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  • 251. Nord, Anette
    et al.
    Lundgren, Johan
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Carlsson, Jörg
    Israelsson, Johan
    Apropå! – HLR och rätten till en värdig död2016In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 20Article in journal (Other (popular science, discussion, etc.))
  • 252.
    Nord, Anette
    et al.
    Linköping University, Sweden.
    Lundgren, Johan
    Bremer, Anders
    University of Borås, Sweden.
    Carlsson, Jörg
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Israelsson, Johan
    Linköping University, Sweden.
    Apropå! – HLR och rätten till en värdig död2016In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 20, article id 113:DZEHArticle in journal (Other (popular science, discussion, etc.))
  • 253.
    Nord, Anette
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Lundgren, Johan
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Bremer, Anders
    Högskolan i Borås.
    Carlsson, Jörg
    Linnéuniversitetet.
    Israelsson, Johan
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    HLR och rätten till en värdig död2016In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 20, article id 2016;113:DZEHArticle in journal (Other (popular science, discussion, etc.))
  • 254.
    Nordenfelt, Lennart
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Der Gegensatz zwischen naturalistischen und holistischen Theorien von Gesundheit und Krankheit2012In: Das Gesunde, das Kranke und die Medizinethik: Moralische Implikationen des Krankheitsbegriffs / [ed] Markus Rothhaar & Andreas Frewer, Stuttgart: Franz Steiner Verlag, 2012, 1, p. 89-104Chapter in book (Other academic)
  • 255.
    Nordenfelt, Lennart
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    The opposition between naturalistic and holistic theories of health and disease2013In: Health, illness and disease: philosophical essays / [ed] Havi Carel and Rachel Cooper, Durham UK: Acumen Publishing, 2013, 1, p. 23-36Chapter in book (Other academic)
    Abstract [en]

    What counts as health or ill health? How do we deal with the fallibility of our own bodies? Should illness and disease be considered simply in biological terms, or should considerations of its emotional impact dictate our treatment of it?  Our understanding of health and illness had become increasingly more complex in the modern world, as we are able to use medicine not only to fight disease but to control other aspects of our bodies, whether mood, blood pressure, or cholesterol. This collection of essays foregrounds the concepts of health and illness and patient experience within the philosophy of medicine, reflecting on the relationship between the ill person and society. Mental illness is considered alongside physical disease, and the important ramifications of society's differentiation between the two are brought to light. Health, Illness and Disease is a significant contribution to shaping the parameters of the evolving field of philosophy of medicine and will be of interest to medical practitioners and policy-makers as well as philosophers of science and ethicists.

  • 256. Nordenskjöld, U
    et al.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Rheumatology.
    Arbetsterapi vid reumatisk sjukdom 2011In: Reumatologi / [ed] Lars Klareskog, Tore Saxne, Yvonne Enman, 2011, 2, p. 423-Chapter in book (Other academic)
  • 257.
    Nordgren, Anders
    Linköping University, Department of Culture and Communication, Arts and Humanities. Linköping University, Faculty of Arts and Sciences.
    First-in-human trials on genome editing: Strategies for handling uncertainty about benefit and uncertainty about harm2017Conference paper (Refereed)
    Abstract [en]

    Human genome editing can be carried out on somatic cells as well as on the germline. In this paper I discuss first-in-human trials on both types of editing. At first sight, risk and risk/benefit assessment might seem to be key issues in such trials. However, according to decision theory, risk presupposes numerical values. In ‘decision-making under risk’, decisionmakers have sufficient information to assign probabilities to alternative outcomes. This is not the case in first-in-human trials. These trials are rather characterized by ‘decision-making under uncertainty’. My overall objective is to clarify the implications of uncertainty about benefit and uncertainty about harm in first-in-human trials on genome editing. A special aim is to analyse strategies for handling uncertainty.

  • 258.
    Nordlund, Christer
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies.
    The moral economy of a miracle drug: on exchange relationships between medical science and the pharmaceutical industry in the 1940s2015In: Value practices in the life sciences and medicine / [ed] Isabelle Dussauge, Claes-Fredrik Helgesson & Francis Lee, Oxford: Oxford University Press, 2015, 1, p. 49-70Chapter in book (Refereed)
  • 259.
    Oliveri, Serena
    et al.
    Univ Milan, Dept Oncol & Hematooncol, Interdisciplinary Res Ctr Decis Making Proc IRIDe, Milan, Italy.;IEO, Appl Res Div Cognit & Psychol Sci, Milan, Italy..
    Howard, Heidi C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Renzi, Chiara
    IEO, Appl Res Div Cognit & Psychol Sci, Milan, Italy..
    Hansson, Mats G.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Pravettoni, Gabriella
    Univ Milan, Dept Oncol & Hematooncol, Interdisciplinary Res Ctr Decis Making Proc IRIDe, Milan, Italy.;IEO, Appl Res Div Cognit & Psychol Sci, Milan, Italy..
    Anxiety delivered direct-to-consumer: are we asking the right questions about the impacts of DTC genetic testing?2016In: Journal of Medical Genetics, ISSN 0022-2593, E-ISSN 1468-6244, Vol. 53, no 12, p. 798-799Article in journal (Refereed)
  • 260.
    Olofsson, Anna
    et al.
    Mid Sweden University, Östersund, Sweden.
    Rashid, Saman
    Mid Sweden University, Östersund, Sweden.
    Öhman, Susanna
    Mid Sweden University, Östersund, Sweden.
    The division of attitudes to GM food between the north and south of Europe2003In: Integrating and Articulating Environments: A Challenge for Northern and Southern Europe / [ed] Fatoş Gokşen, Lisse: Swets & Zeitlinger, 2003, p. 91-108Chapter in book (Other academic)
    Abstract [en]

    When it comes to issues such as genetic engineering, it is important to take into account external sources in the understanding of attitude formation. It is evident that there might be differences in media coverage, policy decisions and other culturally based sources of information when comparing the South with the North of Europe. The objective of this background is to give a short summary of the situation concerning genetic engineering in each cluster of countries in the South and the North of Europe. © 2003 by Taylor & Francis Group, LLC.

  • 261.
    Olszynko-Gryn, Jesse
    et al.
    Department of History and Philosophy of Science, University of Cambridge, Cambridge, UK.
    Bjørvik, Eira
    Department of Community Medicine and Global Health, Faculty of Medicine, University of Oslo, Oslo, Norway.
    Weßel, Merle
    Department of History, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany.
    Jülich, Solveig
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Arts, Department of History of Science and Ideas.
    Jean, Cyrille
    Sciences Po History Centre, Paris, France.
    A historical argument for regulatory failure in the case of Primodos and other ‘hormone pregnancy tests’2018In: Reproductive Biomedicine & Society Online, E-ISSN 2405-6618, Vol. 6, p. 34-44Article in journal (Refereed)
    Abstract [en]

    The drug Primodos and other hormone pregnancy tests (HPTs) remained on the British market for about a decade after they were first implicated, in 1967, as a possible cause of birth defects. In November 2017, an expert working group (EWG) set up by the Medicines and Healthcare Products Regulatory Agency (MHRA) concluded against such an association. However, it was explicitly ‘not within the remit of the EWG to make formal conclusions or recommendations on the historical system or regulatory failures’, a situation that has left many stakeholders dissatisfied. Placing the question of a teratogenicity to one side, this article takes a more contextual and comparative approach than was possible under the auspices of MHRA. It asks why an unnecessary and possibly even harmful drug was allowed to remain on the British market when a reliable and perfectly safe alternative existed: urine tests for pregnancy. Based on archival research in several countries, this article builds a historical argument for regulatory failure in the case of HPTs. It concludes that the independent review which campaigners are calling for would have the potential to not only bring them a form of closure, but would also shed light on pressing issues of more general significance regarding risk, regulation and communication between policy makers, medical experts and patients.

  • 262.
    Pascalev, Assya
    et al.
    Bulgarian Center for Bioethics.
    de Jong, Jessica
    Central Division of the National Police, the Netherlands.
    Ambagtsheer, Frederike
    Erasmus MC University Hospital Rotterdam, the Netherlands.
    Lundin, Susanne
    Lund University.
    Ivanovski, Ninoslav
    University of St. Cyril and Methodius, Macedonia.
    Codreanu, Natalia
    Renal Foundation, Moldova.
    Gunnarson, Martin
    Södertörn University, School of Culture and Education, Centre for Studies in Practical Knowledge.
    Yankov, Jordan
    Bulgarian Center for Bioethics, Bulgaria.
    Frunza, Mihaela
    Academic Society for the Research of Religions and Ideologies, Romania.
    Byström, Ingela
    Lund University.
    Bos, Michael
    Eurotransplant International Foundation, the Netherlands.
    Weimar, Willem
    Erasmus MC University Hospital Rotterdam, the Netherlands.
    Trafficking in Human Beings for the Purpose of Organ Removal: A Comprehensive Literature Review2016In: Trafficking in Human Beings for the Purpose of Organ Removal: Results and Recommendations / [ed] Frederike Ambagtsheer & Willem Weimar, Lengerich: Pabst Science Publishers, 2016Chapter in book (Other academic)
  • 263.
    Pascalev, Assya
    et al.
    Bulgarian Center for Bioethics, Bulgaria.
    Van Assche, Kristof
    Bioethics Institute Ghent, Ghent University, Belgium.
    Sándor, Judit
    Center for Ethics and Law in Biomedicine, Central European University, Hungary.
    Codreanu, Natalia
    Renal Foundation, Moldova.
    Naqvi, Anwar
    Department of Urology and Centre of Biomedical Ethics and Culture, Sindh Institute of Urology and Transplantation, Pakistan.
    Gunnarson, Martin
    Avdelningen för etnologi, Institutionen för kulturvetenskaper, Lunds universitet.
    Frunza, Mihaela
    Academic Society for the Research of Religions and Ideologies, Romania.
    Yankov, Jordan
    Bulgarian Center for Bioethics, Bulgaria.
    Protection of Human Beings Trafficked for the Purpose of Organ Removal: Recommendations2016In: Transplantation Direct, ISSN 2373-8731, Vol. 2, no 2, p. 1-4, article id e59Article in journal (Refereed)
    Abstract [en]

    This report presents a comprehensive set of recommendations for protection of human beings who are trafficked for the purpose of organ removal or are targeted for such trafficking. Developed by an interdisciplinary group of international experts under the auspices of the project Trafficking in Human Beings for the Purpose of Organ Removal (also known as the HOTT project), these recommendations are grounded in the view that an individual who parts with an organ for money within an illegal scheme is ipso facto a victim and that the crime of trafficking in human beings for the purpose of organ removal (THBOR) intersects with the crime of trafficking in organs. Consequently, the protection of victims should be a priority for all actors involved in antitrafficking activities: those combating organ-related crimes, such as health organizations and survivor support services, and those combating trafficking in human beings, such as the criminal justice sectors. Taking into account the special characteristics of THBOR, the authors identify 5 key stakeholders in the protection of human beings trafficked for organ removal or targeted for such trafficking: states, law enforcement agencies and judiciary, nongovernmental organizations working in the areas of human rights and antitrafficking, transplant centers and health professionals involved in transplant medicine, and oversight bodies. For each stakeholder, the authors identify key areas of concern and concrete measures to identify and protect the victims of THBOR. The aim of the recommendations is to contribute to the development of a nonlegislative response to THBOR, to promote the exchange of knowledge and best practices in the area of victim protection, and to facilitate the development of a policy-driven action plan for the protection of THBOR victims in the European Union and worldwide.

  • 264. 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.

  • 265.
    Pelto-Piri, Veikko
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Psychiatric Research Centre.
    Engström, Karin
    Barn- och ungdomsvetenskapliga institutionen, Stockholms universitet, Stockholm, Sweden.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Paternalism, autonomy and reciprocity: ethical perspectives in encounters with patients in psychiatric in-patient care.2013In: BMC Medical Ethics, ISSN 1472-6939, E-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.

  • 266.
    Pergert, Pernilla
    et al.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Bartholdson, Cecilia
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Wenemark, Marika
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Business support and Development, Department of Health and Care Development.
    Lutzen, Kim
    Karolinska Inst, Sweden.
    af Sandeberg, Margareta
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Translating and culturally adapting the shortened version of the Hospital Ethical Climate Survey (HECS-S) - retaining or modifying validated instruments2018In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 19, article id 35Article in journal (Refereed)
    Abstract [en]

    Background: The Hospital Ethical Climate Survey (HECS) was developed in the USA and later shortened (HECS-S). HECS has previously been translated into Swedish and the aim of this study was to describe a process of translating and culturally adapting HECS-S and to develop a Swedish multi-professional version, relevant for paediatrics. Another aim was to describe decisions about retaining versus modifying the questionnaire in order to keep the Swedish version as close as possible to the original while achieving a good functional level and trustworthiness. Methods: In HECS-S, the respondents are asked to indicate the veracity of statements. In HECS and HECS-S the labels of the scale range from almost never true to almost always true; while the Swedish HECS labels range from never to always. The procedure of translating and culturally adapting the Swedish version followed the scientific structure of guidelines. Three focus group interviews and three cognitive interviews were conducted with healthcare professionals. Furthermore, descriptive data were used from a previous study with healthcare professionals (n = 89), employing a modified Swedish HECS. Decisions on retaining or modifying items were made in a review group. Results: The Swedish HECS-S consists of 21 items including all 14 items from HECS-S and items added to develop a multi-professional version, relevant for paediatrics. The descriptive data showed that few respondents selected never and always. To obtain a more even distribution of responses and keep Swedish HECS-S close to HECS-S, the original labels were retained. Linguistic adjustments were made to retain the intended meaning of the original items. The word respect was used in HECS-S with two different meanings and was replaced in one of these because participants were concerned that respecting patients wishes implied always complying with them. Conclusions: The process of developing a Swedish HECS-S included decisions on whether to retain or modify. Only minor adjustments were needed to achieve a good functional level and trustworthiness although some items needed to be added. Adjustments made could be used to also improve the English HECS-S. The results shed further light on the need to continuously evaluate even validated instruments and adapt them before use.

  • 267.
    Pestoff, Rebecka
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Clinical genetics.
    Johansson, Peter
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Gunnarsson, Cecilia
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Clinical genetics.
    Factors influencing use of telegenetic counseling: perceptions of health care professionals in Sweden2019In: Journal of Community Genetics, ISSN 1868-310X, E-ISSN 1868-6001, Vol. 10, no 3, p. 407-415Article in journal (Refereed)
    Abstract [en]

    Genetic counseling services are increasing in demand and limited in access due to barriers such as lack of professional genetic counselors, vast geographic distances, and physical hurdles. This research focuses on an alternative mode of delivery for genetic counseling in Sweden, in order to overcome some of the mentioned barriers. The aim of this study is to identify factors that influence the implementation and use of telegenetic counseling in clinical practice, according to health care professionals in Southeast Sweden. Telegenetic counseling refers to the use of video-conferencing as a means to provide genetic counseling. Qualitative, semi-structured interviews with 16 genetic counseling providers took place and phenomenographic analysis was applied. Significant excerpts were identified in each transcript, which led to sub-categories that constructed the main findings. Three categories emerged from the data: (1) requirements for optimal use, (2) impact on clinical practice, and (3) patient benefits. Each category consists of two or three sub-categories, in total seven sub-categories. These findings could potentially be used to improve access and uptake of telegenetic counseling in Sweden and in other countries with a similar health care system. This could benefit not only remote patient populations, as described in previous research, but also large family groups and patients experiencing obstacles in accessing genetic counseling, such as those with a psychiatric illness or time constraints, and be a useful way to make genetic counseling available in the new era of genomics.

  • 268.
    Petersson, Bo
    Linköping University, Department of Culture and Communication. Linköping University, Faculty of Arts and Sciences.
    Platon2012In: Filosofi och medicin: från Platon till Foucault, Stockholm: Thales, 2012, p. 17-37Chapter in book (Other academic)
  • 269.
    Petersson, Bo
    et al.
    Linköping University, Department of Culture and Social Science. Linköping University, Faculty of Arts and Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
    När kan man forska på patienter utan deras informerade samtycke?1996In: VEST. Tidskrift för vetenskapsstudier, ISSN 0283-6025, no 4, p. 47-56Article in journal (Other academic)
  • 270.
    Pettersson, Mona
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    COMPETENCE AND COMMUNICATION: Do Not Resuscitate Decisions in Cancer Care2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Within cancer care, do not resuscitate (DNR) decisions are frequently made. DNR decisions can be ethically difficult and lead to conflicts of interest and disagreements within the medical team. This thesis brings together empirical knowledge of DNR decisions in cancer care and theoretical discussions on the ethical aspects and the competence needed to make such decisions.

    The overall aim of this project was to investigate the clinical and ethical aspects of DNR decisions from the perspectives of nurses and physicians working in hematology and oncology care. The methods used were qualitative, with individual interviews, and quantitative, using a web survey. Ethical theories, principles and models were used   in the planning of the studies and to explain and discuss the results.

    Fifteen nurses in Study I expressed a close relationship with their patients. They expressed how they needed clear and well-documented decisions on DNR to provide good care to patient and relatives. Sixteen physicians participated in Study II. They described how they made decisions on DNR mainly on medical grounds, but reflected on ethical aspects of the decision, weighing maleficence and beneficence.  In Study III, the interviews from Study I and II were analyzed from the perspective of ethical competence. The results showed that physicians and nurses were able to reflect on their ethical competence in relation to DNR decisions and described ethical competence as both being good and doing right. Also knowledge in ethics was emphasized.  In Study IV, 216 nurses and physicians participated. Most respondents thought it was important for patients and relatives to participate in, and be informed about, a DNR decision, but fewer thought that this was likely to happen. Nurses rated the importance higher than physicians did. The most important attributes in relation to DNR decisions for both nurses and physicians pertained more to medical viewpoints than to ethical values.

    DNR decisions in cancer care can be associated with ethical conflicts of interest, and nurses and physicians have different perspective of DNR decisions which they need to share. Competence in ethics and inter-professional communication are crucial for nurses and physicians participating in such decisions.

  • 271.
    Pettersson, Mona
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Hedström, Mariann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Höglund, Anna T
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Ethical competence in DNR decisions: a qualitative study of Swedish physicians and nurses working in hematology and oncology care2018In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 19, article id 63Article in journal (Refereed)
    Abstract [en]

    Background

    DNR decisions are frequently made in oncology and hematology care and physicians and nurses may face related ethical dilemmas. Ethics is considered a basic competence in health care and can be understood as a capacity to handle a task that involves an ethical dilemma in an adequate, ethically responsible manner. One model of ethical competence for healthcare staff includes three main aspects: being, doing and knowing, suggesting that ethical competence requires abilities of character, action and knowledge. Ethical competence can be developed through experience, communication and education, and a supportive environment is necessary for maintaining a high ethical competence. The aim of the present study was to investigate how nurses and physicians in oncology and hematology care understand the concept of ethical competence in order to make, or be involved in, DNR decisions and how such skills can be learned and developed. A further aim was to investigate the role of guidelines in relation to the development of ethical competence in DNR decisions.

    Methods

    Individual interviews were conducted with fifteen nurses and sixteen physicians. The interviews were analyzed using thematic content analysis.

    Results

    Physicians and nurses in the study reflected on their ethical competence in relation to DNR decisions, on what it should comprise and how it could be developed. The ethical competence described by the respondents related to the concepts being, doing and knowing.

    Conclusions

    In order to make ethically sound DNR decisions in oncology and hematology care, physicians and nurses need to develop appropriate virtues, improve their knowledge of ethical theories and relevant clinical guidelines. Ethical competence also includes the ability to act upon ethical judgements. Continued ethical education and discussions for further development of a common ethical language and a good ethical working climate can improve ethical competence and help nurses and physicians cooperate better with regard to patients in relation to DNR decisions, in their efforts to act in the best interest of the patient.

  • 272.
    Pettersson, Mona
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Hedström, Mariann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Höglund, Anna T
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    “Not the most difficult decision”. Physicians’ experience of Do-Not-Resuscitate (DNR) orders in hematology and oncology care.Manuscript (preprint) (Other academic)
  • 273.
    Pettersson, Mona
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Hedström, Mariann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Höglund, Anna T
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Striving for good nursing care: Nurses' experiences of do not resuscitate orders within oncology and hematology care2014In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 21, no 8, p. 902-915Article in journal (Refereed)
    Abstract [en]

    Background: Within oncology and hematology care, patients are sometimes considered to have such a poor prognosis that they can receive a do not resuscitate order from the physician responsible, stipulating that neither basic nor advanced coronary pulmonary rescue be performed in the event of a cardiac arrest. Studies on do not resuscitate decisions within oncology and hematology units, focusing on the specific role of the nurse in relation to these decisions, are scarce.

    Objective: The aim of this study was to investigate hematology and oncology nurses’ experiences and perceptions of do not resuscitate orders, in order to achieve a deeper understanding of the nurses’ specific role in these decisions.

    Research design: A qualitative, descriptive methodology with individual semi-structured interviews was used.

    Participants and research context: A total of 15 nurses from eight hematology/oncology wards in four hospitals in Sweden were interviewed individually.

    Ethical considerations: In accordance with national regulations, an ethical review was not required for this study. The research followed international guidelines for empirical research, as outlined in the Helsinki Declaration.

    Findings: The nurses strived for good nursing care through balancing harms and goods and observing integrity and quality of life as important values. Experienced hindrances for good care were unclear and poorly documented decisions, uninformed patients and relatives, and disagreements among the caregivers and family. The nurses expressed a need for an ongoing discussion on do not resuscitate decisions, including all concerned parties.

    Conclusion: In order to provide good nursing care, nurses need clear and well-documented do not resuscitate orders, and patients and relatives need to be well informed and included in the decisions. To increase the understanding for each other’s opinions within the medical team, regular ethical discussions are required.

  • 274.
    Pettersson, Mona
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Höglund, Anna T
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Hedström, Mariann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Perspectives on the DNR decisions process: a survey of nurses and physicians in hematology and oncology2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 11, article id e0206550Article in journal (Refereed)
    Abstract [en]

    Introduction

    In cancer care, do-not-resuscitate (DNR) decisions are made frequently; i.e., decisions not to start the heart in the event of a cardiac arrest. A DNR decision can be a complex process involving nurses and physicians with a wide variety of experiences and perspectives. Previous studies have shown different perceptions of the DNR decision process among nurses and physicians, e.g. concerning patient involvement and information. DNR decisions have also been reported to be unclear and documentation inconsistent.

    Objective

    The aim was to investigate how important and how likely to happen nurses and physicians considered various aspects of the DNR decision process, regarding participation, information and documentation, as well as which attributes they found most important in relation to DNR decisions.

    Methods

    A descriptive correlational study using a web survey was conducted, including 132 nurses and 84 physicians working in hematology and oncology.

    Results

    Almost half of the respondents reported it not likely that the patient would be involved in the decision on DNR, and 21% found it unimportant to inform patients of the DNR decision. Further, 57% reported that providing information to the patient was important, but only 21% stated that this was likely to happen. There were differences between nurses and physicians, especially regarding participation by and information to patients and relatives. The attributes deemed most important for both nurses and physicians pertained more to medical viewpoints than to ethical values, but a difference was found, as nurses chose patient autonomy as the most important value, while physicians rated non-maleficence as the most important value in relation to DNR decisions.

    Conclusion

    Nurses and physicians need to be able to talk openly about their different perspectives on DNR decisions, so that they can develop a deeper understanding of the decisions, especially in cases where they disagree. They should also be aware that what they think is important is not always likely to happen. The organization needs to support such discussions through providing an environment that allows ethical discussions on regular basis. Patients and relatives will also benefit from receiving the same information from all caregivers.

  • 275.
    Piltén, Carina
    et al.
    Intensive Care Unit, Capio S:t Gorans Hospital, Stockholm.
    Eldh, Ann Catrine
    Intensive Care Unit, Capio S:t Gorans Hospital, Stockholm.
    Lung recruitment--a nurse and/or physician task. A national survey on requirements for education, regulations and guidelines.2009In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 25, no 1, p. 4-9Article in journal (Refereed)
    Abstract [en]

    International and national guidelines on requirements for performing lung recruitment manoeuvres are lacking. This paper presents a nationwide descriptive survey of the occurrence of and conditions for lung recruitment in adult patients treated with mechanical ventilation in intensive care units (ICUs) in Sweden. All ICUs except neurological, cardiac, paediatric and neonatal ICUs were invited (N=73); of these, 60 ICUs participated in the study (82%). The main outcome measures were prevalence of lung recruitment, whether ICU nurses and/or physicians carried out lung recruitment, requirements for nurses to perform lung recruitment and the existence of local guidelines. Lung recruitment was performed at 92% of the ICUs. Only physicians performed lung recruitment at 27 ICUs (49%), and in 28 units (51%) both physicians and nurses performed this treatment. Lung recruitment was performed more often in units where both physicians and nurses performed lung recruitment than in units where only physicians performed the manoeuvres (46% vs. 12%, p=0.03). Further, local guidelines on lung recruitment manoeuvres were more common in units where both physicians and nurses performed this treatment (71% vs. 41%, p=0.02). The results suggest that recommendations of repeated and prompt lung recruitment manoeuvres are better met if nurses, along with physicians, perform lung recruitment.

  • 276.
    Rasoal, Dara
    et al.
    Örebro University, School of Health Sciences.
    Kihlgren, Annica
    Örebro University, School of Health Sciences.
    Svantesson, Mia
    Örebro University, School of Health Sciences. Örebro University Hospital. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    ‘It’s like sailing’: experiences of the role as facilitator during moral case deliberation2017In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 12, no 3, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Moral case deliberation is one form of clinical ethics support, and there seems to be different ways of facilitating thedialogue. This paper aimed to explore the personal experiences of Swedish facilitators of their role in moral casedeliberations. Being a facilitator was understood through the metaphor of sailing: against the wind or with it. Therole was likened to a sailor’s set of skills: to promote security and well-being of the crew, to help crew navigate theirmoral reflections, to sail a course into the wind against homogeneity, to accommodate the crew’s needs and just sail withthe wind, and to steer towards a harbour with authority and expertise. Balancing the disparate roles of being accom-modative and challenging may create a free space for emotions and ideas, including self-reflection and consideration ofmoral demands. This research opens the question of whether all these skills can be taught through systematic training orwhether facilitators need to possess the characteristics of being therapeutic, pedagogical, provocative, sensitive andauthoritarian.

  • 277.
    Rasoal, Dara
    et al.
    Örebro University, School of Health Sciences.
    Skovdahl, Kirsti
    Department of Nursing and Health Sciences, University College in Southeast Norway, Drammen, Norway.
    Gifford, Mervyn
    Örebro University, School of Health Sciences.
    Kihlgren, Annica
    Örebro University, School of Health Sciences.
    Clinical Ethics Support for Healthcare Personnel: An Integrative Literature Review2017In: HEC Forum, ISSN 0956-2737, E-ISSN 1572-8498, Vol. 29, no 4, p. 313-346Article, review/survey (Refereed)
    Abstract [en]

    This study describes which clinical ethics approaches are available to support healthcare personnel in clinical practice in terms of their construction, functions and goals. Healthcare personnel frequently face ethically difficult situations in the course of their work and these issues cover a wide range of areas from prenatal care to end-of-life care. Although various forms of clinical ethics support have been developed, to our knowledge there is a lack of review studies describing which ethics support approaches are available, how they are constructed and their goals in supporting healthcare personnel in clinical practice. This study engages in an integrative literature review. We searched for peer-reviewed academic articles written in English between 2000 and 2016 using specific Mesh terms and manual keywords in CINAHL, MEDLINE and Psych INFO databases. In total, 54 articles worldwide described clinical ethics support approaches that include clinical ethics consultation, clinical ethics committees, moral case deliberation, ethics rounds, ethics discussion groups, and ethics reflection groups. Clinical ethics consultation and clinical ethics committees have various roles and functions in different coun-tries. They can provide healthcare personnel with advice and recommendations regarding the best course of action. Moral case deliberation, ethics rounds, ethics discussion groups and ethics reflection groups support the idea that group reflection increases insight into ethical issues. Clinical ethics support in the form of a ‘‘bot-tom-up’’ perspective might give healthcare personnel opportunities to think and reflect more than a ‘‘top-down’’ perspective. A ‘‘bottom-up’’ approach leaves the healthcare personnel with the moral responsibility for their choice of action in clinical practice, while a ‘‘top-down’’ approach risks removing such moral responsibility.

  • 278.
    Rejnö, Åsa
    et al.
    University West, Department of Health Sciences, Section for nursing - graduate level. Skaraborg Hospital Skövde, Sweden.
    Silfverberg, Gunilla
    Ersta Sköndal University College, Stockholm, Sweden.
    Ternestedt, Britt-Marie
    Ersta Sköndal University College, Stockholm, Sweden.
    Reasoning about truth-telling in end-of-life care of patients with acute stroke2017In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 24, no 1, p. 100-110Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Ethical problems are a universal phenomenon but rarely researched concerning patients dying from acute stroke. These patients often have a reduced consciousness from stroke onset and thereby lack ability to convey their needs and could be described as 'incompetent' decision makers regarding their own care. OBJECTIVE: The aim of the study was to deepen the understanding of stroke team members' reasoning about truth-telling in end-of-life care due to acute stroke. RESEARCH DESIGN: Qualitative study based on individual interviews utilizing combined deductive and inductive content analysis. PARTICIPANTS AND RESEARCH CONTEXT: A total of 15 stroke team members working in stroke units of two associated county hospitals in western Sweden participated. ETHICAL CONSIDERATIONS: The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden. FINDINGS: The main findings were the team members' dynamic movement between the categories 'Truth above all' and 'Hide truth to protect'. Honesty was highly valued and considered as a reason for always telling the truth, with the argument of truth as common morality. However, the carers also argued for hiding the truth for different reasons such as not adding extra burden in the sorrow, awaiting a timely moment and not being a messenger of bad news. Withholding truth could both be seen as a way of protecting themselves from difficult conversations and to protect others. DISCUSSION: The results indicate that there are various barriers for truthfulness. Interpreted from a virtue of ethics perspective, withholding of truth might also be seen as an expression of sound judgement to put the patient's best interest first. CONCLUSION: The carers may need support in the form of supervision to be given space to reflect on their experience and thereby promote ethically justified care. Here, the multi-professional team can be of great value and contribute through inter-professional sharing of knowledge.

  • 279.
    Ring, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Wettergren, Lena
    Fagerlind, Hanna
    Glimelius, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Lindberg, Mathilde Hedlund
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Kettis, Åsa
    Uppsala University, University Administration, Planning Division.
    QOL assessments in clinical practice: usefulness of ERORTC-QLQC-30 and the SEIOQL2014In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 23, p. 104-104Article in journal (Other academic)
  • 280. Ringblom, J.
    et al.
    Törnqvist, E.
    Hansson, Sven Ove
    Philosophy and History, KTH, School of Architecture and the Built Environment (ABE), Philosophy and History of Technology, Philosophy.
    Rudén, C.
    Öberg, M.
    Assigning ethical weights to clinical signs observed during toxicity testing2017In: Altex, ISSN 1868-596X, E-ISSN 1868-8551, 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.

  • 281. 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.

  • 282. Roberts, James M
    et al.
    Mascalzoni, Deborah
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Ness, Roberta B
    Poston, Lucilla
    Collaboration to Understand Complex Diseases: Preeclampsia and Adverse Pregnancy Outcomes2016In: Hypertension, ISSN 0194-911X, E-ISSN 1524-4563, Vol. 67, no 4, p. 681-687Article, review/survey (Refereed)
  • 283.
    Rydvall, Anders
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Withhold  or  withdraw  futile  treatment in  intensive  care: arguments supported by physicians and the general public2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Since the 60s and with increasing intensity a discussion have continued about balance between useful and useless/harmful treatment. Different attempts have been done to create sustainable criteria and recommendations to manage the situations of futile treatment near the end of life. Obviously, to be able to withhold (WH) or withdraw (WD) treatment which is no longer appropriate or even harmful and burdensome for the patient, other processes than strict medical (or physiological) assessments are necessary.

    Aim. To shed light on the arguments regarding to WH or WD futile treatment we performed two studies of physicians’ and the general populations’ choice and prioritized arguments in the treatment of a 72-year-old woman suffering from a large intra-cerebral bleeding with bad prognosis (Papers I and II) and a new born boy with postpartum anoxic brain damage (Papers III and IV).

    Methods. Postal questionnaires based on two cases presented above involving severely ill patients were used. Arguments for and against to WH or WD treatment, and providing treatment that might hasten death were presented. The respondents evaluated and prioritized arguments for and against withholding neurosurgery, withdrawing life-sustaining treatment and providing drugs to alleviate pain and distress. We also asked what would happen to physicians’ own trust if they took the action described, and what the physician estimated would happen to the general publics’ trust in health services (Paper IV).

    Results. Approximately 70% of the physicians and 46% of the general public responded in both surveys. The 72-year-old woman: A majority of doctors (82.3%) stated that they would withhold treatment, whereas a minority of the general public (40.2%) would do so; the arguments forwarded and considerations regarding quality of life differed significantly between the two groups. Quality-of-life aspects were stressed as an important argument by the majority of both neurosurgeons and ICU-physicians (76.8% vs. 54.0%); however, significantly more neurosurgeons regarded this argument as the most important. A minority in both groups, although more ICU-physicians, supported a patient’s previously expressed wish of not ending in a persistent vegetative state as the most important argument. As the case clinically progressed, a consensus evolved regarding the arguments for decision making.

    The new born child: A majority of both physicians [56 % (CI 50–62)] and the general population [53 % (CI 49–58)] supported arguments for withdrawing ventilator treatment. A large majority in both groups supported arguments for alleviating the patient’s symptoms even if the treatment hastened death, but the two groups display significantly different views on whether or not to provide drugs with the additional intention of hastening death, although the difference disappeared when we compared subgroups of those who were for or against euthanasia-like actions.

    Conclusions. There are indeed considerable differences in how physicians and the general public assess and reason in critical care situations, but the more hopelessly ill the patient became the more the groups' assessments tended to converge, although they prioritized different arguments. In order to avoid unnecessary dispute and miscommunication, it is important that health care providers are aware of the public's views, expectations, and preferences. Our hypothesis—physicians’ estimations of others’ opinions are influenced by their own opinions—was corroborated. This might have implications in research as well as in clinical decision-making.

  • 284.
    Rydvall, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Bergenheim, Tommy
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Neurosurgery.
    Lynöe, Niels
    Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Decision making in a life-threatening cerebral condition: a comparative study of the ethical reasoning of intensive care unit physicians and neurosurgeons2007In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 51, no 10, p. 1338-1343Article in journal (Other academic)
    Abstract [en]

    Severe traumatic brain injury (TBI) is one of the major causes of death in younger age groups. In Umea, Sweden, an intracranial pressure (ICP) targeted therapy protocol, the Lund concept, has been used in treatment of severe TBI since 1994. Decompressive craniectomy is used as a protocol-guided treatment step. The primary aim of the investigation was to study the effect of craniectomy on ICP changes over time in patients with severe TBI treated by an ICP-targeted protocol. In this retrospective study, all patients treated for severe TBI during 1998-2001 who fulfilled the following inclusion criteria were studied: GCS <or= 8 at intubation and sedation, first recorded cerebral perfusion pressure (CPP) of >10 mm Hg, arrival within 24 h of trauma, and need of intensive care for >72 h. Craniectomy was performed when the ICP could not be controlled by evacuation of hematomas, sedation, ventriculostomy, or low-dose pentothal infusion. Ninety-three patients met the inclusion criteria. Mean age was 37.6 years. Twenty-one patients underwent craniectomy as a treatment step. We found a significant reduction of the ICP directly after craniectomy, from 36.4 mm Hg (range, 18-80 mm Hg) to 12.6 mm Hg (range, 2-51 mm Hg). During the following 72 h, we observed an increase in ICP during the first 8-12 h after craniectomy, reaching approximately 20 mm Hg, and later levelling out at approximately 25 mm Hg. The reduction of ICP was statistically significant during the 72 h. The outcome as measured by Glasgow Outcome Scale (GOS) did not significantly differ between the craniectomized group (DC) and the non-craniectomized group (NDC). The outcome was favorable (GOS 5-4) in 71% in the craniectomized group, and in 61% in the non-craniectomized group. Craniectomy is a useful tool in achieving a significant reduction of ICP overtime in TBI patients with progressive intracranial hypertension refractory to medical therapy. The procedure seems to have a satisfactory effect on the outcome, as demonstrated by a high rate of favorable outcome and low mortality in the craniectomized group, which did not significantly differ compared with the non-craniectomized group.

  • 285.
    Rydvall, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Juth, Niklas
    Inst för lärande, informatik, management och etik /Centrum för Hälso- och sjukvårdsetik.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lynöe, Niels
    Inst för lärande, informatik, management och etik /Centrum för Hälso- och sjukvårdsetik.
    To treat or not to treat a newborn child with severe brain damage?: A cross-sectional study of physicians' and the general population's perceptions of intentions2014In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 17, no 1, p. 81-88Article in journal (Refereed)
    Abstract [en]

    Ethical dilemmas are common in the neonatal intensive care setting. The aim of the present study was to investigate the opinions of Swedish physicians and the general public on treatment decisions regarding a newborn with severe brain damage. We used a vignette-based questionnaire which was sent to a random sample of physicians (n = 628) and the general population (n = 585). Respondents were asked to provide answers as to whether it is acceptable to discontinue ventilator treatment, and when it actually is discontinued whether or not it was acceptable to use drugs which hasten death unintentionally or intentionally. The response rate was 67 % of physicians and 46 % of the general population. A majority of both physicians [56 % (CI 50-62)] and the general population [53 % (CI 49-58)] supported arguments for withdrawing ventilator treatment. A large majority in both groups supported arguments for alleviating the patient's symptoms even if the treatment hastened death, but the two groups display significantly different views on whether or not to provide drugs with the additional intention of hastening death, although the difference disappeared when we compared subgroups of those who were for or against euthanasia-like actions. The study indicated that physicians and the general population have similar opinions regarding discontinuing life-sustaining treatment and providing effective drugs which might unintentionally hasten death but seem to have different views on intentions. The results might be helpful to physicians wanting to examine their own intentions when providing adequate treatment at the end of life.

  • 286.
    Rydvall, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Juth, Niklas
    Inst för lärande, informatik, management och etik /Centrum för Hälso- och sjukvårdsetik.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lynøe, Nils
    Inst för lärande, informatik, management och etik /Centrum för Hälso- och sjukvårdsetik.
    Are physicians' estimations of future events value-impregnated?: Cross-sectional study of double intentions when providing treatment that shortens a dying patient's life2014In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 17, no 3, p. 397-402Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to corroborate or undermine a previously presented conjecture that physicians' estimations of others' opinions are influenced by their own opinions. We used questionnaire based cross-sectional design and described a situation where an imminently dying patient was provided with alleviating drugs which also shortened life and, additionally, were intended to do so. We asked what would happen to physicians' own trust if they took the action described, and also what the physician estimated would happen to the general publics' trust in health services. Decrease of trust was used as surrogate for an undesirable action. The results are presented as proportions with a 95 % Confidence Interval (CI). Statistical analysis was based on inter-rater agreement (Weighted Kappa)-test as well as chi (2) test and Odds Ratio with 95 % CI. We found a moderate inter-rater agreement (Kappa = 0.552) between what would happen with the physicians' own trust in healthcare and their estimations of what would happen with the general population's trust. We identified a significant difference between being pro et contra the treatment with double intentions and the estimation of the general population's trust (chi(2) = 72, df = 2 and p < 0.001). Focusing on either decreasing or increasing own trust and being pro or contra the action we identified a strong association [OR 79 (CI 25-253)]. Although the inter-rater agreement in the present study was somewhat weaker compared to a study about the explicit use of the term 'physicians assisted suicide' we found that our hypothesis-physicians' estimations of others' opinions are influenced by their own opinions-was corroborated. This might have implications in research as well as in clinical decision-making. We suggest that Merton's ideal of disinterestedness should be highlighted.

  • 287.
    Rydvall, Anders
    et al.
    Department of Surgical and Perioperative Sciences, Anaesthesiology, University Hospital of Northern Sweden, Lasarettsbacken SE-90185 Umeå, Sweden.
    Lynöe, Niels
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Berzelius vaeg 3 SE-17177 Stockholm, Sweden.
    Withholding and withdrawing life-sustaining treatment: a comparative study of the ethical reasoning of physicians and the general public2008In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 12, no 1, article id R13Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Our objective was to investigate whether a consensus exists between the general public and health care providers regarding the reasoning and values at stake on the subject of life-sustaining treatment. METHODS: A postal questionnaire was sent to a random sample of members of the adult population (n = 989) and to a random sample of intensive care doctors and neurosurgeons (n = 410) practicing in Sweden in 2004. The questionnaire was based on a case involving a severely ill patient and presented arguments for and against withholding and withdrawing treatment, and providing treatment that might hasten death. RESULTS: Approximately 70% of the physicians and 51% of the general public responded. A majority of doctors (82.3%) stated that they would withhold treatment, whereas a minority of the general public (40.2%) would do so; the arguments forwarded (for instance, belief that the first task of health care is to save life) and considerations regarding quality of life differed significantly between the two groups. Most physicians (94.1%) and members of the general public (77.7%) were prepared to withdraw treatment, and most (95.1% of physicians and 82% of members of the general public) agreed that sedation should be provided. CONCLUSION: There are indeed considerable differences in how physicians and the general public assess and reason in critical care situations, but the more hopelessly ill the patient became the more the groups' assessments tended to converge, although they prioritized different arguments. In order to avoid unnecessary dispute and miscommunication, it is important that health care providers be aware of the public's views, expectations, and preferences.

  • 288.
    Salles, Arleen
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Evers, Kathinka
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Farisco, Michele
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Neuroethics and Philosophy in Responsible Research and Innovation: The Case of the Human Brain Project2018In: Neuroethics, ISSN 1874-5490, E-ISSN 1874-5504Article in journal (Refereed)
    Abstract [en]

    Responsible Research and Innovation (RRI) is an important ethical, legal, and political theme for the European Commission. Although variously defined, it is generally understood as an interactive process that engages social actors, researchers, and innovators who must be mutually responsive and work towards the ethical permissibility of the relevant research and its products. The framework of RRI calls for contextually addressing not just research and innovation impact but also the background research process, specially the societal visions underlying it and the norms and priorities that shape scientific agendas. This requires the integration of anticipatory, inclusive, and responsive dimensions, and the nurturing of a certain type of reflexivity among a variety of stakeholders, from scientists to funders. In this paper, we do not address potential limitations but focus on the potential contribution of philosophical reflection to RRI in the context of the Ethics and Society subproject of the Human Brain Project (HBP). We show how the type of conceptual analysis provided by philosophically oriented approaches theoretically and ethically broadens research and innovation within the HBP. We further suggest that overt inclusion of philosophical reflection can promote the aims and objectives of RRI.

  • 289. Sandin, Per
    et al.
    Moula, Payam
    Simple plain fare or exquisite eating - Is simplicity really a consumer virtue?2015In: Know Your Food, Wageningen Academic Publishers , 2015, p. 249-253Chapter in book (Other academic)
    Abstract [en]

    This paper discusses the proposed consumer virtue of material simplicity, as advocated by Joshua Colt Gambrel and Philip Cafaro. We argue that the introduction of simplicity as a virtue is unnecessary and arbitrary. We also argue that there are reasons to doubt whether simplicity is really a virtue, and using counterexamples, we argue that the arguments presented by Gambrel and Cafaro are unconvincing in this respect. Finally, some considerations for further research are suggested.

  • 290.
    Sandlund, Mikael
    et al.
    Umeå University.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Ågård, Anders
    Sahlgrenska University Hospital.
    Engström, Ingemar
    Universitetssjukvårdens forskningscentrum, Örebro.
    Sallin, Karl
    Uppsala University.
    Kontinuitet främjar personligt och professionellt ansvarstagade2017In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, no 42, p. 1-2, article id ETHIArticle in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Att utröna medicinska behov, fatta beslut och se dem genomförda är läkarens ansvar.

    För att få veta den enskilde patientens värderingar och önskemål krävs en förtroendefull relation med vårdgivaren. Kontinuitet förenklar skapandet av en sådan relation.  

    Trots att kontinuitet är centralt är det inte ett mål i sig, utan bör betraktas som ett medel för att uppnå andra mål som följer av läkarens yrkesetik och lagstiftning.

  • 291.
    Sandlund, Mikael
    et al.
    Institutionen för klinisk vetenskap, Umeå universitet, Umeå, Sverige.
    Bremer, Anders
    Institutionen för hälso- och vårdvetenskap, Linnéuniversitetet, Växjö, Sweden; Institutionen för hälso- och vårdvetenskap, Linnéuniversitetet, Kalmar, Sweden.
    Ågård, Anders
    Område medicin, Sahlgrenska universitetssjukhuset, Göteborg, Sverige.
    Engström, Ingemar
    Örebro University, School of Medical Sciences. Universitetssjukvårdens forskningscentrum, Region Örebro län, Örebro, Sverige.
    Sallin, Karl
    Institutionen för folkhälso- och vårdvetenskap, Uppsala universitet, Uppsala, Sverige.
    Kontinuitet främjar personligt och professionellt ansvarstagande2017In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, article id ETHIArticle in journal (Refereed)
  • 292.
    Sandman, Lars
    Högskolan i Borås, Sweden.
    Den palliativa vårdens etik2016In: Palliativ vård ur ett tvärprofessionellt perspektiv / [ed] Inger Benkel, Ulla Molander, Helle Wijk, Liber, 2016, p. 141-166Chapter in book (Other (popular science, discussion, etc.))
  • 293.
    Sandman, Lars
    Högskolan i Borås, Sweden.
    Invited commentary to the discussion paper Ethics dilemmas of early detection of obesity2016In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 44, no 6, p. 546-548Article in journal (Other academic)
    Abstract [en]

    n/a

  • 294.
    Sandman, Lars
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Etik inom ambulanssjukvården2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud & Lars Lundberg, Stockholm: Liber , 2016, 2, p. 26-39Chapter in book (Other academic)
  • 295.
    Sandman, Lars
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. University of Borås, Sweden.
    Gustavsson, Erik
    Linköping University, Department of Culture and Communication, Arts and Humanities. Linköping University, Faculty of Arts and Sciences.
    Beyond the Black Box Approach to Ethics! Comment on "Expanded HTA: Enhancing Fairness and Legitimacy".2016In: International Journal of Health Policy and Management, ISSN 2322-5939, E-ISSN 2322-5939, Vol. 5, no 6, p. 393-394Article in journal (Refereed)
    Abstract [en]

    In the editorial published in this journal, Daniels and colleagues argue that his and Sabin's accountability for reasonableness (A4R) framework should be used to handle ethical issues in the health technology assessment (HTA)-process, especially concerning fairness. In contrast to this suggestion, it is argued that such an approach risks suffering from the irrrelevance or insufficiency they warn against. This is for a number of reasons: lack of comprehensiveness, lack of guidance for how to assess ethical issues within the "black box" of A4R as to issues covered, competence and legitimate arguments and finally seemingly accepting consensus as the final verdict on ethical issues. We argue that the HTA community is already in a position to move beyond this black box approach.

  • 296.
    Sandman, Lars
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Liliemark, Jan
    Linköping University.
    Withholding and withdrawing treatment for cost-effectiveness reasons: Are they ethically on par?2019In: Bioethics, ISSN 0269-9702, E-ISSN 1467-8519, Vol. 33, no 2, p. 278-286Article in journal (Refereed)
    Abstract [en]

    In healthcare priority settings, early access to treatment before reimbursement decisions gives rise to problems of whether negative decisions for cost-effectiveness reasons should result in withdrawing treatment, already accessed by patients. Among professionals there seems to be a strong attitude to distinguish between withdrawing and withholding treatment, viewing the former as ethically worse. In this article the distinction between withdrawing and withholding treatment for reasons of cost effectiveness is explored by analysing the doing/allowing distinction, different theories of justice, consequentialist and virtue perspectives. The authors do not find any strong reasons for an intrinsic difference, but do find some reasons for a consequentialist difference, given present attitudes. However, overall, such a difference does not, all things considered, provide a convincing reason against withdrawal, given the greater consequentialist gain of using cost-effective treatment. As a result, patients should be properly informed when given early access to treatment, that such treatment can be later withdrawn following a negative reimbursement decision.

  • 297. 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?

  • 298.
    Schölin Bywall, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Veldwijk, Jorien
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics. Erasmus School of Health Policy & Management (ESHPM) and Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, Rotterdam, The Netherlands.
    Hansson, Mats G.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Kihlbom, Ulrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Patient Perspectives on the Value of Patient Preference Information in Regulatory Decision Making: A Qualitative Study in Swedish Patients with Rheumatoid Arthritis2019In: Patient, ISSN 1178-1653, E-ISSN 1178-1661, Vol. 12, no 3, p. 297-305Article in journal (Refereed)
    Abstract [en]

    Background

    There is increasing interest in involving patient preferences for benefits and risks in regulatory decision making. Therefore, it is essential to identify patient perspectives regarding the value of patient preference information (PPI).

    Objectives

    The aim of this study was to explore how patients with rheumatoid arthritis (RA) value the use of PPI in regulatory decision making regarding medical products.

    Methods

    Regulators and patients with RA were interviewed to gather initial insights into opinions on the use of PPI in regulatory decisions regarding medical products. The interviews were used to draft and validate the interview guide for focus groups with patients with RA. Participants were purposively sampled in collaboration with the Swedish Rheumatism Association in Stockholm and Uppsala. Each focus group consisted of three to six patients (18 in total). All interviews were audio-recorded, transcribed verbatim, and analysed using content analysis.

    Results

    According to the participants, PPI could lead to regulators considering patients’ needs, lifestyles and well-being when making decisions. PPI was important in all stages of the medical product lifecycle. Participants reported that, when participating in a preference study, it is important to be well-informed about the use of the study and the development, components, administration, and risks related to the medical products.

    Conclusions

    Patients thought PPI could be valuable to consider in regulatory decisions. It is essential for patients to be well-informed when asked for their preferences. Research on information materials to inform patients in preference studies is needed to increase the value of PPI in regulatory decision making.

  • 299.
    Scott, Anna Mae
    et al.
    The Dartmouth Institute for Health Policy & Clinical Practice, USA.
    Bond, Kenneth
    Canadian Agency for Drugs and Technologies in Health (CADTH).
    Gutierrez-Ibarluzea, Inaki
    Servicio de Evaluación de Tecnologías Sanitarias (OSTEBA).
    Hofmann, Björn
    University College of Gjovik, Norway.
    Sandman, Lars
    School of Health Sciences, University of Borås, Sweden.
    QUALITY ASSESSMENT OF ETHICS ANALYSES FOR HEALTH TECHNOLOGY ASSSESSMENT2016In: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 32, no 5, p. 362-369Article in journal (Refereed)
    Abstract [en]

    Objectives: Although consideration of ethical issues is recognized as a crucial part of health technology assessment, ethics analysis for HTA is generally perceived as methodologically underdeveloped in comparison to other HTA domains. The aim of our study is (i) to verify existing tools for quality assessment of ethics analyses for HTA, (ii) to consider some arguments for and against the need for quality assessment tools for ethics analyses for HTA, and (iii) to propose a preliminary set of criteria that could be used for assessing the quality of ethics analyses for HTA.

    Methods: We systematically reviewed the literature, reviewed HTA organizations’ Web sites, and solicited views from thirty-two experts in the field of ethics for HTA.

    Results: The database and HTA agency Web site searches yielded 420 references (413 from databases, seven from HTA Web sites). No formal instruments for assessing the quality of ethics analyses for HTA purposes were identified. Thirty-two experts in the field of ethics for HTA from ten countries, who were brought together at two workshops held in Edmonton (Canada) and Cologne (Germany) confirmed the findings from the literature.

    Conclusions: Generating a quality assessment tool for ethics analyses in HTA would confer considerable benefits, including methodological alignment with other areas of HTA, increase in transparency and transferability of ethics analyses, and provision of common language between the various participants in the HTA process. We propose key characteristics of quality assessment tools for this purpose, which can be applied to ethics analyses for HTA purposes.

  • 300.
    Silén, Marit
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Haglund, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Hansson, Mats G.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Ethics rounds do not improve the handling of ethical issues by psychiatric staff2015In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 69, no 6, p. 1700-1707Article in journal (Refereed)
    Abstract [en]

    Background. One way to support healthcare staff in handling ethically difficult situations is through ethics rounds that consist of discussions based on clinical cases and are moderated by an ethicist. Previous research indicates that the handling of ethically difficult situations in the workplace might have changed after ethics rounds. This, in turn, would mean that the “ethical climate”, i.e. perceptions of how ethical issues are handled, would have changed. Aim. To investigate whether ethics rounds could improve the ethical climate perceived by staff working in psychiatry outpatient clinics. Methods. In this quasi-experimental study, six inter-professional ethics rounds led by a philosopher/ethicist were conducted at two psychiatry outpatient clinics. Changes in ethical climate were measured at these clinics as well as at two control clinics at baseline and after the intervention period using the instrument Hospital Ethical Climate Survey. Results. Within-groups comparisons of median sum scores of ethical climate showed that no statistically significant differences were found in the intervention group before or after the intervention period. The median sum scores for ethical climate were significantly higher, both at baseline and after the intervention period (P ≤ 0.001; P = 0.046), in the intervention group. Conclusions. Ethics rounds in psychiatric outpatient clinics did not result in significant changes in ethical climate. Outcomes of ethics rounds might, to a higher degree, be directed towards patient-related outcomes rather than towards the staff's working environment, as the questions brought up for discussion during the ethics rounds concerned patient-related issues.

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