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  • 1. Lynoe, Niels
    et al.
    Leijonhufvud, Madeleine
    Stockholm University, Faculty of Law, Department of Law.
    Police in an intensive care unit: what can happen?2013In: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 39, no 12, p. 772-775Article in journal (Refereed)
    Abstract [en]

    During spring 2009 a Swedish senior paediatric intensivist and associate professor was detained and later prosecuted for mercy-killing a child with severe brain damage. The intensivist was accused of having used high doses of thiopental after having withdrawn life-sustaining treatment when the child was imminently dying. After more than 2.5years of investigation the physician was acquitted by the Stockholm City Court. The court additionally stated that the physician had provided good end-of-life care. Since the trial it has become evident that the accusation was based on a problematic medicolegal report. Nevertheless, the event has had severe negative consequences for the physician personally and professionally, and probably also, in general, for patients in the final stage of life. This case illustrates, together with other cases, that there is a lack of correspondence between ethical soft law/healthcare law and the Penal Code. To optimise medical practice we suggest that the criminal law be carefully examined and if possible changed. Furthermore, we suggest a peer-review system for assessing medicolegal reports in cases of suspected homicide.

  • 2. Lynöe, Niels
    et al.
    Wessel, Maja
    Olsson, Daniel
    Alexanderson, Kristina
    Tännsjö, Torbjörn
    Stockholm University, Faculty of Humanities, Department of Philosophy.
    Juth, Niklas
    Duelling with doctors, restoring honour and avoiding shame?: A cross-sectional study of sick-listed patients' experiences of negative healthcare encounters with special reference to feeling wronged and shame2013In: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 39, no 10, p. 654-657Article in journal (Refereed)
    Abstract [en]

    Aims: The aim of this study was to examine if it is plausible to interpret the appearance of shame in a Swedish healthcare setting as a reaction to having one's honour wronged.

    Methods: Using a questionnaire, we studied answers from a sample of long-term sick-listed patients who had experienced negative encounters (n=1628) and of these 64% also felt wronged. We used feeling wronged to examine emotional reactions such as feeling ashamed and made the assumption that feeling shame could be associated with having one's honour wronged. In statistical analyses relative risks (RRs) were computed, adjusting for age, sex, disease-labelling, educational levels, as well as their 95% CI.

    Results: Approximately half of those who had been wronged stated that they also felt shame and of those who felt shame, 93% (CI 91 to 95) felt that they had been wronged. The RR was 4.5 (CI 3.0 to 6.8) for shame when wronged. This can be compared with the other emotional reactions where the RRs were between 1.1 (CI 0.9 to 1.3)-1.4 (CI 1.2 to 1.7). We found no association between country of birth and feeling shame after having experienced negative encounters.

    Conclusions: We found that the RR of feeling shame when wronged was significantly higher compared with other feelings. Along with theoretical considerations, and the specific types of negative encounters associated with shame, the results indicate that our research hypothesis might be plausible. We think that the results deserve to be used as point of departure for future research.

  • 3. Pelto-Piri, Veikko
    et al.
    Engström, Karin
    Stockholm University, Faculty of Social Sciences, Department of Child and Youth Studies.
    Engström, Ingemar
    Paternalism, autonomy and reciprocity: ethical perspectives in encounters with patients in psychiatric in-patient care.2013In: BMC Medical Ethics, ISSN 1472-6939, Vol. 14, no 1, p. 49-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Psychiatric staff members have the power to decide the options that frame encounters with patients. Intentional as well as unintentional framing can have a crucial impact on patients' opportunities to be heard and participate in the process. We identified three dominant ethical perspectives in the normative medical ethics literature concerning how doctors and other staff members should frame interactions in relation to patients; paternalism, autonomy and reciprocity. The aim of this study was to describe and analyse statements describing real work situations and ethical reflections made by staff members in relation to three central perspectives in medical ethics; paternalism, autonomy and reciprocity.

    METHODS: All staff members involved with patients in seven adult psychiatric and six child and adolescent psychiatric clinics were given the opportunity to freely describe ethical considerations in their work by keeping an ethical diary over the course of one week and 173 persons handed in their diaries. Qualitative theory-guided content analysis was used to provide a description of staff encounters with patients and in what way these encounters were consistent with, or contrary to, the three perspectives.

    RESULTS: The majority of the statements could be attributed to the perspective of paternalism and several to autonomy. Only a few statements could be attributed to reciprocity, most of which concerned staff members acting contrary to the perspective. The result is presented as three perspectives containing eight values.Paternalism; 1) promoting and restoring the health of the patient, 2) providing good care and 3) assuming responsibility.Autonomy; 1) respecting the patient's right to self-determination and information, 2) respecting the patient's integrity and 3) protecting human rights.Reciprocity; 1) involving patients in the planning and implementation of their care and 2) building trust between staff and patients.

    CONCLUSIONS: Paternalism clearly appeared to be the dominant perspective among the participants, but there was also awareness of patients' right to autonomy. Despite a normative trend towards reciprocity in psychiatry throughout the Western world, identifying it proved difficult in this study. This should be borne in mind by clinics when considering the need for ethical education, training and supervision.

  • 4. Ringblom, Joakim
    et al.
    Törnqvist, Elin
    Hansson, Sven Ove
    Rudén, Christina
    Stockholm University, Faculty of Science, Department of Environmental Science and Analytical Chemistry.
    Öberg, Mattias
    Assigning Ethical Weights to Clinical Signs Observed During Toxicity Testing2017In: Altex Alternatives to Animal Experimentation, ISSN 1868-596X, Vol. 34, no 1, p. 148-156Article in journal (Refereed)
    Abstract [en]

    Reducing the number of laboratory animals used and refining experimental procedures to enhance animal welfare are fundamental questions to be considered in connection with animal experimentation. Here, we explored the use of cardinal ethical weights for clinical signs and symptoms in rodents by conducting trade-off interviews with members of Swedish Animal Ethics Committees in order to derive such weights for nine typical clinical signs of toxicity. The participants interviewed represent researchers, politically nominated political nominees and representatives of animal welfare organizations. We observed no statistically significant differences between these groups with respect to the magnitude of the ethical weights assigned, though the political nominees tended to assign lower weights. Overall, hunched posture was considered the most severe clinical sign and body weight loss the least severe. The ethical weights assigned varied considerably between individuals, from zero to infinite value, indicating discrepancies in prioritization of reduction and refinement. Cardinal ethical weights may be utilized to include both animal welfare refinement and reduction of animal use in designing as well as in retrospective assessment of animal experiments. Such weights may also be used to estimate ethical costs of animal experiments.

  • 5. Sandor, Judit
    et al.
    Bárd, Petra
    Tamburrini, Claudio
    Stockholm University, Faculty of Humanities, Department of Philosophy.
    Tännsjö, Torbjörn
    Stockholm University, Faculty of Humanities, Department of Philosophy.
    The case of biobank with the law: between a legal and scientific fiction2012In: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 38, no 6, p. 347-350Article in journal (Refereed)
    Abstract [en]

    According to estimates more than 400 biobanks currently operate across Europe. The term 'biobank' indicates a specific field of genetic study that has quietly developed without any significant critical reflection across European societies. Although scientists now routinely use this phrase, the wider public is still confused when the word 'bank' is being connected with the collection of their biological samples. There is a striking lack of knowledge of this field. In the recent Eurobarometer survey it was demonstrated that even in 2010 two-thirds of the respondents had never even heard about biobanks. The term gives the impression that a systematic collection of biological samples can constitute a 'bank' of considerable financial worth, where the biological samples, which are insignificant in isolation but are valuable as a collection, can be preserved, analysed and put to 'profitable use'. By studying the practices of the numerous already existing biobanks, the authors address the following questions: to what extent does the term ` biobank' reflect the normative concept of using biological samples for the purposes of biomedical research? Furthermore, is it in harmony with the so far agreed legal-ethical consensus in Europe or does it deliberately pull science to the territory of a new, ambiguous commercial field? In other words, do biobanks constitute a medico-legal fiction or are they substantively different from other biomedical research protocols on human tissues?

  • 6.
    Tännsjö, Torbjörn
    Stockholm University, Faculty of Humanities, Department of Philosophy.
    Ought We to Enhance Our Cognitive Capacities?2009In: Bioethics, ISSN 0269-9702, E-ISSN 1467-8519, Vol. 23, no 7, p. 421-432Article in journal (Refereed)
    Abstract [en]

    Ought we to enhance our cognitive capacities beyond the normal human range? There is no denying that it might be a good idea to level out differences between people with respect to cognitive capacities, and there is no denying that some persons' reaching beyond normal capacities may have some good side-effects on society at large (but also bad side-effects, of course). But is there any direct gain to be made by having ones cognitive capacities enhanced? Will this as such make our lives go better? No, I argue, or, at least, there doesn't seem to exist any evidence suggesting that it would. And it doesn't matter whether we consider the question from a narrow hedonistic perspective, from a more refined hedonistic perspective, from a desire-satisfaction view, or if we adopt some reasonable objective list view of what makes a life go well. Only on an extremely perfectionist — and implausible —view of what makes our lives go well could any direct value in cognitive enhancement find support. Finally, there are no good reasons to do with our sense of identity to enhance even our capacity to remember. So, cognitive enhancement as such would not make our lives go any better.

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