75 research outputs found
Attitudes towards priority setting in the Norwegian health care system: a general population survey
Background: In an ideal world, everyone would receive medical resources in accordance with their needs. In reality, resources are often scarce and have an alternative use. Thus, we are forced to prioritize. Although Norway is one of the leading countries in normative priority setting work, few descriptive studies have been conducted in the country. To increase legitimacy in priority setting, knowledge about laypeopleâs attitudes is central. The aim of the study is there- fore to assess the general populationâs attitudes towards a broad spectrum of issues pertinent to priority setting in the Norwegian publicly financed health care system.
Methods: We developed an electronic questionnaire that was distributed to a representative sample of 2 540 Norwegians regarding their attitudes towards priority setting in Norway. A total of 1 035 responded (response rate 40.7%). Data were analyzed with descriptive statistics and binary logistic regression.
Results: A majority (73.0%) of respondents preferred increased funding of publicly financed health services at the expense of other sectors in society. Moreover, a larger share of the respondents suggested either increased taxes (37.0%) or drawing from the Government Pension Fund Global (31.0%) as sources of funding. However, the respondents were divided on whether it was acceptable to say ânoâ to new cancer drugs when the effect is low and the price is high: 38.6% somewhat or fully disagreed that this was acceptable, while 46.5% somewhat or fully agreed. Lastly, 84.0% of the respondents did not find it acceptable that the Norwegian municipalities have different standards for providing care services.
Conclusion: Although the survey suggests support for priority setting among Norwegian laypeople, it has also revealed that a significant minority are reluctant to accept it.publishedVersio
Fastlegers reservasjonsadgang â hyklersk eller velbegrunnet?
In the Norwegian debate about General Practitionersâ (GP) right to conscientious objection to referrals for abortion, some claimed that the GPsâ request was self-contradictory and inadequately justified. It was claimed that the GPsâ suggested balancing act, that is, refusing referral for abortion, while instead facilitating referral by a colleague, is ethically inconsistent and implies a particular kind of ethical hypocrisy, termed âthe ethics of clean handsâ. Upon closer inspection, however, it turns out that this important critique applies to some ways of practicing conscientious refusal, but not to all. Even though this particular case was resolved in a way that does not involve toleration of conscientious objection, the charge of âethics of clean handsâ is fundamentally interesting, and may spur a discussion of freedom of conscience and the limits of tolerance, a topic that will be recurring in the public square in ever new shapes.I debatten om fastlegers adgang til reservasjon mot henvisning til abort hevdet noen at reservasjonslegenes Ăžnske er selvmotsigende og utilstrekkelig begrunnet. Det ble hevdet at reservasjonslegenes foreslĂ„tte balansegang â Ă„ nekte henvisning til abort, men i stedet legge til rette for at en kollega henviser («kollegahenvisning») â er etisk inkonsistent og innebĂŠrer et sĂŠregent etisk hykleri, som har blitt kalt «de rene henders etikk». Ved nĂŠrmere ettersyn viser det seg at denne viktige kritikken har brodd mot noen mĂ„ter Ă„ praktisere reservasjon pĂ„, men ikke mot alle. Selv om den konkrete saken fikk en lĂžsning som ikke innebĂŠrer reservasjonsadgang, er anklagen om «de rene henders etikk» prinsipielt interessant og kan anspore en diskusjon om samvittighetsfrihetens og toleransens grenser, et tema som vil vende tilbake til offentlighetens sĂžkelys i stadig nye former.publishedVersio
Importance of systematic deliberation and stakeholder presence: A national study of clinical ethics committees
Background: Case consultation performed by clinical ethics committees (CECs) is a complex activity which should be evaluated. Several evaluation studies have reported stakeholder satisfaction in single institutions. The present study was conducted nationwide and compares cliniciansâ evaluations on a range of aspects with the CECâs own evaluation. Methods: Prospective questionnaire study involving case consultations at 19 Norwegian CECs for 1âyear, where consultations were evaluated by CECs and clinicians who had participated. Results: Evaluations of 64 case consultations were received. Cases were complex with multiple ethical problems intertwined. Clinicians rated the average CEC consult highly, being both satisfied with the process and perceiving it to be useful across a number of aspects. CEC evaluations corresponded well with those of clinicians in a large majority of cases. Having next of kin/patients present was experienced as predominantly positive, though practised by only half of the CECs. The educational function of the consult was evaluated more positively when the CEC used a systematic deliberation method. Conclusions: CEC case consultation was found to be a useful service. The study is also a favourable evaluation of the Norwegian CEC system, implying that it is feasible to implement well-functioning CECs on a large scale. There are good reasons to involve the stakeholders in the consultations as a main rule.acceptedVersio
Ethical challenges in tracheostomy-assisted ventilation in amyotrophic lateral sclerosis
Author's accepted version (post-print).This is a post-peer-review, pre-copyedit version of an article published in Journal of Neurology. The final authenticated version is available online at: http://dx.doi.org/10.1007/s00415-018-9054-x.Available from 15/09/2019.acceptedVersio
Attitudes towards assisted dying are influenced by question wording and order: a survey experiment
Professional and conscience-based refusals: the case of the psychiatrist's harmful prescription
By way of a case story, two common presuppositions in the academic debate on conscientious objection in healthcare are challenged. First, the debate typically presupposes a sharp division between conscience-based refusals based on personal core moral beliefs and refusals based on professional (eg, medical) reasons. Only the former might involve the moral gravity to warrant accommodation. The case story challenges this division, and it is argued that just as much might sometimes be at stake morally in refusals based on professional reasons. The objector's moral integrity might be equally threatened in objections based on professional reasons as in objections based on personal beliefs. Second, the literature on conscientious objection typically presupposes that conflicts of conscience pertain to well-circumscribed and typical situations which can be identified as controversial without attention to individualising features of the concrete situation. However, the case shows that conflicts of conscience can sometimes be more particular, born from concrete features of the actual situation, and difficult, if not impossible, to predict before they arise. Guidelines should be updated to address such âsituation-basedâ conscientious refusals explicitly
Life, medicine and human fulfilment. End-of-life decisions in light of a revised natural law theory
Can clinical ethics committees be legitimate actors in bedside rationing?
Background
Rationing and allocation decisions at the clinical level â bedside rationing â entail complex dilemmas that clinicians and managers often find difficult to handle. There is a lack of mechanisms and aids for promoting fair decisions, especially in hard cases. Reports indicate that clinical ethics committees (CECs) sometimes handle cases that involve bedside rationing dilemmas. Can CECs have a legitimate role to play in bedside rationing?
Main text
Aided by two frameworks for legitimate priority setting, we discuss how CECs can contribute to enhanced epistemic, procedural and political legitimacy in bedside rationing decisions. Drawing on previous work we present brief case vignettes and outline several potential roles that CECs may play, and then discuss whether these might contribute to rationing decisions becoming legitimate. In the process, key prerequisites for such legitimacy are identified. Legitimacy places demands on aspects such as the CECâs deliberation process, the involvement of stakeholders, transparency of process, the opportunity to appeal decisions, and the competence of CEC members. On these conditions, CECs can help strengthen the legitimacy of some of the rationing decisions clinicians and managers have to make.
Conclusions
On specified conditions, CECs can have a well-justified advisory role to play in order to enhance the legitimacy of bedside rationing decisions
BĂžr leger ha reservasjonsrett ved assistert befruktning?
Omfanget av helsepersonells reservasjonsrett har nylig vÊrt gjenstand for debatt i Norge. Vi spÞr om leger bÞr ha reservasjonsrett ved utfÞrelse og henvisning til assistert befruktning, og drÞfter argumenter for og imot ved hjelp av et rammeverk med sju kriterier for vurdering av reservasjon. Reservasjonsrettens grunnleggende dilemma er hvordan to viktige hensyn, henholdsvis pasientens rett til behandling og hensynet til helsepersonellets moralske integritet, best kan ivaretas. Det argumenteres for at leger bÞr ha rett til Ä reservere seg mot Ä utfÞre, assistere ved og henvise til assistert befruktning generelt hvis begrunnelsen er hensynet til befruktede eggs moralske verdi. Videre finner vi at leger ogsÄ kan ha en moralsk rett til reservasjon mot Ä utfÞre, assistere ved og henvise til assistert befruktning for likekjÞnnede, men da pÄ nÊrmere spesifiserte vilkÄr.
NĂžkkelord: reservasjonsrett, assistert befruktning, samvittighet, moralsk integritet
English summary: Should physicians have the right to conscientiously object to assisted reproduction?
The extent of the healthcare worker's right to conscientious objection has recently been debated in Norway. This article asks whether physicians should have a right to conscientious objection to the performance of, and referral for, assisted reproduction, and discusses arguments for and against the same, utilizing a framework of seven criteria for the evaluation of conscientious objection. The fundamental dilemma of conscientious objection is how two important considerations can be reconciled: the patient's right to treatment, and the protection of the healthcare worker's moral integrity. It is argued that physicians should have the right to object to performing, assisting with, and referring for assisted reproduction generally when the objection is grounded in the moral value of the embryo. Furthermore, physicians may also have a moral right to object to performing, assisting with, and referring for assisted reproduction for same-sex couples, but only on conditions that are further specified
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