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Sweden: growing interest in ethics.

Sweden: Growing Interest in Ethics

Since the publication of the first doctoral thesis in Sweden on medical ethics, Clarence Blomquist's Medicinsk etik (Medical Ethics) in 1971,[1] the medical ethics books of scholarly interest have been few and far between in Sweden.[2] In the 1980s a number of books have been published, however, indicating a growing interest in the field.

To some extent these books are an outflow of ongoing debates focused by public policy concerns. During the 1960s and 70s the questions of abortion and euthanasia were preeminent. In the 80s developments in reproductive medicine and genetics and the question of introducing brain-related criteria for death have been the center of attention. These discussions led to the current Swedish abortion act (1975), improved official recommendations for the care of patients in the terminal phase of life (1978-79), a new law on artificial insemination (1985), and the adoption of brain-death criteria (1988). Regulation of in vitro fertilization (IVF) and genetic research is presently under intense discussion.

One of the most successful recent publications is Medicinsk etik och manniskosyn (Medical Ethics and View of Man), edited by Holsten Fagerberg,[3] which is widely used as a textbook in both medical and nursing curriculae. The contributors, two theological ethicists and two physicians, succeed in combining a general introduction to medical ethics with the development of a normative ethics and a theory of human nature. The book starts by presenting the ethical platform, developed from a theory initially formulated by Peter Knauer,[4] that an action is morally right if, on a long view and as a whole, it is not counterproductive. Their view of man is inspired by Arthur Koestler's concept `holon'--the tension between the individual's self-assertion and adaptability--and based on: evidence for freedom of choice and (moral) responsibility from genetic and neurophysiological research. The topics treated, such as the concepts `health' and `disease', the use of contraceptives, abortion, prenatal diagnostics, artificial insemination, IVF, organ transplantation, euthanasia, suicide, psychiatric care, alcohol and drug abuse, and issues in medical research, are placed in their historical and medical context.

Most of these topics are also treated in Gert Wretmark, et al., Etik i varden: teori, praktik, forskning (Ethics in Medical Care: Theory, Practice, Research.)[5] Written in the style of personal reflections by two physicians and a hospital priest, the book is imbued with life by examples based on their everyday experiences. Besides medical ethics issues like truthfulness, respect for human life, euthanasia, suicide, abortion, artificial insemination by donor, IVF, prenatal diagnostics, and research ethics, the authors address psychological aspects of the care of patients. One chapter is devoted to ethics in the medical care of children, where attention is called to how our views on children and children's rights have changed in recent decades. In Sweden the increased legal protection of children has manifested itself not only in the prohibition of corporal punishment and in the right and obligation of medical personnel to suspend professional secrecy when there is evidence of assault or battery of children, but also in the stipulation that parents (guardians) shall increasingly take the child's wishes and viewpoints into consideration as he or she grows and develops.[6]

A valuable complement to these two books is Medicinsk etik. En praktisk exempelsamling som utgangspunkt for diskussioner (Medical Ethics. A Practical Selection of Examples as Point of Departure for Discussion) by Ake Andren-Sandberg.[7] The author approaches ethical problems in twenty-five concrete, mostly clinical examples partly based on his own experience as a clinician. About half of the cases, however, are seen from a nurse's, social worker's or other medical staff member's perspective.

In a collection of essays, Etik, liv och halsa (Ethics, Life and Health), Bo Hanson,[8] a theologian, addresses theological perspectives on diseases in general and HIV-infection and AIDS in particular, and also discusses the ethical consequences of brain-death criteria, views on sexuality, problems of genetic research, attitudes toward animals, reasons for codified professional ethics, control of medical research, and views of man in medical care. The book ends with an interesting outline for an epistemological foundation of ethics based on the criteria of tradition, logical consistency and universalizability, implications in language itself, and the conscience.

Foster, familj, samhalle, Fosterdiagnostikens innebord och etik (Fetus, Family, Society. The Meaning and Ethics of Prenatal Diagnostics), edited by Holsten Fagerberg,[9] is the work of a committee of physicians and theologians appointed by the Conference of Bishops of the Church of Sweden. They give specific attention to prenatal diagnostics for the purpose of providing information for discontinuation of a pregnancy when the fetus is injured or diseased. None of the authors objects to prenatal diagnostics in itself. Their opinions differ, however, on the legitimacy of indications for abortion. A great merit of the book is the lucid and rich medical background it provides.

In the last few years a dawning interest in ethics research at medical faculty can be noticed. In 1986, the Swedish Medical Research Council allocated funds for a three-year fellowship in philosophy of medical science and medical ethics. In 1988, Carl M. Kjellstrand defended his doctoral thesis on "Giving Life--Giving Death: Ethical Problems of High-Technology Medicine" at the Karolinska Institute. This thesis, published in Acta Medica Scandinavia (Supplement 725, 1988), studied issues of distributive justice raised in dialysis and renal transplantation.

An increased international scholarly engagement in medical ethics is expected through the European Society for Philosophy of Medicine and Health Care, founded in The Netherlands in 1987, and its Nordic section, The Section for Medical Ethics in the Nordic Countries, founded in 1988.[10] References [1]Clarence Blomquist, Medicinsk etik (Stockholm: Natur och Kultur, 1971). [2]For a brief overview of the medical ethics literature and debate in Sweden during the past twenty years, see B. Ingemar B. Lindahl, "Medical Ethics in Sweden," Theoretical Medicine 9 (1988), 309-335. [3]Holsten Fagerberg, ed., Medicinsk etik och manniskosyn (Malmo: Liber Forlag, 1984). [4]Peter Knauer, "The Hermeneutic Function of the Principle of Double Effect," Natural Law Forum 12 (1967), 132-62; "Fundamentalethik: Teleologische als Deontologische Normenbegrundung," Theologie und Philosophie 55 (1980), 321-58. [5]Gert Wretmark, Astrid Andersson Wretmark, and Johnny Ludvigsson Etik i varden: teori, praktik, forskning (Lund: Studentlitteratur, 1983) [6]The needs and interests of the child was the general point of departure also of the legislation in Sweden on artificial insemination in 1985 that allows the child access to information about the identity of his or her biological father. See B. Ingemar B. Lindahl, "Philosophy of Medicine in Scandinavia," Theoretical Medicine 6 (1985), 65-84, the Appendix, pp. 77-79; and "Medical Ethics in Sweden." [7]Ake Andren-Sandberg, Medicinsk etik. En praktisk exempelsamling som utgangspunkt for diskussioner (Lund, 1986). [8]Bo Hanson, Etik, liv och halsa (Lund: Studentlitteratur, 1988). [9]Holsten Fagerberg, ed., Foster, familj, samhalle. Fosterdiagnostikens innebord och etik (Lund: Liber Laromedel, 1980). [10]Nordisk Medicin 103 (1988), 361.
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Title Annotation:medical ethics
Author:Lindahl, B. Ingemar B.
Publication:The Hastings Center Report
Date:Jul 1, 1989
Words:1141
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