Books by Christian Munthe
This volume outlines and analyses ethical issues actualized by applying a precautionary approach ... more This volume outlines and analyses ethical issues actualized by applying a precautionary approach to the regulation of new biotechnologies. It presents a novel way of categorizing and comparing biotechnologies from a precautionary standpoint. Based on this, it addresses underlying philosophical problems regarding the ethical assessment of decision-making under uncertainty and ignorance, and discusses how risks and possible benefits of such technologies should be balanced from an ethical standpoint. It argues on conceptual and ethical grounds for a technology neutral regulation as well as for a regulation that not only checks new technologies but also requires old, inferior ones to be phased out. It demonstrates how difficult ethical issues regarding the extent and ambition of precautionary policies need to be handled by such a regulation, and presents an overarching framwork for doing so.
"The aim of this first part of The Philosophy of Hate Crime Anthology is to introduce the topic o... more "The aim of this first part of The Philosophy of Hate Crime Anthology is to introduce the topic of its accompanying, second part, the annotated bibliography of the philosophy of hate crime authored and compiled by David Brax.2 Together, these documents provide a provides a guide to the philosophical and theoretical issues underlying hate crime legislation and policy. These issues are rarely at the top of the news agenda, but are important to the assessment of various more concrete and readily debated questions. They are, as we shall attempt to demonstrate, crucial in order to achieve well-founded hate crime policies. In effect, this bibliography purports to explain such connections and to present briefly the debates about the philosophical issues as they are conducted within different fields of expertise, with pointers to relevant reading materials and what these contribute to the discussion.
The realisation of this aim is an outcome of the project When Law and Hate Collide, coordinated by the law school of the University of Central Lancashire, UK, and involving researchers from the Göthe University of Frankfurt, Germany and the University of Gothenburg, Sweden. This project was funded by the European Commission's Daphne III program (contract no. 2009-DAP3- AG-1221), which aims at providing the European Union with a strengthened basis for designing hate crime policies at the European level, as well as support member state initiatives of this nature."
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ABSTRACT
Medical or health-oriented screening programs are amongst the most debated aspects of health care and public health practices in health care and public health ethics, as well as health policy discussions. In spite of this, most treatments of screening in the research literature restrict themselves to isolated scientific aspects, sometimes complemented by economic analyses or loose speculations regarding policy aspects. At the same time, recent advances in medical genetics and technology, as well as a rapidly growing societal focus on public health concerns, inspires an increase in suggested or recently started screening programs.
This book involves an in-depth analysis of the ethical, political and philosophical issues related to health-oriented screening programs. It explores the considerations that arise when heath care interacts with other societal institutions on a large scale, as is the case with screening: What values may be promoted or compromised by screening programs? What conflicts of values do typically arise – both internally and in relation to the goals of health care, on the one hand, and the goals of public health and the general society, on the other? What aspects of screening are relevant for determining whether it should be undertaken or not and how it should be organised in order to remain defensible? What implications does the ethics of screening have for health care ethics as a whole?
These questions are addressed by applying philosophical methods of conceptual analysis, as well as models and theories from moral and political philosophy, medical ethics, and public health ethics, to a large number of ongoing and proposed screening programs which makes this book the first comprehensive work on the ethics of screening. Analyses and suggestions are made that are of potential interest to health care staff, medical researchers, policy makers and the general public.
CONTENTS
Acknowledgements
Chapter 1: Introduction
1.1 The Wilson and Jungner Criteria
1.2 Point and Plan
1.3 The Concept of Screening
Chapter 2: Why Screening?
2.1 Screening, Treatment and Prevention: Preliminary Remarks
2.2 Health: Life and Well-being
2.2.1 Health and Counselling
2.2.2 The Good of People and of the Population
2.3 Autonomy
2.3.1 Respecting and Promoting Autonomy
2.3.2 Promoting Autonomy through Screening
2.4 Justice
2.5 Summary
Chapter 3: Screening – What, When and Whom?
3.1 Diseases and Groups
3.1.1 Prenatal Screening
3.1.2 Neonatal Screening
3.1.2.1 Reasons for Screening in the Neonatal Period
3.1.2.2 Neonatal Screening and Parental Informed Consent
3.1.2.3 Expanding Neonatal Screening – How Far?
3.1.3 Child and Adolescent Screening
3.1.3.1 Stigmatisation
3.1.3.2 The Child as Decision Maker
3.1.4 Adult Screening
3.2 Testing and Analysis
3.2.1 Safety
3.2.2 Validity
3.2.3 Predictive Value
3.3 Treatments
3.3.1 Abortion as Treatment
3.3.2 Counselling as Treatment
3.4 Summary
Chapter 4: Screening – How?
4.1 Informed Consent
4.2 Counselling
4.2.1 Genetic Counselling as a Template
4.2.2 Expansion: Shared Decision Making
4.3 Funding and Participation
4.4 Summary
Chapter 5: Case Studies
5.1 Non-Invasive Prenatal Diagnosis
5.2 Neonatal Screening for Fragile X
5.3 Mammography Screening
5.4 PSA Screening for Prostate Cancer
Chapter 6: Serving Society or Serving the Patient?
6.1 Summary of the Analysis So far
6.2 The Public Health – Health Care Tension Area
6.3 The Relevance of a Social Science Perspective
6.4 An Institutional Approach to health-related Ethics: A Sketch
6.5 Applying the Institutional Approach: Three Cases
6.5.1 Institutions, Functions and Ethics: Reproductive Care vs. Communicable Disease
6.5.2 Direct to Consumer Genetic Testing: The Limits of Context Relativity
6.5.3 Screening and Justice: The Case Against Allocating Health Care Resources to Screening
6.6 Revisiting the Wilson and Jungner Criteria for Screening
6.7 Closing
Refrences
Index
Since a couple of decades, the notion of a precautionary principle plays a central and increasing... more Since a couple of decades, the notion of a precautionary principle plays a central and increasingly influential role in international as well as national policy and regulation regarding the environment and the use of technology. Urging society to take action in the face of potential risks of human activities in these areas, the recent focus on climate change has further sharpened the importance of this idea. However, the idea of a precautionary principle has also been problematised and criticised by scientists, scholars and policy activists, and been accused of almost every intellectual sin imaginable: unclarity, impracticality, arbitrariness and moral as well as political unsoundness. In that light, the very idea of precaution as an ideal for policy making rather comes out as a dead end. On the basis of these contrasting starting points, Christian Munthe undertakes an innovative, in-depth philosophical analysis of what the idea of a precautionary principle is and should be about. A novel theory of the ethics of imposing risks is developed and used as a foundation for defending the idea of precaution in environmental and technological policy making against its critics, while at the same time avoiding a number of identified flaws. The theory is shown to have far-reaching consequences for areas such as bio-, information- and nuclear technology, and global environmental policy in areas such as climate change. The author argues that, while the price we pay for precaution must not be too high, we have to be prepared to pay it in order to act ethically defensible. A number of practical suggestions for precautionary regulation and policy making are made on the basis of this, and some challenges to basic ethical theory as well as consumerist societies, the global political order and liberal democracy are identified.
Preimplantation genetic diagnosis (PGD) is taken to mark the starting-point of a new phase in hum... more Preimplantation genetic diagnosis (PGD) is taken to mark the starting-point of a new phase in human reproduction, where the possibility of choosing children on genetic grounds without having to resort to dangerous or ethically controversial procedures (such as abortion) will gradually increase. Ethical and political issues actualised by this development are addressed.
The discussion touches upon issues regarding the moral status of embryos and gametes, the moral import of respecting individual autonomy and its implications for the requirement of informed consent in health-care, the connection between disease, disability and the value of life, the moral status of possible future people, and the connection between choosing children and eugenic policies of the past. Practical policy issues are addressed on the basis of this, as well as an empirical case-study of the introduction of PGD in Sweden.
The book ends up in a set of recommendations regarding the management of research on, introduction and routine use of pure selection, both within health care and from the point of view of society as a whole. It is argued that research on such procedures should be allowed and supported by society. However, tight restrictions regarding the clinical introduction of new procedures in this area is highly desirable. A rough model for implementing such restrictions is also presented. It is further asserted that, although reasons of economy and safety should limit the access to pure selection, society should not apply any explicit restrictions based on ideas regarding how different traits affect a person's quality of life. It is stressed that, in order to avoid a resurrection of eugenic policies of the past, the development in this field underlines the need for continued and strengthened public support to the sick, disabled and mentally retarded.
Keywords: assisted procreation, bioethics, embryo experimentation, eugenics, genetic testing, in vitro fertilisation, medical ethics, medical genetics, polar body biopsy, preconception diagnosis, preimplantation genetic diagnosis, prenatal diagnosis, public policy, reproductive medicine, research ethics, sex preselection.
"Motives put forward by specialists on prenatal diagnosis in support of this procedure when it wa... more "Motives put forward by specialists on prenatal diagnosis in support of this procedure when it was introduced in Swedish health care during the 1970's are described and analysed. The motives are set in relation later criticism of prenatal diagnosis as well as general bioethical issues.
Three motives are described: 1) Prenatal diagnosis is a tool for improving genetic counselling, thereby promoting the autonomy and reducing the anxieties of pregnant women who fear having children with some disorder or disease. 2) The point of prenatal diagnosis is to effect medical prevention by reducing the number of children born with diseases or disorders. 3) Prenatal diagnosis has an economic advantage in that it may save society from some of the costs involved in the care for disabled or retarded people.
These motives are found to communicate an unclear and partly inconsistent body of ethical values. First, complex ethical issues in connection with abortion were not addressed. Secondly, it is highly unclear how considerations of autonomy was balanced against considerations of well-being and economic aims. This unclear picture of the support of the autonomy of patients is also relevant when the economic motive is set in relation to accusations that prenatal diagnosis springs from similar moral values as eugenic policies of the past. Three interpretations of this motive are distinguished of which only one may actually support eugenic policies. However, even if the economic motive is interpreted in a very defensive way, it still expresses a tolerance of policymakers setting aside the autonomy of individual patients in order to achieve economic aims. It is argued that the expression of such tolerance can only be blocked by a clear willingness to actively fight any threat against the autonomy of patients, and that the expression of such an attitude is incompatible with the use of the economic motive. "
Arguments put forward for five positions on the moral status of abortion are discussed. The posit... more Arguments put forward for five positions on the moral status of abortion are discussed. The positions range from the view that abortion may be right only if it is necessary to save the woman's life, to the claim that while most safe abortions requested by the woman are right, some abortions would be wrong not to perform and there are cases where it is right to perform abortion even if the woman does not want it. The arguments are found invalid and/or irrelevant. It is argued that a tenable position on the moral status of abortion has to be supported by an act-utilitarian moral theory dubbed BHU.
Application of BHU yields that it is impossible to obtain good reasons for any of the positions. However, this is also true of most other moral theories. Four tentative conclusions seem plausible: 1) Abortion is seldom right in countries where most women lack opportunities to have cheap, safe legal abortions. In other countries, however, many abortions can be right. 2) In many of the justifiable cases of abortion, the woman faces a moral dilemma where she cannot avoid acting wrongly even if she acts rightly. 3) It is in general wrong to omit abortion if the foetus is so severly deformed that it would develop into a person with a life worth not living. It is also in general wrong to omit abortion if this results in abortion being performed at a later time. 4) In very rare cases it may be right to perform abortion even if the woman does not want it, but in practice we lack all means of identifying these cases.
Papers by Christian Munthe
Journal of Medical Ethics, accpeted and in press., 2019
In response to Koplin and Wilkinson, I argue, first, that the uncertain clinical prospects of hum... more In response to Koplin and Wilkinson, I argue, first, that the uncertain clinical prospects of human-pig chimera based transplantation makes the reason to spend resources for clarifying whether or not such practice might imply serious ethical breach due to enhanced cognitive capacities of the chimeras rather weak. This as the benefits of further pursuing this avenue of research is so uncertain, so that taking even very unclear risks of serious ethical breach (thus in need of clarification for justification of the research) is not worth the price in terms of spent resources. Secondly, I argue that, as there are some reason to pursue this avenue further (and thus investigate the risk in question), the analogy to the notion of halting all farming of larger animals for food does not hold up. The reason is that we do not need to probe any further any comparable risk to know that such farming practices should be halted.
In review, 2019
Background Emissions of high concentrations of antibiotics from manufacturing sites select for re... more Background Emissions of high concentrations of antibiotics from manufacturing sites select for resistant bacteria and may contribute to the emergence of new forms of resistance in pathogens. Many scientists, industry, policy makers and other stakeholders recognize such pollution as an unnecessary and unacceptable risk to global public health. An attempt to assess and reduce such discharges, however, quickly meets with complex realities that need to be understood to identify effective ways to move forward. This paper charts relevant key actor-types, their stakes and interests, incentives that can motivate them to act to improve the situation, as well as counterincentives that may undermine such motivation. Methods The actor types and their respective interests have been identified using research literature, publicly available documents, websites, and the knowledge of the authors. Results Thirty-three different types of actor-types were identified, representing e.g. commercial actors, public agencies, states and international institutions. These are in complex ways connected by differing and partly similar interests that sometimes may conflict, sometimes pull in the same direction. Some actor types can act to create incentives and counterincentives for others in this area. Conclusions The analysis demonstrates and clarifies the challenges in addressing industrial emissions of antibiotics, notably the complexity of the relations between different types of actors, their international dependency and the need for transparency. The analysis however also suggests possible ways of initiating incentive-chains to eventually improve the prospects of motivating industry to reduce emissions. High resource consumer states, especially in multinational cooperation, hold a key position to initiate such chains.
Research On Social Work Practice, 2019
Objective:
Foster family care is associated with adverse short- and long-term consequences for t... more Objective:
Foster family care is associated with adverse short- and long-term consequences for the child. A systematic review was conducted on interventions for foster children and foster careers.
Method:
A comprehensive search process was used to find eligible interventions evaluated in randomized controlled trials or quasi-experimental studies. The quality of studies was assessed with GRADE, and effects were synthesized using meta-analytic methods.
Results:
In all, 28 publications of 18 interventions, including 5,357 children, were identified. Only three specific interventions had sufficient confidence of evidence. No study had examined tools for foster parent selection nor had evaluated preservice programs related to outcomes.
Discussion:
These analyses provide new insights and hope into the field of systematic interventions in foster care. The overall results indicate that it is possible to improve eight outcomes but cannot point out which programs are superior. Ethically, social care organizations should systematically collect knowledge about effects and side effects.
Keywords foster care, field of practice, systematic review, literature review, adolescents, population, children
Euroepean Review, 2019
The daring vision of using big data technology to substantially advance the scientific understand... more The daring vision of using big data technology to substantially advance the scientific understanding of human nature, individually and socially, and possibly solve age-old challenges of bridging the subjective and objective sides of human nature, rests on substantial assumptions about the concept of a human being. The daring big data vision may at the same time, in itself, serve to change the very concept of a human, regardless of how well the vision’s assumptions and prospects hold up to scrutiny. This issue of the European Review presents an attempt to critically engage with the question of how this complex situation affects the content and prospects of the vision of reconsidering humanity with the help of big data. In this introduction, the land scape of the issue is sketched and some general remarks of where the emerging map might take future research are made. In general, even if the assumptions of the daring big data vision turn out wanting, pragmatic factors may very well transform our own image of ourselves to fit it.
Bioethics. Online first: https://doi.org/10.1111/bioe.12605, 2019
Antibiotic resistance, arising when bacteria develop defences against antibiotics, creates a publ... more Antibiotic resistance, arising when bacteria develop defences against antibiotics, creates a public health threat of massive proportions. This raises challenging questions for standard notions in bioethics when suitable policy is to be characterised and justified. We examine the particular proposal of expediting innovation of new antibiotics by cutting various forms of regulatory “red tape” in the standard system for the clinical introduction of new drugs. We find strong principled reasons in favour of such lowering of the ethical standards of research and clinical introduction of new antibiotic formulas. However, this support is undermined by pragmatic challenges due to expected responses from stakeholders, creating uncertainty about what policy could actually be effectively implemented. We describe an underlying dilemma on how to rationally justify compromises between ideal ethical justification and pragmatic risks that needs to be further addressed in this light. We suggest a solution to this dilemma related to proposals of expediting antibiotic drug innovation.
Journal of Argumentation in Context, 2018
This article explores ethical aspects of using open argumentation in person centered care (PCC), ... more This article explores ethical aspects of using open argumentation in person centered care (PCC), where health professionals (HPs) openly criticize or contradict factual claims, assumptions, preferences or value commitments of patients. We argue that such disputing may be claimed to have an important place in advanced versions of PCC, but that it actualizes important clinical ethical aspects of doing such disputation well. This may prompt caution in the implementation of PCC, but also inspire educational and organizational reform. We also probe the notion of openly disputing with patients when PCC is applied in less standard settings (where it is nevertheless advocated), using the cases of children, psychiatry and public health interventions, such as antibiotic stewardship programs, as examples. These contexts both offer new reasons for why PCC may or should include open disputing with patients, but also to introduce new ethical complications. Some of these may transform either to arguments against PCC implementation in these areas, or to a more open view of to what extent an HP may seek to dominate patients in a PCC setting. We are especially skeptical about the meaningfulness of applying advanced PCC in areas of psychiatry with high levels of compulsory elements, such as forensic psychiatric detention.
Bioethics , 2019
We consider the implications for the ethical evaluation of research programs of two fundamental c... more We consider the implications for the ethical evaluation of research programs of two fundamental changes in the revised research ethical guideline of the Council for International Organizations of Medical Sciences. The first is the extension of scope that follows from exchanging “biomedical” for “health-related” research, and the second is the new evaluative basis of “social value,” which implies new ethical requirements of research. We use the example of antibiotic resistance interventions to explore the need to consider what we term the pragmatic risks of such interventions to evaluate the so- cial value of certain kinds of health-related research. These (pragmatic) risks severely threaten the social value of interventions in every area where human and social re- sponses significantly impact on their effectiveness. Thus, the social value of health-re- lated research needed to demonstrate its effectiveness depends on the successful management of such risks. Research designed to take into account pragmatic risks also gives rise to similar types of risks, and the potential for social value in light of those risks needs to be considered in ethical reviews based on the new guidelines. We argue that, to handle this new expanded task, the international system of research ethical review addressed by the guidelines needs institutional development. In particular, we consider lifting research ethical review to a level closer to actual health policy making..
Wasserman, D. & Cureton, A. (eds.). The Oxford Handbook of the Philosophy of Disability. Oxford: Oxford University Press (in press)
This chapter explores disability-based criticism against what is here called selective reproducti... more This chapter explores disability-based criticism against what is here called selective reproductive technology (SRT), such as prenatal screening programmes, in light of recent calls for disability theory, as well as political activism based on that, to accommodate for an intersectional turn across all types of critical social identity studies (class, disability, gender, lgbt, queer, race, etc.). Applying intersectionality to the disability SRT critique generates complex and provoking implications; not invalidating it, but radically transforming its shape and direction. Most notably, it inserts a wedge between the identity-based experience that SRT unjustly discriminates and oppresses disabled people, and the identity political call for SRT programmes to be shut down or, at least, not publicly supported. Intersectionality steers the justification towards politically addressing structural factors explaining injustice independently of identity-based experience, and SRT programmes may have to be allowed for such action to be sustainable also from a disability identity standpoint.
This article explores the relationship between parental authority, adolescent autonomy, and their... more This article explores the relationship between parental authority, adolescent autonomy, and their respective responsibility. Adolescence is a transitional phase in which the child reaches maturity and takes on the full rights and responsibilities of an adult. During this phase several capacities related to decision-making and moral agency are in drastic flux. We analyse the moral relationship between parents and adolescents in light of recent findings concerning adolescent decision-making in developmental psychology. By combining the mentioned psychological research with standard ideas pertaining to what is required to have a right to self-determination and being responsible we argue that there is reason to believe that adolescents sometimes have a right to make decision that they are not responsible for. If our argument is correct then we face an hithertho unexplored quadrilemma concerning the limits of parental discretion and the distribution of responsibility between parents and child. We present a suggestion for how this quadrilemma may plausibly be resolved.
We address the moral importance of fish, invertebrates such as crustaceans, snails and insects, a... more We address the moral importance of fish, invertebrates such as crustaceans, snails and insects, and other animals about which there is qualified scientific uncertainty about their sentience. We argue that, on a sentientist basis, one can at least say that how such animals fare make ethically significant claims on our character. It is a requirement of a morally decent (or virtuous) person that she at least pays attention to and is cautious regarding the possibly morally relevant aspects of such animals. This involves having a moral stance, in the sense of patterns of perception, such that one notices such animals as being morally relevant in various situations. For the person who does not already consider these animals in this way, this could be a big change in moral psychology, and can be assumed to have behavioural consequences, albeit indeterminate. Character has been largely neglected in the literature, which focuses on act-centred approaches (i.e. that the evidence on sentience supports, or does not support, taking some specific action). We see our character-centred approach as complementary to, not superior to, act-centred approaches. Our approach has the advantage of allowing us to make ethically interesting and practically relevant claims about a wider range of cases, but it has the drawback of providing less specific action guidance.
Health Care Analysis, 2017
In contrast to standardized guidelines, personalized medicine and person centered care are two no... more In contrast to standardized guidelines, personalized medicine and person centered care are two notions that have recently developed and are aspiring for more individualized health care for each single patient. While having a similar drive toward individualized care, their sources are markedly different. While personalized medicine stems from a biomedical framework, person centered care originates from a caring perspective, and a wish for a more holistic view of patients. It is unclear to what extent these two concepts can be combined or if they conflict at fundamental or pragmatic levels. This paper reviews existing literature in both medicine and related philosophy to analyze closer the meaning of the two notions, and to explore the extent to which they overlap or oppose each other, in theory or in practice, in particular regarding ethical assumptions and their respective practical implications.
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Books by Christian Munthe
The realisation of this aim is an outcome of the project When Law and Hate Collide, coordinated by the law school of the University of Central Lancashire, UK, and involving researchers from the Göthe University of Frankfurt, Germany and the University of Gothenburg, Sweden. This project was funded by the European Commission's Daphne III program (contract no. 2009-DAP3- AG-1221), which aims at providing the European Union with a strengthened basis for designing hate crime policies at the European level, as well as support member state initiatives of this nature."
In Medicine, Health Care and Philosophy: http://www.springerlink.com/content/44275q410286r7q1/
ABSTRACT
Medical or health-oriented screening programs are amongst the most debated aspects of health care and public health practices in health care and public health ethics, as well as health policy discussions. In spite of this, most treatments of screening in the research literature restrict themselves to isolated scientific aspects, sometimes complemented by economic analyses or loose speculations regarding policy aspects. At the same time, recent advances in medical genetics and technology, as well as a rapidly growing societal focus on public health concerns, inspires an increase in suggested or recently started screening programs.
This book involves an in-depth analysis of the ethical, political and philosophical issues related to health-oriented screening programs. It explores the considerations that arise when heath care interacts with other societal institutions on a large scale, as is the case with screening: What values may be promoted or compromised by screening programs? What conflicts of values do typically arise – both internally and in relation to the goals of health care, on the one hand, and the goals of public health and the general society, on the other? What aspects of screening are relevant for determining whether it should be undertaken or not and how it should be organised in order to remain defensible? What implications does the ethics of screening have for health care ethics as a whole?
These questions are addressed by applying philosophical methods of conceptual analysis, as well as models and theories from moral and political philosophy, medical ethics, and public health ethics, to a large number of ongoing and proposed screening programs which makes this book the first comprehensive work on the ethics of screening. Analyses and suggestions are made that are of potential interest to health care staff, medical researchers, policy makers and the general public.
CONTENTS
Acknowledgements
Chapter 1: Introduction
1.1 The Wilson and Jungner Criteria
1.2 Point and Plan
1.3 The Concept of Screening
Chapter 2: Why Screening?
2.1 Screening, Treatment and Prevention: Preliminary Remarks
2.2 Health: Life and Well-being
2.2.1 Health and Counselling
2.2.2 The Good of People and of the Population
2.3 Autonomy
2.3.1 Respecting and Promoting Autonomy
2.3.2 Promoting Autonomy through Screening
2.4 Justice
2.5 Summary
Chapter 3: Screening – What, When and Whom?
3.1 Diseases and Groups
3.1.1 Prenatal Screening
3.1.2 Neonatal Screening
3.1.2.1 Reasons for Screening in the Neonatal Period
3.1.2.2 Neonatal Screening and Parental Informed Consent
3.1.2.3 Expanding Neonatal Screening – How Far?
3.1.3 Child and Adolescent Screening
3.1.3.1 Stigmatisation
3.1.3.2 The Child as Decision Maker
3.1.4 Adult Screening
3.2 Testing and Analysis
3.2.1 Safety
3.2.2 Validity
3.2.3 Predictive Value
3.3 Treatments
3.3.1 Abortion as Treatment
3.3.2 Counselling as Treatment
3.4 Summary
Chapter 4: Screening – How?
4.1 Informed Consent
4.2 Counselling
4.2.1 Genetic Counselling as a Template
4.2.2 Expansion: Shared Decision Making
4.3 Funding and Participation
4.4 Summary
Chapter 5: Case Studies
5.1 Non-Invasive Prenatal Diagnosis
5.2 Neonatal Screening for Fragile X
5.3 Mammography Screening
5.4 PSA Screening for Prostate Cancer
Chapter 6: Serving Society or Serving the Patient?
6.1 Summary of the Analysis So far
6.2 The Public Health – Health Care Tension Area
6.3 The Relevance of a Social Science Perspective
6.4 An Institutional Approach to health-related Ethics: A Sketch
6.5 Applying the Institutional Approach: Three Cases
6.5.1 Institutions, Functions and Ethics: Reproductive Care vs. Communicable Disease
6.5.2 Direct to Consumer Genetic Testing: The Limits of Context Relativity
6.5.3 Screening and Justice: The Case Against Allocating Health Care Resources to Screening
6.6 Revisiting the Wilson and Jungner Criteria for Screening
6.7 Closing
Refrences
Index
The discussion touches upon issues regarding the moral status of embryos and gametes, the moral import of respecting individual autonomy and its implications for the requirement of informed consent in health-care, the connection between disease, disability and the value of life, the moral status of possible future people, and the connection between choosing children and eugenic policies of the past. Practical policy issues are addressed on the basis of this, as well as an empirical case-study of the introduction of PGD in Sweden.
The book ends up in a set of recommendations regarding the management of research on, introduction and routine use of pure selection, both within health care and from the point of view of society as a whole. It is argued that research on such procedures should be allowed and supported by society. However, tight restrictions regarding the clinical introduction of new procedures in this area is highly desirable. A rough model for implementing such restrictions is also presented. It is further asserted that, although reasons of economy and safety should limit the access to pure selection, society should not apply any explicit restrictions based on ideas regarding how different traits affect a person's quality of life. It is stressed that, in order to avoid a resurrection of eugenic policies of the past, the development in this field underlines the need for continued and strengthened public support to the sick, disabled and mentally retarded.
Keywords: assisted procreation, bioethics, embryo experimentation, eugenics, genetic testing, in vitro fertilisation, medical ethics, medical genetics, polar body biopsy, preconception diagnosis, preimplantation genetic diagnosis, prenatal diagnosis, public policy, reproductive medicine, research ethics, sex preselection.
Three motives are described: 1) Prenatal diagnosis is a tool for improving genetic counselling, thereby promoting the autonomy and reducing the anxieties of pregnant women who fear having children with some disorder or disease. 2) The point of prenatal diagnosis is to effect medical prevention by reducing the number of children born with diseases or disorders. 3) Prenatal diagnosis has an economic advantage in that it may save society from some of the costs involved in the care for disabled or retarded people.
These motives are found to communicate an unclear and partly inconsistent body of ethical values. First, complex ethical issues in connection with abortion were not addressed. Secondly, it is highly unclear how considerations of autonomy was balanced against considerations of well-being and economic aims. This unclear picture of the support of the autonomy of patients is also relevant when the economic motive is set in relation to accusations that prenatal diagnosis springs from similar moral values as eugenic policies of the past. Three interpretations of this motive are distinguished of which only one may actually support eugenic policies. However, even if the economic motive is interpreted in a very defensive way, it still expresses a tolerance of policymakers setting aside the autonomy of individual patients in order to achieve economic aims. It is argued that the expression of such tolerance can only be blocked by a clear willingness to actively fight any threat against the autonomy of patients, and that the expression of such an attitude is incompatible with the use of the economic motive. "
Application of BHU yields that it is impossible to obtain good reasons for any of the positions. However, this is also true of most other moral theories. Four tentative conclusions seem plausible: 1) Abortion is seldom right in countries where most women lack opportunities to have cheap, safe legal abortions. In other countries, however, many abortions can be right. 2) In many of the justifiable cases of abortion, the woman faces a moral dilemma where she cannot avoid acting wrongly even if she acts rightly. 3) It is in general wrong to omit abortion if the foetus is so severly deformed that it would develop into a person with a life worth not living. It is also in general wrong to omit abortion if this results in abortion being performed at a later time. 4) In very rare cases it may be right to perform abortion even if the woman does not want it, but in practice we lack all means of identifying these cases.
Papers by Christian Munthe
Foster family care is associated with adverse short- and long-term consequences for the child. A systematic review was conducted on interventions for foster children and foster careers.
Method:
A comprehensive search process was used to find eligible interventions evaluated in randomized controlled trials or quasi-experimental studies. The quality of studies was assessed with GRADE, and effects were synthesized using meta-analytic methods.
Results:
In all, 28 publications of 18 interventions, including 5,357 children, were identified. Only three specific interventions had sufficient confidence of evidence. No study had examined tools for foster parent selection nor had evaluated preservice programs related to outcomes.
Discussion:
These analyses provide new insights and hope into the field of systematic interventions in foster care. The overall results indicate that it is possible to improve eight outcomes but cannot point out which programs are superior. Ethically, social care organizations should systematically collect knowledge about effects and side effects.
Keywords foster care, field of practice, systematic review, literature review, adolescents, population, children
The realisation of this aim is an outcome of the project When Law and Hate Collide, coordinated by the law school of the University of Central Lancashire, UK, and involving researchers from the Göthe University of Frankfurt, Germany and the University of Gothenburg, Sweden. This project was funded by the European Commission's Daphne III program (contract no. 2009-DAP3- AG-1221), which aims at providing the European Union with a strengthened basis for designing hate crime policies at the European level, as well as support member state initiatives of this nature."
In Medicine, Health Care and Philosophy: http://www.springerlink.com/content/44275q410286r7q1/
ABSTRACT
Medical or health-oriented screening programs are amongst the most debated aspects of health care and public health practices in health care and public health ethics, as well as health policy discussions. In spite of this, most treatments of screening in the research literature restrict themselves to isolated scientific aspects, sometimes complemented by economic analyses or loose speculations regarding policy aspects. At the same time, recent advances in medical genetics and technology, as well as a rapidly growing societal focus on public health concerns, inspires an increase in suggested or recently started screening programs.
This book involves an in-depth analysis of the ethical, political and philosophical issues related to health-oriented screening programs. It explores the considerations that arise when heath care interacts with other societal institutions on a large scale, as is the case with screening: What values may be promoted or compromised by screening programs? What conflicts of values do typically arise – both internally and in relation to the goals of health care, on the one hand, and the goals of public health and the general society, on the other? What aspects of screening are relevant for determining whether it should be undertaken or not and how it should be organised in order to remain defensible? What implications does the ethics of screening have for health care ethics as a whole?
These questions are addressed by applying philosophical methods of conceptual analysis, as well as models and theories from moral and political philosophy, medical ethics, and public health ethics, to a large number of ongoing and proposed screening programs which makes this book the first comprehensive work on the ethics of screening. Analyses and suggestions are made that are of potential interest to health care staff, medical researchers, policy makers and the general public.
CONTENTS
Acknowledgements
Chapter 1: Introduction
1.1 The Wilson and Jungner Criteria
1.2 Point and Plan
1.3 The Concept of Screening
Chapter 2: Why Screening?
2.1 Screening, Treatment and Prevention: Preliminary Remarks
2.2 Health: Life and Well-being
2.2.1 Health and Counselling
2.2.2 The Good of People and of the Population
2.3 Autonomy
2.3.1 Respecting and Promoting Autonomy
2.3.2 Promoting Autonomy through Screening
2.4 Justice
2.5 Summary
Chapter 3: Screening – What, When and Whom?
3.1 Diseases and Groups
3.1.1 Prenatal Screening
3.1.2 Neonatal Screening
3.1.2.1 Reasons for Screening in the Neonatal Period
3.1.2.2 Neonatal Screening and Parental Informed Consent
3.1.2.3 Expanding Neonatal Screening – How Far?
3.1.3 Child and Adolescent Screening
3.1.3.1 Stigmatisation
3.1.3.2 The Child as Decision Maker
3.1.4 Adult Screening
3.2 Testing and Analysis
3.2.1 Safety
3.2.2 Validity
3.2.3 Predictive Value
3.3 Treatments
3.3.1 Abortion as Treatment
3.3.2 Counselling as Treatment
3.4 Summary
Chapter 4: Screening – How?
4.1 Informed Consent
4.2 Counselling
4.2.1 Genetic Counselling as a Template
4.2.2 Expansion: Shared Decision Making
4.3 Funding and Participation
4.4 Summary
Chapter 5: Case Studies
5.1 Non-Invasive Prenatal Diagnosis
5.2 Neonatal Screening for Fragile X
5.3 Mammography Screening
5.4 PSA Screening for Prostate Cancer
Chapter 6: Serving Society or Serving the Patient?
6.1 Summary of the Analysis So far
6.2 The Public Health – Health Care Tension Area
6.3 The Relevance of a Social Science Perspective
6.4 An Institutional Approach to health-related Ethics: A Sketch
6.5 Applying the Institutional Approach: Three Cases
6.5.1 Institutions, Functions and Ethics: Reproductive Care vs. Communicable Disease
6.5.2 Direct to Consumer Genetic Testing: The Limits of Context Relativity
6.5.3 Screening and Justice: The Case Against Allocating Health Care Resources to Screening
6.6 Revisiting the Wilson and Jungner Criteria for Screening
6.7 Closing
Refrences
Index
The discussion touches upon issues regarding the moral status of embryos and gametes, the moral import of respecting individual autonomy and its implications for the requirement of informed consent in health-care, the connection between disease, disability and the value of life, the moral status of possible future people, and the connection between choosing children and eugenic policies of the past. Practical policy issues are addressed on the basis of this, as well as an empirical case-study of the introduction of PGD in Sweden.
The book ends up in a set of recommendations regarding the management of research on, introduction and routine use of pure selection, both within health care and from the point of view of society as a whole. It is argued that research on such procedures should be allowed and supported by society. However, tight restrictions regarding the clinical introduction of new procedures in this area is highly desirable. A rough model for implementing such restrictions is also presented. It is further asserted that, although reasons of economy and safety should limit the access to pure selection, society should not apply any explicit restrictions based on ideas regarding how different traits affect a person's quality of life. It is stressed that, in order to avoid a resurrection of eugenic policies of the past, the development in this field underlines the need for continued and strengthened public support to the sick, disabled and mentally retarded.
Keywords: assisted procreation, bioethics, embryo experimentation, eugenics, genetic testing, in vitro fertilisation, medical ethics, medical genetics, polar body biopsy, preconception diagnosis, preimplantation genetic diagnosis, prenatal diagnosis, public policy, reproductive medicine, research ethics, sex preselection.
Three motives are described: 1) Prenatal diagnosis is a tool for improving genetic counselling, thereby promoting the autonomy and reducing the anxieties of pregnant women who fear having children with some disorder or disease. 2) The point of prenatal diagnosis is to effect medical prevention by reducing the number of children born with diseases or disorders. 3) Prenatal diagnosis has an economic advantage in that it may save society from some of the costs involved in the care for disabled or retarded people.
These motives are found to communicate an unclear and partly inconsistent body of ethical values. First, complex ethical issues in connection with abortion were not addressed. Secondly, it is highly unclear how considerations of autonomy was balanced against considerations of well-being and economic aims. This unclear picture of the support of the autonomy of patients is also relevant when the economic motive is set in relation to accusations that prenatal diagnosis springs from similar moral values as eugenic policies of the past. Three interpretations of this motive are distinguished of which only one may actually support eugenic policies. However, even if the economic motive is interpreted in a very defensive way, it still expresses a tolerance of policymakers setting aside the autonomy of individual patients in order to achieve economic aims. It is argued that the expression of such tolerance can only be blocked by a clear willingness to actively fight any threat against the autonomy of patients, and that the expression of such an attitude is incompatible with the use of the economic motive. "
Application of BHU yields that it is impossible to obtain good reasons for any of the positions. However, this is also true of most other moral theories. Four tentative conclusions seem plausible: 1) Abortion is seldom right in countries where most women lack opportunities to have cheap, safe legal abortions. In other countries, however, many abortions can be right. 2) In many of the justifiable cases of abortion, the woman faces a moral dilemma where she cannot avoid acting wrongly even if she acts rightly. 3) It is in general wrong to omit abortion if the foetus is so severly deformed that it would develop into a person with a life worth not living. It is also in general wrong to omit abortion if this results in abortion being performed at a later time. 4) In very rare cases it may be right to perform abortion even if the woman does not want it, but in practice we lack all means of identifying these cases.
Foster family care is associated with adverse short- and long-term consequences for the child. A systematic review was conducted on interventions for foster children and foster careers.
Method:
A comprehensive search process was used to find eligible interventions evaluated in randomized controlled trials or quasi-experimental studies. The quality of studies was assessed with GRADE, and effects were synthesized using meta-analytic methods.
Results:
In all, 28 publications of 18 interventions, including 5,357 children, were identified. Only three specific interventions had sufficient confidence of evidence. No study had examined tools for foster parent selection nor had evaluated preservice programs related to outcomes.
Discussion:
These analyses provide new insights and hope into the field of systematic interventions in foster care. The overall results indicate that it is possible to improve eight outcomes but cannot point out which programs are superior. Ethically, social care organizations should systematically collect knowledge about effects and side effects.
Keywords foster care, field of practice, systematic review, literature review, adolescents, population, children
Objective: The aim of the present study was to identify elements in the patient-pediatrician consultations that might influence such integration of the disease among adolescents with T1DM.
Methods: Twelve pediatrician –adolescent consultations were video-recorded and analyzed. The adolescents all had an immigrant background.
Results: Integration of the disease appeared enabled when responsibility was shared, when hope, autonomy and emotions were confirmed, and the pediatrician asked probing questions. Letting objective data dominate the adolescent’s experiences, using risk as a motivator, neutralizing emotions in relation to having diabetes, and confirming forgetfulness may instead inhibit disease integration.
Conclusion: An extended person-centered approach with focus on the adolescent’s experiences of everyday-life with a chronic disease and less attention on physical parameters in the pediatrician-adolescent consultations, may increase integration of the disease.
A general theory of reproductive public health ethics will view reproductition as a social rather than biological process, taking place at a collective level, and its values will hence be public goods and aggregates, while notions of individual rights will not be primary. This view also means that there is no basic relevant distinction to be made between procreating a population through migration and through biological reproduction.
types, or that of FP employing mental health care interventions to influence the tendency of criminal or other sort of behaviour. While FP may certainly (attempt to) do these things (implying an interest in specific parts of nature, specific expertise, etc), the issue of how to characterize its generic object of study, interest or action is more profoundly conceptual in that it may inform us about what FP is and what object may or may not be properly studied or intervened upon based on FP. This, in turn, will also provide an answer to what exactly the expertise of an FP specialist is supposed to be about, as well as pertain to disputes over the proper social authority and impact of knowledge coming out of the FP area. The paper will
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explore and compare three distinct strategies for providing an answer to this question, which are both criticised from a normative and philosophical perspective. First, FP might try to characterise its object of interest by embracing the socio-political relativity implied by the fact that criminal law, implying that the object of FP changes with every difference between jurisdiction across countries as well as over time. This seems to imply that there is no such thing as one object of FP, no specific FP expertise, and so on and thus undermines the idea of FP as a science, specific health care speciality or expertise. Second, FP may adopt a very abstract definition of its object, possible to include all jurisdictional variations one might imagine. This, however, seems to imply a problematic boundlessness: the idea that practically any behaviour or human condition is a proper concern of FP (since any such may be criminalized in some jurisdiction). This, in turn implies normative problems both with regard to the claims about a particular FP expertise and with regard to the ethical integrity of FP as a scientific and medical field.
For instance, as I write this, the Large Hadron Collider team at the CERN lab outside Geneva are making last preparation for the “beam injection” experiment, for which at least two prominent physicists have issued stern #end of the world” warnings. How should this be managed, and why? Depending on the answer, what does that imply for the implementation of, e.g. uncertain actions to counter the potential harms of climate change, the eventuality that a meteorite might hit Earth, or that our own technology shaped to manage this dangerous world of our’s pulls the rug out from under our feet? (here we have everything from antimicrobial resistance to rebelling synbio AI’s on the menu). Especially if we consider less distant needs, for which there exist quite workable solutions, if only the funds for their implementation are released – such as the quarter of a million children dying of starvation every month. At the same time, some of the futurustic fears may not themselves be worthy our dread – at least not if we think disciplined and ethically ablout it. The talk will dig into this mass of issues, with a particular concentration on the ethics of exploring distant (albeit potent) dangers and salvation, using the concept of the price of precaution, developed by myself in some recent writings.
References:
Munthe, C (2011). The Price of Precaution and the Ethics of Risk. Springer SBM.
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Speakers include:
Otto Cars (Uppsala University)
Michael J. Selgelid (Monash University and WHO)
Marcel Verweij (Wagenigen University)
Clare Chandler (London School of Hygiene & Tropical Medicine)
Michael Millar (Barts Health NHS Trust)
Jonathan Anomaly (UNC Chapel Hill & Duke University)
Julian Savulescu (University of Oxford)
Steven J. Hoffman (University of Ottawa)
Jasper Littmann (Robert Koch Institute)
Alena Buyx (University of Kiel)