bioethics, Family studies, Person-centred Therapy, Family, Medical Ethics, and 6 moreShared decision making, Clinical Ethics, Patient-Centered Care, Person Centered Therapy, (1) Advanced nursing practice (2) Children's nursing (3) Neonatal and child health (4) Family centred care, and Healthcare Ethics
This chapter charts and critically analyses the ethical challenge of assessing how much (and what kind of) evidence is required for the justification of interventions in response antibiotic resistance (ABR), as well as other major public... more
This chapter charts and critically analyses the ethical challenge of assessing how much (and what kind of) evidence is required for the justification of interventions in response antibiotic resistance (ABR), as well as other major public health threats. Our ambition here is to identify and briefly discuss main issues, and point to ways in which these need to be further advanced in future research. This will result in a tentative map of complications, underlying problems and possible challenges. This map illustrates that the ethical challenges in this area are much more complex and profound than is usually acknowledged, leaving no tentatively plausible intervention package free of downsides. This creates potentially overwhelming theoretical conundrums when trying to justify what to do. We therefore end by pointing out two general features of the complexity we find to be of particular importance, and a tentative suggestion for how to create a theoretical basis for further analysis. Acknowledgement
Research Interests:
Agricultural biotechnology, in particular genetically modified organisms (GMOs), is subject to regulation in many areas of the world, not least in the European Union (EU). A number of authors have argued that those regulatory processes... more
Agricultural biotechnology, in particular genetically modified organisms (GMOs), is subject to regulation in many areas of the world, not least in the European Union (EU). A number of authors have argued that those regulatory processes are unfair, costly, and slow and that regulation therefore should move in the direction of increased 'technology neutrality'. The issue is becoming more pressing, especially since new biotechnologies such as CRISPR increasingly blur the regulatory distinction between GMOs and non-GMOs. This paper offers a definition of technology neutrality, uses the EU GMO regulation as a starting point for exploring technology neutrality, and presents distinctions between variants of the call for technology neutral GMO regulation in the EU.
Research Interests:
We explore the ethical implications of restricting researchers’, patients’ and clinicians’ activities in the field of stem cell science, either by not allowing them to engage in it wherever they are in virtue of their citizenship, or by... more
We explore the ethical implications of restricting researchers’, patients’ and clinicians’ activities in the field of stem cell science, either by not allowing them to engage in it wherever they are in virtue of their citizenship, or by restricting it everywhere altogether regardless of the ethical disagreement.