25 found
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  1.  35
    Severity as a Priority Setting Criterion: Setting a Challenging Research Agenda.Mathias Barra, Mari Broqvist, Erik Gustavsson, Martin Henriksson, Niklas Juth, Lars Sandman & Carl Tollef Solberg - 2019 - Health Care Analysis 1:1-20.
    Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to today’s severity criteria in (...)
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  2.  52
    Shared Decision Making, Paternalism and Patient Choice.Lars Sandman & Christian Munthe - 2010 - Health Care Analysis 18 (1):60-84.
    In patient centred care, shared decision making is a central feature and widely referred to as a norm for patient centred medical consultation. However, it is far from clear how to distinguish SDM from standard models and ideals for medical decision making, such as paternalism and patient choice, and e.g., whether paternalism and patient choice can involve a greater degree of the sort of sharing involved in SDM and still retain their essential features. In the article, different versions of SDM (...)
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  3.  9
    The Importance of Being Pregnant: On the Healthcare Need for Uterus Transplantation.Lars Sandman - 2018 - Bioethics 32 (8):519-526.
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  4. Everyday Ethics in the Care of Elderly People.Ingrid Ågren Bolmsjö, Lars Sandman & Edith Andersson - 2006 - Nursing Ethics 13 (3):249-263.
    This article analyses the general ethical milieu in a nursing home for elderly residents and provides a decision-making model for analysing the ethical situations that arise. It considers what it means for the residents to live together and for the staff to be in ethically problematic situations when caring for residents. An interpretative phenomenological approach and Sandman’s ethical model proved useful for this purpose. Systematic observations were carried out and interpretation of the general ethical milieu was summarized as ‘being in (...)
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  5.  17
    Everyday Ethical Problems in Dementia Care: A Teleological Model.Ingrid Ågren Bolmsjö, Anna-Karin Edberg & Lars Sandman - 2006 - Nursing Ethics 13 (4):340-359.
    In this article, a teleological model for analysis of everyday ethical situations in dementia care is used to analyse and clarify perennial ethical problems in nursing home care for persons with dementia. This is done with the aim of describing how such a model could be useful in a concrete care context. The model was developed by Sandman and is based on four aspects: the goal; ethical side-constraints to what can be done to realize such a goal; structural constraints; and (...)
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  6. Shared Decision-Making and Patient Autonomy.Lars Sandman & Christian Munthe - 2009 - Theoretical Medicine and Bioethics 30 (4):289-310.
    In patient-centred care, shared decision-making is advocated as the preferred form of medical decision-making. Shared decision-making is supported with reference to patient autonomy without abandoning the patient or giving up the possibility of influencing how the patient is benefited. It is, however, not transparent how shared decision-making is related to autonomy and, in effect, what support autonomy can give shared decision-making. In the article, different forms of shared decision-making are analysed in relation to five different aspects of autonomy: (1) self-realisation; (...)
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  7.  61
    Adherence, Shared Decision-Making and Patient Autonomy.Lars Sandman, Bradi B. Granger, Inger Ekman & Christian Munthe - 2012 - Medicine, Health Care and Philosophy 15 (2):115-127.
    In recent years the formerly quite strong interest in patient compliance has been questioned for being too paternalistic and oriented towards overly narrow biomedical goals as the basis for treatment recommendations. In line with this there has been a shift towards using the notion of adherence to signal an increased weight for patients’ preferences and autonomy in decision making around treatments. This ‘adherence-paradigm’ thus encompasses shared decision-making as an ideal and patient perspective and autonomy as guiding goals of care. What (...)
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  8.  13
    Withholding and Withdrawing Treatment for Cost‐Effectiveness Reasons: Are They Ethically on Par?Lars Sandman & Jan Liliemark - 2019 - Bioethics 33 (2):278-286.
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  9.  40
    Person Centred Care and Shared Decision Making: Implications for Ethics, Public Health and Research.Christian Munthe, Lars Sandman & Daniela Cutas - 2012 - Health Care Analysis 20 (3):231-249.
    This paper presents a systematic account of ethical issues actualised in different areas, as well as at different levels and stages of health care, by introducing organisational and other procedures that embody a shift towards person centred care and shared decision-making (PCC/SDM). The analysis builds on general ethical theory and earlier work on aspects of PCC/SDM relevant from an ethics perspective. This account leads up to a number of theoretical as well as empirical and practice oriented issues that, in view (...)
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  10.  6
    Health-Care Needs and Shared Decision-Making in Priority-Setting.Erik Gustavsson & Lars Sandman - 2015 - Medicine, Health Care and Philosophy 18 (1):13-22.
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  11.  9
    Person Centered Care and Personalized Medicine: Irreconcilable Opposites or Potential Companions?Leila El-Alti, Lars Sandman & Christian Munthe - 2019 - Health Care Analysis 27 (1):45-59.
    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 (...)
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  12.  8
    Why We Don’T Need “Unmet Needs”! On the Concepts of Unmet Need and Severity in Health-Care Priority Setting.Lars Sandman & Björn Hofmann - 2019 - Health Care Analysis 27 (1):26-44.
    In health care priority setting different criteria are used to reflect the relevant values that should guide decision-making. During recent years there has been a development of value frameworks implying the use of multiple criteria, a development that has not been accompanied by a structured conceptual and normative analysis of how different criteria relate to each other and to underlying normative considerations. Examples of such criteria are unmet need and severity. In this article these crucial criteria are conceptually clarified and (...)
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  13.  20
    Ethical Deliberations About Involuntary Treatment: Interviews with Swedish Psychiatrists.Manne Sjöstrand, Lars Sandman, Petter Karlsson, Gert Helgesson, Stefan Eriksson & Niklas Juth - 2015 - BMC Medical Ethics 16 (1):1-12.
    BackgroundInvoluntary treatment is a key issue in healthcare ethics. In this study, ethical issues relating to involuntary psychiatric treatment are investigated through interviews with Swedish psychiatrists.MethodsIn-depth interviews were conducted with eight Swedish psychiatrists, focusing on their experiences of and views on compulsory treatment. In relation to this, issues about patient autonomy were also discussed. The interviews were analysed using a descriptive qualitative approach.ResultsThe answers focus on two main aspects of compulsory treatment. Firstly, deliberations about when and why it was justifiable (...)
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  14.  5
    Evaluating Facts and Facting Evaluations: On the Fact-Value Relationship in HTA.Bjorn Hofmann, Ken Bond & Lars Sandman - 2018 - Journal of Evaluation in Clinical Practice 24 (5):957-965.
    Health technology assessment is an evaluation of health technologies in terms of facts and evidence. However, the relationship between facts and values is still not clear in HTA. This is problematic in an era of fake facts and truth production. Accordingly, the objective of this study is to clarify the relationship between facts and values in HTA. We start with the perspectives of the traditional positivist account of evaluating facts and the social-constructivist account of facting values. Our analysis reveals diverse (...)
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  15.  14
    The Concept of Negotiation in Shared Decision Making.Lars Sandman - 2009 - Health Care Analysis 17 (3):236-243.
    In central definitions of shared decision-making within medical consultations we find the concept of negotiation used to describe the interaction between patient and professional in case of conflict. It has been noted that the concept of negotiation is far from clear in this context and in other contexts it is used both in terms of rational deliberation and bargaining. The articles explores whether rational deliberation or bargaining accurately describes the negotiation in shared decision-making and finds that it fails to do (...)
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  16.  12
    The Relevance of Group Size in Health Care Priority Setting: A Reply to Juth.Lars Sandman & Erik Gustavsson - 2017 - Health Care Analysis 25 (1):21-33.
    How to handle orphan drugs for rare diseases is a pressing problem in current health-care. Due to the group size of patients affecting the cost of treatment, they risk being disadvantaged in relation to existing cost-effectiveness thresholds. In an article by Niklas Juth it has been argued that it is irrelevant to take indirectly operative factors like group size into account since such a compensation would risk discounting the use of cost, a relevant factor, altogether. In this article we analyze (...)
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  17.  11
    Ethical Conflicts in Prehospital Emergency Care.Lars Sandman & Anders Nordmark - 2006 - Nursing Ethics 13 (6):592-607.
    This article analyses and presents a survey of ethical conflicts in prehospital emergency care. The results are based on six focus group interviews with 29 registered nurses and paramedics working in prehospital emergency care at three different locations: a small town, a part of a major city and a sparsely populated area. Ethical conflict was found to arise in 10 different nodes of conflict: the patient/carer relationship, the patient’s self-determination, the patient’s best interest, the carer’s professional ideals, the carer’s professional (...)
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  18.  5
    Individual Responsibility as Ground for Priority Setting in Shared Decision-Making.Lars Sandman, Erik Gustavsson & Christian Munthe - 2016 - Journal of Medical Ethics 42 (10):653-658.
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  19.  15
    What's the Use of Human Dignity Within Palliative Care?Lars Sandman - 2002 - Nursing Philosophy 3 (2):177-181.
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  20.  12
    Conceptions of Decision-Making Capacity in Psychiatry: Interviews with Swedish Psychiatrists.Manne Sjöstrand, Petter Karlsson, Lars Sandman, Gert Helgesson, Stefan Eriksson & Niklas Juth - 2015 - BMC Medical Ethics 16 (1):34.
    Decision-making capacity is a key concept in contemporary healthcare ethics. Previous research has mainly focused on philosophical, conceptual issues or on evaluation of different tools for assessing patients’ capacity. The aim of the present study is to investigate how the concept and its normative role are understood in Swedish psychiatric care. Of special interest for present purposes are the relationships between decisional capacity and psychiatric disorders and between health law and practical ethics.
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  21.  21
    Ethical Considerations of Refusing Nutrition After Stroke.Lars Sandman, Ingrid Ågren Bolmsjö & Albert Westergren - 2008 - Nursing Ethics 15 (2):147-159.
    The aim of this article is to analyse and discuss the ethically problematic conflict raised by patients with stroke who refuse nutritional treatment. In analysing this conflict, the focus is on four different aspects: (1) Is nutritional treatment biologically necessary? (2) If necessary, is the reason for refusal a functional disability, lack of appetite or motivation, misunderstanding of the situation or a genuine conflict of values? (3) If the latter, what values are involved in the conflict? (4) How should we (...)
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  22.  5
    On the Autonomy Turf. Assessing the Value of Autonomy to Patients.Lars Sandman - 2004 - Medicine, Health Care and Philosophy 7 (3):261-268.
  23.  10
    Should People Die a Natural Death?Lars Sandman - 2005 - Health Care Analysis 13 (4):275-287.
    In the article the concept of natural death as used in end-of-life decision contexts is explored. Reviewing some recent empirical studies on end-of-life decision-making, it is argued that the concept of natural death should not be used as an action-guiding concept in end-of-life decisions both for being too imprecise and descriptively open in its current use but mainly since it appears to be superfluous to the kind of considerations that are really at stake in these situations. Considerations in terms of (...)
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  24.  10
    Developing Organisational Ethics in Palliative Care.Lars Sandman, Ulla Molander & Inger Benkel - 2017 - Nursing Ethics 24 (2):138-150.
  25.  3
    Dual Loyalties: Everyday Ethical Problems of Registered Nurses and Physicians in Combat Zones.Kristina Lundberg, Sofia Kjellström & Lars Sandman - 2019 - Nursing Ethics 26 (2):480-495.
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