Principles of need are constantly referred to in health care priority setting. The common denominator for any principle of need is that it will ascribe some kind of special normative weight to people being worse off. However, this common ground does not answer the question how a plausible principle of need should relate to the aggregation of benefits across individuals. Principles of need are sometimes stated as being incompatible with aggregation and sometimes characterized as accepting aggregation in much the same (...) way as utilitarians do. In this paper we argue that if one wants to take principles of need seriously both of these positions have unreasonable implications. We then characterize and defend a principle of need consisting of sufficientarian elements as well as prioritarian which avoids these unreasonable implications. (shrink)

One generally considered plausible way to allocate resources in health care is according to people’s needs. In this paper I focus on a somewhat overlooked issue, that is the conceptual structure of health care needs. It is argued that what conceptual understanding of needs one has is decisive in the assessment of what qualifies as a health care need and what does not. The aim for this paper is a clarification of the concept of health care need with a starting (...) point in the general philosophical discussion about needs. I outline three approaches to the concept of need and argue that they all share the same conceptual underpinnings. The concept of need is then analyzed in terms of a subject x needing some object y in order to achieve some goal z. I then discuss the relevant features of the object y and the goal z which make a given need qualify as a health care need and not just a need for anything. (shrink)

In this paper we explore the relation between health-care needs and patients’ desires within shared decision-making in a context of priority setting in health care. We begin by outlining some general characteristics of the concept of health-care need as well as the notions of SDM and desire. Secondly we will discuss how to distinguish between needs and desires for health care. Thirdly we present three cases which all aim to bring out and discuss a number of queries which seem to (...) arise due to the double focus on a patient’s need and what that patient desires. These queries regard the following themes: the objectivity and moral force of needs, the prediction about what kind of patients which will appear on a micro level, implications for ranking in priority setting, difficulties regarding assessing and comparing benefits, and implications for evidence-based medicine. (shrink)

There is a growing body of literature which suggests that decisions about healthcare priority setting should take into account the extent to which patients are worse off. However, such decisions are often based on how badly off patients are with respect to the condition targeted by the treatment whose priority is under consideration (condition‐specific severity). In this paper I argue that giving priority to the worse off in terms of condition‐specific severity does not reflect the morally relevant sense of being (...) worse off. I conclude that an account of giving priority to the worse off relevant for healthcare priority setting should take into account how badly off patients are when all of their conditions are considered (holistic severity). (shrink)

How should scarce healthcare resources be distributed? This is a contentious issue that became especially pressing during the pandemic. It is often emphasised that studies exploring public views about this question provide valuable input to the issue of healthcare priority setting. While there has been a vast number of such studies it is rarely articulated, more specifically, what the results from these studies would mean for the justification of principles for priority setting. On the one hand, it seems unreasonable that (...) public values would straightforwardly decide the ethical question of how resources should be distributed. On the other hand, in a democratic society, it seems equally unreasonable that they would be considered irrelevant for this question. In this paper we draw on the notion of reflective equilibrium and discuss the relevance and roles that empirical studies may plausibly have for justification in priority setting ethics. We develop a framework for analysing how different kinds of empirical results may have different kinds of implications for justification. (shrink)

This paper describes the design and evaluation of a personality for the robotic user interface “iCat”. An application was developed that helps users find a TV-programme that fits their interests. Two experiments were conducted to investigate what personality users prefer for the robotic TV-assistant, what level of control they prefer, and how personality and the level of control relate to each other. The first experiment demonstrated that it is possible to create convincing personalities of the TV-assistant by applying various social (...) cues. The results of the second experiment showed that an extravert and agreeable TV-assistant was preferred over a more introvert and formal one. Overall, the most preferred combination was an extravert and friendly personality with low user control. Additionally, it was found that perceived level of control was influenced by the robot’s personality. This suggests that the robot’s personality can be used as a means to increase the amount of control that users perceive. (shrink)

Background Health care workers (HCWs) are susceptible to moral stress and distress when they are faced with morally challenging situations where it is difficult to act in line with their moral standards. In times of crisis, such as disasters and pandemics, morally challenging situations are more frequent, due to the increased imbalance between patient needs and resources. However, the concepts of moral stress and distress vary and there is unclarity regarding the definitions used in the literature. This study aims to (...) map and analyze the descriptions used by HCWs regarding morally challenging situations (moral stress) and refine a definition through conceptual analysis. Methods Qualitative data were collected in a survey of 16,044 Swedish HCWs who attended a COVID-19 online course in autumn 2020. In total, 643 free-text answers with descriptions of moral stress were analyzed through content analysis. Results Three themes emerged from the content analysis (1) “Seeing, but being prevented to act; feeling insufficient/inadequate and constrained in the profession,” (2) “Someone or something hindered me; organizational structures as an obstacle,” and (3) “The pandemic hindered us; pandemic-related obstacles.” The three themes correspond to the main theme, “Being prevented from providing good care.” Discussion The main theme describes moral stress as various obstacles to providing good care to patients in need and acting upon empathic ability within the professional role. The themes are discussed in relation to established definitions of moral stress and are assessed through conceptual analysis. A definition of moral stress was refined, based on one of the established definitions. Conclusions On the basis of the study results and conceptual analysis, it is argued that the presented definition fulfils certain conditions of adequacy. It is essential to frame the concept of moral stress, which has been defined in different ways in different disciplines, in order to know what we are talking about and move forward in developing prevention measures for the negative outcomes of this phenomenon. (shrink)

In the introductory “Intellectual Autobiography” of the Georg Henrik von Wright volume of the Library of Living Philosophers series, von Wright mentions the discrepancy he always felt between his narrow logical-analytical professional work and a drive to make philosophy relevant to his life, calling it a rift in his philosophical personality. This article examines the nature of the rift and the various stages the problem went through during von Wright’s career. It is argued that the initial impression that his books (...) The Varieties of Goodness and Explanation and Understanding had contributed to healing the rift, was subdued by a gradual shift in existential focus from individualistic ethics towards a critical concern for destructive ways of thinking inherent in the Western culture, connected with von Wright’s “political awakening” at the end of the 1960s. The most urgent questions of our times called for novel, non-analytical, ways of doing philosophy, employed in von Wright’s later works on science and reason, and the myth of progress. Eventually von Wright’s earlier methodological concerns were also alleviated by his belief that logical-analytical philosophy was inherently unsuitable for exposing the cultural structures it was very much a part of. (shrink)

Intensive research is carried out to develop a disease-modifying drug for Alzheimer’s disease. The development of drug candidates that reduce Aß or tau in the brain seems particularly promising. However, these drugs target people at risk for AD, who must be identified before they have any, or only moderate, symptoms associated with the disease. There are different strategies that may be used to identify these individuals. Each of these strategies raises different ethical challenges. In this paper, we analyse these challenges (...) in relation to the risk stratification for AD necessary for using these drugs. We conclude that the new drugs must generate large health benefits for people at risk of developing AD to justify the ethical costs associated with current risk stratification methods, benefits much larger than current drug candidates have. This conclusion raises a new set of ethical questions that should be further discussed. No data are available. (shrink)

Der Autor stellt die Seinsfrage von dessen Bejahung durch eine fundamentalontologische Liebe aus. Ihre psychosozialen Möglichkeiten sowie die christliche Vergebungslehre werden ausgelotet und die Konfessionen daran erinnert, ihrer Kernbotschaft gerecht zu werden: das von ihnen gepredigte Sein auch selbst zu leben.

This article has two main divisions, the first consisting in parts 1-3, the second in parts 4-8. The purpose of the first division is to assess Hauerwas's contentions regarding what he takes to be serious debilities in modern theological culture. The objects of Hauerwas's criticism are: (1) natural theology; (2) reason as it is represented in the structure of the modern university and in the "Enlightenment Project"; and (3) liberal Protestantism--the latter particularly as it turns up, by his account, in (...) Reinhold Niebuhr's theology. The article will offer a defense of natural theology and an alternative approach to Niebuhr's theology while showing how Hauerwas's contentions concerning these two matters are mistaken. Parts 4-8 are theological studies. These studies concentrate on selected though main aspects of Hauerwas's outlook. Part 4 concerns a problematic implication of the notion, mainly from Barth, of divinity's humanity; Part 5 a note of difficulty from William James about the idea of the theistic God and its pertinence to the Barthian or Hauerwasian God; Part 6 the relation between belief and witness; Part 7 theology's discourse and analogy; Part 8 the Barthian-Hauerwasian theology as a metaphysics. Part 1, concerning natural theology, stands over both divisions. These observations are not in the main intended as textual studies, though in certain passages the analysis is closely attentive to Hauerwas's text. Also, the paper does not offer the sort of account that would come from a historian, intellectual biographer, or social or cultural analyst or critic. Its focus is philosophical-theological criticism. (shrink)

El análisis de rituales performativos de memoria supone un reto metodológico para la investigación social interpretativa, ya que las interacciones rituales están inscritas en un contexto más amplio, que está determinado por las tradiciones simbólicas y por los acuerdos institucionales que configuran el marco de las ceremonias. A partir del estudio de ceremonias conmemorativas del Día Internacional de Recuerdo del Holocausto se mostrará la interconexión en el análisis de estos distintos niveles. Para ello nos basamos en datos videográficos de un (...) proyecto de investigación en curso sobre ceremonias de memoria del Holocausto en Espana y Alemania, que examina la tesis sobre una incipiente “cultura de la memoria global”. En el análisis de los materiales seguimos enfoques metodológicos que provienen de la sociología del conocimiento hermenéutica y la sociología de géneros comunicativos. (shrink)

In Gustavsson et al,1 we discussed the ethical issues that arise when identifying the relevant population for disease-modifying drugs targeting Alzheimer disease. More specifically, we focused on novel immunotherapies aimed at amyloid β and tau, two relevant biomarkers. The commentaries to our paper2 3 acknowledge our conclusion: screening for AD involve ethical costs that cannot be justified unless a drug with clinically relevant effect becomes available. Since Aduhelm is the only immunotherapy targeting AD currently approved by the Food and (...) Drug Administration, we use that as a …. (shrink)

It is uncontroversial to claim that the extent to which health care interventions benefit patients is a relevant consideration for health care priority setting. However, when effects accrue to the individual patient, effects of a more indirect kind may accrue to other individuals as well, such as the patient's children, friends, or partner. If, and if so how, such relational effects should be considered relevant in priority setting is contentious. In this paper, we illustrate this question by using disease‐modifying drugs (...) for Alzheimer's disease as a case in point. The ethical analysis begins by sketching the so‐called prima facie case for ascribing moral weight to relational effects and then moves on to consider a number of objections to it. We argue that, whereas one set of objections may be dismissed, there is another set of arguments that poses more serious challenges for including relational effects in priority setting. (shrink)

Vår skapende evne -- Liberalisme og ekstremisme -- Karl Popper og rasjonell politisk handling -- Vasemachos eller samtalekunstens tragedie -- Hvem er de fremmedgjorte -- Ved profetens føtter -- Den totalitære lengsel -- Har Camus bidratt til filosofien -- Om å lese Glucksmann -- Camus og Glucksmann -- Ved Jean-Paul Sartres død -- "Udraabere af inderlighed" og a dre moralske dyr.

How to handle orphan drugs for rare diseases is a pressing problem in current health-care. Due to the group size of patients affecting the cost of treatment, they risk being disadvantaged in relation to existing cost-effectiveness thresholds. In an article by Niklas Juth it has been argued that it is irrelevant to take indirectly operative factors like group size into account since such a compensation would risk discounting the use of cost, a relevant factor, altogether. In this article we analyze (...) Juth’s argument and observe that we already do compensate for indirectly operative factors, both outside and within cost-effectiveness evaluations, for formal equality reasons. Based on this we argue that we have reason to set cost-effectiveness thresholds to integrate equity concerns also including formal equality considerations. We find no reason not to compensate for group size to the extent we already compensate for other factors. Moreover, groups size implying a systematic disadvantage also on a global scale, i.e. taking different aspects of the health condition of patients suffering from rare diseases into account, will provide strong reason for why group size is indeed relevant to compensate for. (shrink)

This article addresses the issues of identity and ethics. Individual identity can be understood from an essence and/or constructive perspective, and organizational identity from an individual and/or strategic perspective. Three ethical dilemmas are identified in relation to human identity: construction of corporate identity, change of corporate identity, and the corporations’ role in society, summarized as the utility vs humanity dilemma. The conclusion recommends an increased focus on human values management and a process of detachment and transparency in identity issues.

Background Genetic testing is moving from targeted investigations of monogenetic diseases to broader testing that may provide more information. For example, recent health economic studies of genetic testing for an increased risk of breast cancer suggest that it is associated with higher cost-effectiveness to screen for pathogenic variants in a seven gene panel rather than the usual two gene test for variants in BRCA1 and BRCA2. However, irrespective of the extent to which the screening of the panel is cost-effective, there (...) may be ethical reasons to not screen for pathogenic variants in a panel, or to revise the way in which testing and disclosing of results are carried out. Main text In this paper we discuss the ethical aspects of genetic testing for an increased risk of breast cancer with a special focus on the ethical differences between screening for pathogenic variants in BRCA1/2 and a seven gene panel. The paper identifies that the panel increases the number of secondary findings as well as the number of variants of uncertain significance as two specific issues that call for ethical reflection. Conclusions We conclude that while the problem of handling secondary findings should not be overstated with regard to the panel, the fact that the panel also generate more variants of uncertain significance, give rise to a more complex set of problems that relate to the value of health as well as the value of autonomy. Therefore, it is insufficient to claim that the seven gene panel is preferable by only referring to the higher cost effectiveness of the panel. (shrink)

This paper tries to evolve a distinctive model of Swedish management from the standpoint of human values. The author attempts to understand the deeper and subtle aspects of the Scandinavian manage ment style and discusses ways to understand different management styles in different cultural contexts and how they can be sustained in an information age where culture-specific values face extinction. His analysis draws on several sources including personal experiences and mythological references. The paper explores the 'deep structure' of the Swedish (...) mind and enumerates 'typical Swedish' values like equality, self-criticism, worship of nature, and their relationship with the Swedish management style. It also articulates the dilemma of the Swedish manager who has to stick to traditional Swedish values at work and at the same time be responsive to universal human values. According to the author, the ideal way to overcome this dilemma is to transcend into pure being by knowing one's real self and then coming out into the world of action to reflect the universal in the relative. (shrink)

Granulocyte transfusions have been administered to patients with life-threatening infections for more than five decades. However, to what extent this should be the case is far from established. On the one hand, the clinical effects of these transfusions are difficult to prove in clinical studies, and the donors of granulocytes may be exposed to certain risks. On the other hand, clinical experience seems to support the idea that granulocyte transfusions do play an important role for severely ill patients, and the (...) donors are primarily motivated by altruistic reasons. In this paper, we first discuss the ethical issues that arise from the fact that there is a conflict between clinical experience and the results from the attempts to perform randomized control trials, and second, the risk/benefit assessment that has to be made between two different parties, namely the recipient and the donor of granulocyte transfusions. (shrink)