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[100-year-old who refused to be revived].

https://arctichealth.org/en/permalink/ahliterature267575
Source
Lakartidningen. 2015;112
Publication Type
Article
Date
2015
Author
Jörg Carlsson
Niels Lynøe
Source
Lakartidningen. 2015;112
Date
2015
Language
Swedish
Publication Type
Article
Keywords
Advance Directives
Aged, 80 and over
Humans
Medical Futility
Sweden
PubMed ID
25584605 View in PubMed
Less detail

'Are smokers less deserving of expensive treatment? A randomised controlled trial that goes beyond official values'.

https://arctichealth.org/en/permalink/ahliterature278693
Source
BMC Med Ethics. 2015 May 04;16:28
Publication Type
Article
Date
May-04-2015
Author
Joar Björk
Niels Lynøe
Niklas Juth
Source
BMC Med Ethics. 2015 May 04;16:28
Date
May-04-2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Attitude of Health Personnel
Attitude to Health
Ethics, Medical
Female
Health Behavior
Health Care Costs
Health Care Rationing
Humans
Male
Middle Aged
Oncologists
Patient Care - economics - ethics
Patient Rights
Physicians
Pulmonologists
Risk-Taking
Smoking
Social Justice
Sweden
Young Adult
Abstract
To investigate whether Swedish physicians, contrary to Swedish health care policy, employ considerations of patient responsibility for illness when rationing expensive treatments.
A random sample of oncologists and pulmonologists made up the main study-group (n = 296). A random sample of GPs (n = 289) and participants from the general population (n = 513) was used as contrast group. The participants randomly received one version of a questionnaire containing a case description of a terminally ill lung cancer patient. The two versions differed in only one aspect: in one version the patient was a smoker and in the other a non-smoker. The main questions were whether to offer a novel, expensive and marginally life-prolonging treatment and whether the patient could be held responsible for her illness. The quantitative data was analysed using Chi2-tests and comments were analysed using content analysis.
Among oncologists and pulmonologists, 78% (95% CI: 72-85) would offer the treatment to the non-smoker and 66% (95% CI: 58-74) to the smoker (Chi-2 = 5.4, df = 1, p = 0.019). Among the GPs, 69% (95% CI: 61-76) would treat the non-smoker and 56% (95% CI: 48-64) the smoker (Chi-1 = 4.9, df = 1 and p = 0.026). Among the general population the corresponding proportions were 84% (95% CI: 79-88) and 69% (95% CI: 63-74).
This study indicates that applying an experimental design allowed us to go beyond the official norms and to show that, compared to a smoking patient, both the general population and physicians are more inclined to treat a non-smoking patient. This clearly runs counter to the official Swedish health care norms. It also seems to run counter to the fact that among the physicians studied, there was no association between finding the patient responsible for her disease and the inclination to treat her. We think these paradoxical findings merit further studies.
Notes
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Cites: Med Health Care Philos. 2013 Aug;16(3):429-4122893116
PubMed ID
25935412 View in PubMed
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[Beneficial with Kierkegaard in the palliative care?].

https://arctichealth.org/en/permalink/ahliterature137468
Source
Lakartidningen. 2010 Dec 8-14;107(49):3153-5
Publication Type
Article
Author
Niels Lynøe
Author Affiliation
Centrum för hälso- och sjukvårdsetik, Karolinska Institutet, Stockholm.
Source
Lakartidningen. 2010 Dec 8-14;107(49):3153-5
Language
Swedish
Publication Type
Article
Keywords
Attitude to Death
Denmark
Existentialism
History, 19th Century
Humans
Medicine in Literature
Palliative Care - ethics
Philosophy - history
Right to Die - ethics
Terminal Care - ethics
PubMed ID
21280352 View in PubMed
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Continuous deep sedation, physician-assisted suicide, and euthanasia in Huntington's disorder.

https://arctichealth.org/en/permalink/ahliterature138804
Source
Int J Palliat Nurs. 2010 Nov;16(11):527-33
Publication Type
Article
Date
Nov-2010
Author
Anna Lindblad
Niklas Juth
Carl Johan Fürst
Niels Lynöe
Author Affiliation
Stockholm Centre for Healthcare Ethics, Karolinska Institutet, Stockholm, Sweden.
Source
Int J Palliat Nurs. 2010 Nov;16(11):527-33
Date
Nov-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Attitude of Health Personnel
Attitude to Health
Euthanasia
Female
Humans
Huntington Disease
Hypnotics and Sedatives - administration & dosage
Male
Mental Competency
Middle Aged
Physicians
Practice Guidelines as Topic
Suicide, Assisted
Sweden
Terminal Care
Abstract
To investigate the attitudes among Swedish physicians and the general public towards continuous deep sedation (CDS) as an alternative treatment for a competent, not imminently dying patient with Huntington's disorder requesting physician-assisted suicide (PAS) and euthanasia.
A questionnaire was distributed to 1200 physicians in Sweden and 1201 individuals in Stockholm. It consisted of three parts: 1) A vignette about a competent patient with Huntington's disease requesting PAS. When no longer competent, relatives request euthanasia on behalf of the patient. Responders were asked about their attitudes towards these requests and whether CDS would be an acceptable alternative. 2) General questions about PAS and euthanasia. 3) Background variables.
The response rate was 56% (physicians) and 52% (general public). The majority of the general public and a fairly large proportion of physicians reported more liberal views on CDS than are expressed in current Swedish and international recommendations.
In light of the results, we suggest that there is a need for a broader discussion about the recommendations for CDS, with a special focus on the needs of patients with progressive neurodegenerative disorders.
PubMed ID
21135785 View in PubMed
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Doctor for patients or doctor for society? Comparative study of GPs' and psychiatrists' assessments of clinical practice.

https://arctichealth.org/en/permalink/ahliterature70752
Source
Scand J Prim Health Care. 2004 Dec;22(4):228-32
Publication Type
Article
Date
Dec-2004
Author
Niels Lynöe
Bengt Mattsson
Author Affiliation
Medical Ethics, Department of Public Health and Clinical Medicine, Umeå University and LIME, Karolinska Institute, Stockholm, Sweden. niels.lynoe@lime.ki.se
Source
Scand J Prim Health Care. 2004 Dec;22(4):228-32
Date
Dec-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Attitude of Health Personnel
Comparative Study
Conflict of Interest
Deception
Decision Making - ethics
Ethics, Medical
Female
Humans
Male
Mental health services
Middle Aged
Physician's Role
Physicians - ethics
Physicians, Family - ethics
Questionnaires
Research Support, Non-U.S. Gov't
Sweden
Abstract
OBJECTIVE: To study general practitioners' (GPs') inclination to be the advocate of their patients or representatives of the society. The GPs' opinions were compared with those of psychiatrists. DESIGN: A postal questionnaire with two case histories. Loyalty towards the social insurance or towards a patient in distress, and loyalty towards a patient seeking asylum or towards society were posited. The degree of distress and urgency of the patients' situation varied. SUBJECTS AND SETTING: A random sample of Swedish GPs (n =167) and psychiatrists (n =112). RESULTS: All doctors significantly changed their minds when asked to fake a psychiatric diagnosis compared with a somatic diagnosis. Compared with psychiatrists, general practitioners tend to be more pragmatic (p =0.016) and in addition female doctors in some cases in both groups seem to be more pragmatic (p =0.023). Good clinical practice seems to be of importance in both groups. If the patient's life is threatened doctors are, however, prepared to overrule their own professional interests. The interests of society seem not to have any strong support in either of the two groups or the two cases. CONCLUSIONS: GPs as well as psychiatrists find it less improper to fake a psychiatric diagnosis than to fake a somatic. GP tends to be more pragmatic than psychiatrists and female doctors tend to be more pragmatic than male in both groups.
PubMed ID
15765638 View in PubMed
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Does feeling respected influence return to work? Cross-sectional study on sick-listed patients' experiences of encounters with social insurance office staff.

https://arctichealth.org/en/permalink/ahliterature115292
Source
BMC Public Health. 2013;13:268
Publication Type
Article
Date
2013
Author
Niels Lynöe
Maja Wessel
Daniel Olsson
Kristina Alexanderson
Gert Helgesson
Author Affiliation
Stockholm Centre for Healthcare Ethics (CHE), Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
Source
BMC Public Health. 2013;13:268
Date
2013
Language
English
Publication Type
Article
Keywords
Adult
Attitude to Health
Cross-Sectional Studies
Female
Humans
Male
Middle Aged
Professional-Patient Relations
Questionnaires
Return to Work - psychology - statistics & numerical data
Sick Leave - statistics & numerical data
Social Security - organization & administration
Sweden
Young Adult
Abstract
Previous research shows that how patients perceive encounters with healthcare staff may affect their health and self-estimated ability to return to work. The aim of the present study was to explore long-term sick-listed patients' encounters with social insurance office staff and the impact of these encounters on self-estimated ability to return to work.
A random sample of long-term sick-listed patients (n = 10,042) received a questionnaire containing questions about their experiences of positive and negative encounters and item lists specifying such experiences. Respondents were also asked whether the encounters made them feel respected or wronged and how they estimated the effect of these encounters on their ability to return to work. Statistical analysis was conducted using 95% confidence intervals (CI) for proportions, and attributable risk (AR) with 95% CI.
The response rate was 58%. Encounter items strongly associated with feeling respected were, among others: listened to me, believed me, and answered my questions. Encounter items strongly associated with feeling wronged were, among others: did not believe me, doubted my condition, and questioned my motivation to work. Positive encounters facilitated patients' self-estimated ability to return to work [26.9% (CI: 22.1-31.7)]. This effect was significantly increased if the patients also felt respected [49.3% (CI: 47.5-51.1)]. Negative encounters impeded self-estimated ability to return to work [29.1% (CI: 24.6-33.6)]; when also feeling wronged return to work was significantly further impeded [51.3% (CI: 47.1-55.5)].
Long-term sick-listed patients find that their self-reported ability to return to work is affected by positive and negative encounters with social insurance office staff. This effect is further enhanced by feeling respected or wronged, respectively.
Notes
Cites: Scand J Public Health. 2001 Dec;29(4):285-9111775785
Cites: Eur J Public Health. 2013 Apr;23(2):230-522552260
Cites: Scand J Public Health. 2003;31(4):275-8215099033
Cites: Work. 2004;22(3):247-5415156090
Cites: Scand J Public Health Suppl. 2004;63:49-10815513654
Cites: Work. 2005;25(3):231-4016179772
Cites: Work. 2006;26(2):179-9016477110
Cites: Work. 2006;27(1):57-6516873981
Cites: J Occup Rehabil. 2007 Sep;17(3):398-40817610050
Cites: Occup Environ Med. 2008 Mar;65(3):153-717881466
Cites: Scand J Public Health. 2008 Jan;36(1):92-818426789
Cites: J Rehabil Med. 2008 Nov;40(10):805-1119242616
Cites: Work. 2009;32(1):39-4819276524
Cites: J Occup Rehabil. 2009 Jun;19(2):185-9319247817
Cites: Occup Med (Lond). 2009 Aug;59(5):347-5219297339
Cites: Disabil Rehabil. 2009;31(15):1215-2619280436
Cites: Disabil Rehabil. 2009;31(16):1318-2719294545
Cites: Occup Med (Lond). 2010 Mar;60(2):121-619955300
Cites: Work. 2010;35(2):209-1920164616
Cites: Work. 2010;37(2):167-7720938077
Cites: Eur J Oncol Nurs. 2011 Jul;15(3):267-7421478053
Cites: J Occup Rehabil. 2003 Sep;13(3):183-9512966692
PubMed ID
23522034 View in PubMed
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Do strong value-based attitudes influence estimations of future events?

https://arctichealth.org/en/permalink/ahliterature144646
Source
J Med Ethics. 2010 Apr;36(4):255-6
Publication Type
Article
Date
Apr-2010
Author
Niklas Juth
Niels Lynöe
Author Affiliation
Stockholm Centre for Healthcare Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden.
Source
J Med Ethics. 2010 Apr;36(4):255-6
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Humans
Physicians - psychology
Suicide, Assisted - legislation & jurisprudence - psychology
Sweden
Abstract
The purpose of the present study was to examine whether or not strong values might influence physicians' estimations of future events. In an empirical study about physicians' attitudes towards physician assisted suicide (PAS) we asked about the physicians' main reasons for being pro, doubtful or contra PAS and also asked them to estimate what would happen with patients' trust if PAS were to be legally accepted in Swedish society. Finally we asked the physicians about their own trust in healthcare in the event of PAS being legally accepted. We found that in contrast to those who were pro PAS and doubtful, the group who were against PAS did not discriminate between their own opinion and their estimation of what they thought might happen with patients' trust in the future. Against the backdrop of the present study, we present a hypothesis maintaining that feeling strongly against controversial medical procedures is associated with being inclined to let one's own beliefs influence our capacity to interpret and estimate empirical results. We think this hypothesis merits closer examination.
PubMed ID
20338940 View in PubMed
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Duelling with doctors, restoring honour and avoiding shame? A cross-sectional study of sick-listed patients' experiences of negative healthcare encounters with special reference to feeling wronged and shame.

https://arctichealth.org/en/permalink/ahliterature258215
Source
J Med Ethics. 2013 Oct;39(10):654-7
Publication Type
Article
Date
Oct-2013
Author
Niels Lynøe
Maja Wessel
Daniel Olsson
Kristina Alexanderson
Torbjörn Tännsjö
Niklas Juth
Author Affiliation
Centre for Healthcare Ethics, Department of LIME, Karolinska Institutet, , Stockholm, Sweden.
Source
J Med Ethics. 2013 Oct;39(10):654-7
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Cross-Sectional Studies
Delivery of Health Care - ethics
Emotions - ethics
Humans
Patient satisfaction
Professional-Patient Relations - ethics
Quality of Health Care
Shame
Sick Leave
Social Security
Sweden - epidemiology
Abstract
The aim of this study was to examine if it is plausible to interpret the appearance of shame in a Swedish healthcare setting as a reaction to having one's honour wronged.
Using a questionnaire, we studied answers from a sample of long-term sick-listed patients who had experienced negative encounters (n=1628) and of these 64% also felt wronged. We used feeling wronged to examine emotional reactions such as feeling ashamed and made the assumption that feeling shame could be associated with having one's honour wronged. In statistical analyses relative risks (RRs) were computed, adjusting for age, sex, disease-labelling, educational levels, as well as their 95% CI.
Approximately half of those who had been wronged stated that they also felt shame and of those who felt shame, 93% (CI 91 to 95) felt that they had been wronged. The RR was 4.5 (CI 3.0 to 6.8) for shame when wronged. This can be compared with the other emotional reactions where the RRs were between 1.1 (CI 0.9 to 1.3)-1.4 (CI 1.2 to 1.7). We found no association between country of birth and feeling shame after having experienced negative encounters.
We found that the RR of feeling shame when wronged was significantly higher compared with other feelings. Along with theoretical considerations, and the specific types of negative encounters associated with shame, the results indicate that our research hypothesis might be plausible. We think that the results deserve to be used as point of departure for future research.
PubMed ID
23378529 View in PubMed
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The ethics of research using biobanks: reason to question the importance attributed to informed consent.

https://arctichealth.org/en/permalink/ahliterature176656
Source
Arch Intern Med. 2005 Jan 10;165(1):97-100
Publication Type
Article
Date
Jan-10-2005
Author
Klaus Hoeyer
Bert-Ove Olofsson
Tom Mjörndal
Niels Lynöe
Author Affiliation
Divisions of Medical Ethics, University of Copenhagen, Copenhagen, Denmark. k.hoeyer@pubhealth.ku.dk
Source
Arch Intern Med. 2005 Jan 10;165(1):97-100
Date
Jan-10-2005
Language
English
Publication Type
Article
Keywords
Biotechnology - ethics
Blood Banks - ethics
Blood Donors
Ethics, Research
Female
Humans
Industry - ethics
Informed Consent - ethics - psychology
Male
Questionnaires
Sweden
Tissue Banks - ethics
Abstract
During the past decade, the use of stored tissue has become an object of increased ethical query. A Swedish biobank and a biotech company have been praised for solving the ethical problems with explicit informed consent procedures, and we decided to investigate donors' perceptions of the system.
A questionnaire was sent to a randomized sample of 1200 donors who had donated blood and signed informed consent forms.
The response rate was 80.9%. Of the respondents, 64.5% were aware that they had consented to donate a blood sample, 55.4% thought that they had consented to donate phenotypic information, and 31.6% believed that they could withdraw their consent. Among respondents, 3.9% considered informing donors about the research objective as the most important ethical issue in relation to biobanks, and 5.6% were unsatisfied with the information they had been given. There was 85.9% acceptance of surrogate decision making by regional research ethics committees.
Considering that the donors in this study were not always aware of their donation but generally were not unsatisfied with the information they had received, and that they did not rate being informed about the research objective as an important issue, informed consent seems to be an inadequate measure of public acceptance of biobank-based research.
PubMed ID
15642883 View in PubMed
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Honour-related threats and human rights: a qualitative study of Swedish healthcare providers' attitudes towards young women requesting a virginity certificate or hymen reconstruction.

https://arctichealth.org/en/permalink/ahliterature106782
Source
Eur J Contracept Reprod Health Care. 2013 Dec;18(6):451-9
Publication Type
Article
Date
Dec-2013
Author
Niklas Juth
Torbjörn Tännsjö
Sven-Ove Hansson
Niels Lynöe
Author Affiliation
Stockholm Centre for Healthcare Ethics, Karolinska Institutet.
Source
Eur J Contracept Reprod Health Care. 2013 Dec;18(6):451-9
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Attitude of Health Personnel
Culture
Female
Human Rights
Humans
Hymen - surgery
Interviews as Topic
Male
Middle Aged
Qualitative Research
Sexual Abstinence - ethnology
Sweden
Abstract
To investigate the preferred actions of healthcare staff, as well as their reasoning and attitudes about young females' requests for a virginity certificate or hymen restoration.
A qualitative study, consisting of semi-structured interviews of healthcare providers from different parts of Sweden and from different medical specialties and professions, who had experience of women who asked for a virginity certificate or a hymen repair.
Using content analysis, ten themes emerged regarding healthcare personnel's attitudes and reasoning about young female patients and their requests for demonstration of virginity. The themes logically were categorised as values, beliefs, and cultural affiliation.
Responders had a more pragmatic and permissive view than the restrictive, official Swedish policy opposing hymenoplasties within the public healthcare system. There were degrees of willingness to accommodate such requests, due, for example, to different moral beliefs and medical concerns. Responders expressed frustration over the difficulty of following up patients, a situation likely due to the restrictive policy. The patient-centred approach adopted by a Dutch team of health professionals would probably better enable quality assurance.
PubMed ID
24111994 View in PubMed
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30 records – page 1 of 3.