Should Parents of Neonates With Bleak Prognosis Be Encouraged to Opt for Another Child With Better Odds? On the Notion of Moral Replaceability.

The notion of moral exchangeability is scrutinized and its proper place in neonatal care is examined. On influential moral outlooks, the neonate is morally exchangeable. On these views, if the parents are prepared to let go of the neonate with a poor prognosis and opt instead for another child who is healthy, this may be the morally right thing for them to do, and neonatal care ought to ease their choice. The notion of moral exchangeability has a different place in different moral theories. Three theories are examined: deontological ethics (insisting on the sanctity of innocent human life), according to which there is no place for the replacement of 1 child for another. It is different, however, with utilitarianism and in the moral rights theory based on self-ownership. According to utilitarianism, we are all replaceable. According to the moral rights theory, neonates are replaceable to the extent that they have not developed personhood. Even a deontological ethicist of a Kantian bent would concur here with the moral rights theory. Because influential moral theories imply that the neonate is morally exchangeable, it is reasonable within neonatal care, as a general rule, to grant the parents a veto against any attempts to save a child with a poor prognosis. In particular, if the parents are prepared instead to have another, healthy child, this is to be recommended. However, this rule cannot be strict. In rare cases, it is necessary to yield to parents who insist that their neonate be saved despite a poor prognosis.

Honour-related threats and human rights: a qualitative study of Swedish healthcare providers' attitudes towards young women requesting a virginity certificate or hymen reconstruction.

OBJECTIVES: 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. METHOD: 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. RESULTS: 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. CONCLUSIONS: 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.

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.

AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

The case of biobank with the law: between a legal and scientific fiction.

According to estimates more than 400 biobanks currently operate across Europe. The term 'biobank' indicates a specific field of genetic study that has quietly developed without any significant critical reflection across European societies. Although scientists now routinely use this phrase, the wider public is still confused when the word 'bank' is being connected with the collection of their biological samples. There is a striking lack of knowledge of this field. In the recent Eurobarometer survey it was demonstrated that even in 2010 two-thirds of the respondents had never even heard about biobanks. The term gives the impression that a systematic collection of biological samples can constitute a 'bank' of considerable financial worth, where the biological samples, which are insignificant in isolation but are valuable as a collection, can be preserved, analysed and put to 'profitable use'. By studying the practices of the numerous already existing biobanks, the authors address the following questions: to what extent does the term 'biobank' reflect the normative concept of using biological samples for the purposes of biomedical research? Furthermore, is it in harmony with the so far agreed legal-ethical consensus in Europe or does it deliberately pull science to the territory of a new, ambiguous commercial field? In other words, do biobanks constitute a medico-legal fiction or are they substantively different from other biomedical research protocols on human tissues?

Why should we respect the privacy of donors of biological material?

Why should we respect the privacy of donors of biological material? The question is answered in the present article in general philosophical terms from the point of view of an ethics of honour, a libertarian theory of rights, a view of respect for privacy based on the idea that autonomy is of value in itself, and utilitarianism respectively. For different reasons the ethics of honour and the idea of the value of autonomy are set to one side. It surfaces that the moral rights theory and utilitarianism present conflicting answers to the question. The main thrust of the argument is that there is no way of finding an overlapping consensus, so politicians have to take decisions that are bound to be controversial in that they can be questioned on reasonable philosophical grounds.

Ought we to enhance our cognitive capacities?

Ought we to improve our cognitive capacities beyond the normal human range? It might be a good idea to level out differences between peoples cognitive capacities; and some people's reaching beyond normal capacities may have some good side-effects on society at large (but also bad side-effects, of course). But is there any direct gain to be made from having ones cognitive capacities enhanced? Would this as such make our lives go better? No, I argue; or at least there doesn't seem to be any evidence suggesting that it would. And it doesn't matter whether we consider the question from a narrow hedonistic perspective, from a more refined hedonistic perspective, from a desire-satisfaction view, or from some reasonable objective list view of what makes a life go well. Only an extremely perfectionist--and implausible--view of what makes our lives go well could support any direct value in cognitive enhancement. Finally, our sense of identity gives us no good reasons to enhance even our capacity to remember. So, cognitive enhancement as such would not improve our lives.

Ethical aspects of triage in mass casualty.

PURPOSE OF REVIEW: There is a growing awareness that, not only in war, but also in relation to natural disasters, we may have to face situations of mass casualty. Little has been said about the philosophical aspects of the triage problem arising in anesthesiology in these circumstances, however. There are only a few articles where these problems are addressed in a fruitful manner. These articles are reviewed here. RECENT FINDINGS: Even though important triage problems have been identified in the recent literature, they have not been solved in the discussion. Furthermore, there is no unanimity about how they should be solved in principle or in practice. SUMMARY: The implications of the discussions reviewed here are mainly for policy making and only indirectly for the clinic. When the problems have been sorted out in the political process, however, one would hope that a result should surface in the form of clear guidelines for clinical application. One of the reviewed articles puts forward suggestions to this effect. This, however, could only be the beginning of an important discussion to come.

Non-voluntary sterilization.

We cannot easily condemn in principle a policy where people are non-voluntarily sterilized with their informed consent (where they accept sterilization, if they do, in order to avoid punishment). There are conceivable circumstances where such a policy would be morally acceptable. One such conceivable circumstance is the one (incorrectly, as it were) believed by most decent advocates of eugenics in the late nineteenth and early twentieth century to exist: to wit, a situation where the human race as such is facing a threat. Perhaps today's Chinese experience with a threat of over-population is a more realistic example? Finally, there is some room for a kind of non-voluntary (and coercive) sterilization without informed consent. I think of people who are severely mentally retarded, and who cannot understand how sexual intercourse relates to conception. If some of these persons are fertile and sexually active, it may very well be the morally right thing to do to sterilize these persons, in their own best interest, but without their consent--if necessary even through coercive means.

Compulsory sterilisation in Sweden.

In the Fall of 1997 the leading Swedish newspaper, Dagens Nyheter, created a media hype over the Swedish policy of compulsory sterilisation that had been in operation between 1935 and 1975. In the discussion that followed, the moral condemnation of our medical past was unanimous. However, the reasons for rejecting what had gone on were varied and mutually inconsistent. Three strands of criticism were common: the argument from autonomy, the argument from caution, and the argument from biological scepticism. In the paper it is argued that what point of departure you choose in your criticism of the past should be of consequence also for your ideas about present and future medical practice. In particular, if you rely on the argument from autonomy, you should be prepared to accept a liberal (present and future) use of reproductive techniques.

Ought we to sentence people to psychiatric treatment?

In principle, there seem to be three main ways in which society can react when people commit crimes under influence of mental illness. (1) The standard model. We excuse them. If they are dangerous they are detained in the interest of safety of the rest of the citizens. (2) The Swedish model. We hold them responsible for their criminal offence, we convict them, but we do not sentence them to jail. Instead, we sentence them to psychiatric treatment. (3) My model. We sentence them to jail, but offer them (voluntary) psychiatric treatment. The advantages of my model are obvious. We get a clear delineation of roles. We allow the psychiatrist to be just a doctor, not a warden. We liberate psychiatry of the objective of deciding whether people who were mentally ill when they committed criminal offences 'could have acted otherwise' -- a hopeless task. We allow that psychiatrists live up to their professional ethical code (The Hawaii Declaration). We treat psychically ill persons as 'normal', we allow them to repent their crimes, which renders easier their recovery. However, two objections to my model come to mind. First of all, is it not unfair to sentence people to jail who could not help doing what they did? And, secondly, the question of fairness set to one side, is it not inhumane to sentence mentally ill persons to jail? Is it not inhumane to the mentally ill persons themselves, and does it not mean that they will be a burden to other prisoners? In my paper I show that, if our system of criminal punishment takes a civilised form, neither of these objections carries any weight.