Patients with borderline personality disorder (BPD) sometimes request to be admitted to hospital under compulsory care, often under the argument that they cannot trust their suicidal impulses if treated voluntarily. Thus, compulsory care... more
Patients with borderline personality disorder (BPD) sometimes request to be admitted to hospital under compulsory care, often under the argument that they cannot trust their suicidal impulses if treated voluntarily. Thus, compulsory care is practised as a form of Ulysses contract in such situations. In this normative study we scrutinize the arguments commonly used in favour of such Ulysses contracts: (1) the patient lacking free will, (2) Ulysses contracts as self-paternalism, (3) the patient lacking decision competence, (4) Ulysses contracts as a defence of the authentic self, and (5) Ulysses contracts as a practical solution in emergency situations. In our study, we have accepted consequentialist considerations as well as considerations of autonomy. We conclude that compulsory care is not justified when there is a significant uncertainty of beneficial effects or uncertainty regarding the patient’s decision-making capacity. We have argued that such uncertainty is present regarding ...
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The aim of this study was to explore experiences of authorship issues among persons who have recently received their doctoral degree in medicine in Sweden. A survey was mailed to all who received their PhD at a medical faculty at a... more
The aim of this study was to explore experiences of authorship issues among persons who have recently received their doctoral degree in medicine in Sweden. A survey was mailed to all who received their PhD at a medical faculty at a Swedish university the first half of 2016. Questions concerned experiences of violations of the first three authorship criteria in the Vancouver rules and of misuse of authorship order in the articles of their thesis, and the respondents’ attitudes to these matters. The questionnaire was returned by 285 respondents (68%). According to the majority (53%), the Vancouver rules were not fully respected in the articles of their thesis. A vast majority (97%) found it important that authorship issues are handled correctly, but only 19% responded that their department has a clear and consistently applied policy. We conclude that authorship guidelines are frequently disrespected at medical faculties in Sweden. The universities seem to provide limited support on au...
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Introduction: Current research of moral distress is mainly derived from challenges within high-resource health care settings, and there is lack of clarity among the different definitions. Disaster responders are prone to a range of moral... more
Introduction: Current research of moral distress is mainly derived from challenges within high-resource health care settings, and there is lack of clarity among the different definitions. Disaster responders are prone to a range of moral challenges during the work, which may give rise to moral distress. Further, organizations have considered increased drop-out rates and sick leaves among disaster responders as consequences of moral distress. Therefore, initiatives have been taken to address and understand the impacts of moral distress and its consequences for responders. Since there is unclarity among the different definitions, a first step is to understand the concept of moral distress and its interlinkages within the literature related to disaster responders. Hypothesis/Problem: To examine how disaster responders are affected by moral challenges, systematic knowledge is needed about the concepts related to moral distress. This paper aims to elucidate how the concept of moral distr...
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Research Interests: Law and Applied Ethics
As we need knowledge about the prevalence of scientific dishonesty, this study investigates the knowledge of, experiences with, and attitudes toward various forms of scientific dishonesty among PhD students at the main medical faculties... more
As we need knowledge about the prevalence of scientific dishonesty, this study investigates the knowledge of, experiences with, and attitudes toward various forms of scientific dishonesty among PhD students at the main medical faculties in Sweden and Norway. An anonymous questionnaire was distributed to all post-graduate research students attending basic PhD courses at the medical faculties in Stockholm and Oslo during the fall 2014. The responding doctoral students reported to know about various forms of scientific dishonesty from the literature, in their department, and for some also through their own experience. Some forms of scientific misconduct were considered to be acceptable by a significant minority. There was a high level of willingness to report misconduct but little awareness of relevant policies for scientific conduct.
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ABSTRACT Assessments of quality in healthcare often focus on treatment outcome or patient safety, but rarely acknowledge the importance of patients’ encounters with healthcare personnel. The aim of this study was to gain an improved... more
ABSTRACT Assessments of quality in healthcare often focus on treatment outcome or patient safety, but rarely acknowledge the importance of patients’ encounters with healthcare personnel. The aim of this study was to gain an improved understanding of negative experiences of healthcare encounters by investigating experiences of the general population. A questionnaire was distributed to a randomly selected sample population of 1484 inhabitants in Stockholm County, Sweden. The material was subjected to conventional content analysis. Seventeen different types of complaint about negative encounters were identified, including unpleasant behavior, not being listened to, inadequate information, and discrimination. Two possible underlying explanations are discussed; structural factors relating to the organization and allocation of healthcare, and individual factors relating to the staff’s attitudes and professional practice. The results indicate that different strands of actions are needed to reduce patients’ negative experiences of encounters in healthcare, depending on the setting as well as on which of the two factors predominates.
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Thesis (doctoral)--Göteborg University, 2005. Includes bibliographical references (p. 438-449) and index.
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Etiska aspekter på rutinfrågor om våldsutsatthet i hälso-och sjukvården samt socialtjänsten
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ABSTRACT Besides the actual testing and analysis of samples, application of follow-up procedures, et cetera, screening programmes also involve the processes of contacting people for recruitment to the programme, informing them about the... more
ABSTRACT Besides the actual testing and analysis of samples, application of follow-up procedures, et cetera, screening programmes also involve the processes of contacting people for recruitment to the programme, informing them about the procedures prior to testing, as well as about the result of the test afterwards, counselling about possible follow up-procedures, and help with coping with the reactions to the test result. These features of screening programmes give rise to a host of questions of how screening programmes should be designed and conducted in these respects. Plausibly, all programmes should involve all of the tasks mentioned to some extent. But how much? And in what way? If ill-designed, the programme may end up not promoting the values it could have promoted and producing negative side-effects it could have avoided. So, even if defensible in terms of the condition targeted, the testing method utilised and the treatments available, a programme may still be open to serious criticism if organised in an inferior way. This has been underscored, e.g., in research on the new risk assessment methods in prenatal screening discussed in Section 3.2.1.
Hymen reconstruction is a controversial measure performed to help young females under threat of honour-related violence. Official guidelines often reject offering hymen reconstructions. On the other hand, extraordinary measures in order... more
Hymen reconstruction is a controversial measure performed to help young females under threat of honour-related violence. Official guidelines often reject offering hymen reconstructions. On the other hand, extraordinary measures in order to enable operations of Jehovah's Witnesses who want a bloodless operation in order to avoid religiously related sanctions are often considered praiseworthy. The aim is thus to examine whether or not there are relevant differences between these two measures. We identified twelve potential differences. One difference could be considered relevant (patient-safety), but in favour of hymenoplastic operations. Since we did not identify enough relevant differences to justify offering bloodless operations to Jehovah's Witnesses but not offering hymen reconstruction due to honour-related norms, we conclude that these two groups of patients should be treated equally. This means that neither of the patient groups should be offered these extraordinary op...
Research Interests: Applied Ethics, Violence, Patient Safety, Religion and medicine, Islam, and 15 moreVirginity, Humans, Female, Male, Obstetrics and Gynaecology, Hymen, Social Values, Patient Participation, Blood Transfusion, Minors, Sexual Abstinence, Personal autonomy, cultural characteristics, Family Characteristics, and Reconstructive Surgical Procedures
This article is about the justifiability of accepting worse cost effectiveness for orphan drugs, that is, treatments for rare diseases, in a publicly financed health care system. Recently, three arguments have been presented that may be... more
This article is about the justifiability of accepting worse cost effectiveness for orphan drugs, that is, treatments for rare diseases, in a publicly financed health care system. Recently, three arguments have been presented that may be used in favour of exceptionally advantageous economic terms for orphan drugs. These arguments share the common feature of all referring to considerations of justice or fairness: the argument of the irrelevance of group size, the argument from the principle of need, and the argument of identifiability. It is argued that all of these arguments fail to support the conclusion that orphan drugs should be subsidized to a larger extent than treatments for common diseases. The argument of the irrelevance fails to distinguish between directly and indirectly relevant considerations of fairness or justice. The recent attempt to revive the moral relevance of identifiability has provided no novel reasons to think that identifiability is morally relevant in itself...
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In palliative care there is much debate about which end of life treatment strategies are legitimate and which are not. Some writers argue that there is an important moral dividing-line between palliative sedation and euthanasia, making... more
In palliative care there is much debate about which end of life treatment strategies are legitimate and which are not. Some writers argue that there is an important moral dividing-line between palliative sedation and euthanasia, making the first acceptable and the latter not. We have questioned this. In a recent article, Lars Johan Materstvedt has argued that we are wrong on two accounts: first, that we fail to account properly for the moral difference between continuous deep palliative sedation at the end of life and euthanasia, and, second, that we fail to account properly for the difference between permanent loss of consciousness and death. Regarding the first objection, we argue that Materstvedt misses the point: we agree that there is a difference in terms of intentions between continuous deep palliative sedation and euthanasia, but we question whether this conceptual difference makes up for a moral difference. Materstvedt fails to show that it does. Regarding the second object...
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To investigate the preferred actions of healthcare staff, as well as their reasoning and attitudes about young females' requests for a virginity certificate or hymen restoration. A qualitative study, consisting of semi-structured... more
To investigate the preferred actions of healthcare staff, as well as their reasoning and attitudes about young females' requests for a virginity certificate or hymen restoration. A qualitative study, consisting of semi-structured interviews of healthcare providers from different parts of Sweden and from different medical specialties and professions, who had experience of women who asked for a virginity certificate or a hymen repair. Using content analysis, ten themes emerged regarding healthcare personnel's attitudes and reasoning about young female patients and their requests for demonstration of virginity. The themes logically were categorised as values, beliefs, and cultural affiliation. Responders had a more pragmatic and permissive view than the restrictive, official Swedish policy opposing hymenoplasties within the public healthcare system. There were degrees of willingness to accommodate such requests, due, for example, to different moral beliefs and medical concerns....
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Objectives To investigate the hypothesis that complaints of adverse events related to encounters with healthcare personnel are underreported and to identify barriers to filing such complaints. Design A cross-sectional study, where a... more
Objectives To investigate the hypothesis that complaints of adverse events related to encounters with healthcare personnel are underreported and to identify barriers to filing such complaints. Design A cross-sectional study, where a questionnaire was sent to the respondents asking whether or not they have filed complaints of adverse events. Respondents were also asked whether they have had reasons for doing so but abstained, and if so their reasons for not complaining. The authors also asked about participants' general experience of and trust in healthcare. Setting The County of Stockholm, Sweden. Participants A random sample of 1500 individuals of the general population registered by the Swedish National Tax Board as living in the County of Stockholm in April 2008. Of the selected group, aged 18-99 years, 50% were women and 50% men. Response rate was 62.1%, of which 58% were women and 42% were men; the median age was 49 years. Primary and secondary outcome measures Primary outc...
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To investigate the attitudes among Swedish physicians and the general public towards continuous deep sedation (CDS) as an alternative treatment for a competent, not imminently dying patient with Huntington's disorder requesting... more
To investigate the attitudes among Swedish physicians and the general public towards continuous deep sedation (CDS) as an alternative treatment for a competent, not imminently dying patient with Huntington's disorder requesting physician-assisted suicide (PAS) and euthanasia. A questionnaire was distributed to 1200 physicians in Sweden and 1201 individuals in Stockholm. It consisted of three parts: 1) A vignette about a competent patient with Huntington's disease requesting PAS. When no longer competent, relatives request euthanasia on behalf of the patient. Responders were asked about their attitudes towards these requests and whether CDS would be an acceptable alternative. 2) General questions about PAS and euthanasia. 3) Background variables. The response rate was 56% (physicians) and 52% (general public). The majority of the general public and a fairly large proportion of physicians reported more liberal views on CDS than are expressed in current Swedish and internationa...
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The background of this paper is the ongoing dismantling of the social insurance systems in favour of commercialisation and privatisation of insurances needed for illness, old age and premature death. This combined with the increased... more
The background of this paper is the ongoing dismantling of the social insurance systems in favour of commercialisation and privatisation of insurances needed for illness, old age and premature death. This combined with the increased possibility of using genetic testing for differentiating personal insurance premiums has the potentiality of creating a 'genetic proletariat'--an uninsurable high-risk population. The common way of handling this problem in Sweden, and many other developed countries around the North Atlantic, has been to regulate insurance companies' right to ask for and use genetic information in various ways. There is a distinction between partial regulation (that allows insurance companies access to genetic information from genetic tests already made, sometimes only above a specified amount, but not to demand new tests) and total regulation (that forbids insurance companies to ask for or use any genetic information). I will argue that these forms of regulat...
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Different ideas of the normative relevance of autonomy can give rise to profoundly different action-guiding principles in healthcare. If autonomy is seen as a value rather than as a right, it can be argued that... more
Different ideas of the normative relevance of autonomy can give rise to profoundly different action-guiding principles in healthcare. If autonomy is seen as a value rather than as a right, it can be argued that patients' decisions should sometimes be overruled in order to protect or promote their own autonomy. We refer to this as paternalism in the name of autonomy. In this paper, we discuss different elements of autonomy (decision-making capacity, efficiency, and authenticity) and arguments in favor of paternalism for the sake of autonomy that have been proposed in the bioethical debate. We argue that if autonomy is valuable, then paternalism for the sake of autonomy may be justified. However, policies allowing paternalism in the name of autonomy may be self-defeating.