Wednesday, 11 March 2015

Do Your Practical Philosophy Doctoral Training with Me, Lars Sandman and Others. Calls Now Open!

At the moment, two separate calls for applications to win a fully funded 4 year doctoral training position in practical philosophy at my department are open. In both cases, the deadline for applying is May 4, 2015.

The first call is a general one, open to any area of interest within the field of practical philosophy (e.g., moral philosophy, metaethics, applied ethics, social and political philosophy/theory, and so on).

Details are here.

The second call is attached to a research program on ethical barriers to person centred care, where the winner will work specifically with myself and Lars Sandman, plus researchers at the Center for Healthcare Ethics at Karolinska Institutet, Stockholm University and The Royal Institute of Technology. The applicant here is bound by the aims and topics of the program, but free to sketch a project within those frames.

Details are here.

Sunday, 8 March 2015

Guest Editorial on the Ethics of How to Balance Risks and Chances of Benefits in Neurosurgery with High Stakes

When you're a medical ethics or bioethics researcher, it is always an important proof of the value of what you do when policy makers and professionals in the fields you relate to find your ideas relevant to consider in their decision-making. Therefore, I'm pretty happy and proud about this recent publication:  On kind invitation by the editor in chief, I have written a guest editorial for the European neurosurgery journal, Acta Neurochirurgica, and yesterday it went online. The title is 'The ethics of “primo non nocere”, professional responsibility and shared decision making in high-stakes neurosurgery', and so far the journal management has chosen to make it freely accessible for download:

 Should that generosity ever go away, I have uploaded my own submitted version (not including corrections made in copy-editing and proofreading) here.

In the article, I analyse a debate between to neurosurgical teams (of Jannick Brennum and Hugues Duffau, respectively) on whether or not it would be  ethically acceptable to offer an option to people with fatal brain disease (e.g., cancer), to offer an option of going for more radical surgery to boost the chance of longer survival, which at the same time brings increased risks of major functional disability (such as loss of eyesight or ability to walk). I show that this seemingly straightforward issue actualises a cluster of rather different ethical questions, and that both sides of the debate may have been lured astray or getting lost in this situation. I end by suggesting a "diagnosis" of what the question is at heart about, and offer a thought experiment to hopefully help the medical professionals to further their debate on this particular issue. I don't have any pretension of solving the issue, but as my thought experiment suggests, I do harbour suspicions that some of the reasoning going on this far among the discussants may have been influenced by an irrational temporal bias.

Wednesday, 25 February 2015

New Article on the Ethics, Philosophy and Practice of Person-centred Care and Shared Decision-making

One topic that's been part of my research activities for some years now is the ethical and philosophical implications of movements to transform health care practices towards more of what's often called a "patient-" or "person-centred" perspective, sharing clinical decisions with patients to a larger extent. I've been lucky to publish a few analytical works in this area in collaboration with, e.g., Lars Sandman and Daniela Cutas, which have attracted quite some attention, partly as an outcome of an ongoing research collaboration with the pediatric diabetes centre at the Sahlgrenska University Hospital, involving medicine, psychology, organisation, communication, care and human factors risk research, besides philosophy and ethics. Now I'm happy to announce the first of a number of planned articles coming out of empirical and multi-disciplinary investigations of communicative aspects of adolescent diabetes care undertaken in this project, authored by Anders Herlitz, myself, Marianne Törner and Gun Forsander. This article uses outtakes from a video-study of continuous doctor-patient consultation sessions forming the bulk of adolescent diabetes inpatient care (the rest is self-care performed by the younsters themselves) to question received assumptions in standard notion of what person-centredness and shared decision-making should involve, basing our arguments in received results from behavioural science and moral psychology. Instead, we advocates a new approach for patients who are at risk of suffering from weak decision capacities when performing self-care, while being in need of significant portions of such care. We also argue, that this new model exposes an hitherto ignored ethical tension within the person-centredness and shared decision-making advocacy, which needs to be adressed and managed for care to be defensible.

The article is entitled "The Counselling, Self-care, Adherence Approach to Person-centred Care and Shared Decision-making: Moral Psychology, Executive Autonomy and Ethics in Multi-dimensional Care Decisions", and has been accepted for publication in the journal Health Communication, to appear shortly. Meanwhile, interested parties may sample our final draft after the critical review that lead to acceptance (a so-called postprint), which has been made available here. In the pipeline are at least two more works based on this study, one of which on the role of parents and family in adolescent care, and one on conrete strategies to promote what in the article promoted here is called "robust decision capacity". In the future lingers further yet undecided things, as I am part of a group that has just received a nice bit of funding for continuing working on this topic.