Suchergebnisse

Teknologien har endret helsevesenet radikalt de siste 200 år. Den har ikke bare endret mulighetene til å diagnostisere og behandle sykdom. Teknologien har også formet våre oppfatninger av sykdom: Teknologien etablerer de grunnelementer som definerer sykdom (ontologi) og bestemmer sykdommenes tegn (semiologi). Den former vår kunnskap om sykdom (epistemologi), og den genererer sykdommenes praksiser (pragmatikk). Ved å øke den diagnostiske følsomheten, blir flere syke, og sykdommer med avansert teknologibruk har høyere status enn sykdommer uten. Teknologien trekker søkelyset mot det den lar oss måle og manipulere og influerer dermed våre mål. Teknologien påvirker altså ikke bare sykdom gjennom pasienters behov og industriens interesser, men gjennom formingen av helsefagenes rasjonalitet. Ved å forme våre oppfatninger av sykdom, formes våre forestillinger av godt og (v)ondt. Denne artikkelen undersøker hvordan teknologi skaper sykdom og presenterer et rammeverk for å forstå hvordan verdier er involvert i (sam)spillet mellom teknologi og sykdom. Samtidig som teknologien har blitt en stor hjelp i kampen mot lidelse og død, har den blitt en del av vår rasjonalitet og vår vurdering av sykdom, av lidelse og vår død – ja oss selv.

Diseases change the life of individuals, the social status of groups, the obligations of professionals, and the welfare of nations. Disease classifications function as a demarcation of access to care, rights, and duties. Disease also fosters social stigmatization and discrimination, and is a personal, professional, and political matter. It raises a wide range of ethical issues that are of utmost importance in patient communication and education. Accordingly, the objective of this article is to present and discuss a range of basic ethical aspects of this core concept of medicine and health care. First and foremost, disease evokes compassion for the person suffering and induces a moral impetus to health professionals and health policy makers to avoid, eliminate or ameliorate disease. The concept of disease has many moral functions, especially with respect to attributing rights and obligations. Classifying something as disease also has implications for the status and prestige of the condition as well as for the attitudes and behavior towards people with the condition. Acknowledging such effects is crucial for avoiding discrimination and good communication. Moreover, different perspectives on disease can create conflicts between patients, professionals and policy makers. While expanding the concept of disease makes it possible to treat many more people for more conditions - earlier, it also poses ethical challenges of doing more harm than good, e.g., in overdiagnosis, overtreatment, and medicalization. Understanding these ethical issues can be difficult even for health professionals, and communicating them to patients is challenging, but crucial for making informed consent. Accordingly, acknowledging and addressing the many specific ethical aspects of disease is crucial for patient communication and education.

Velkommen til dette temanummeret om Sykdommens Etikk; det andre numme- ret med denne tittelen og en direkte fortsettelse av første nummeret som kom ut våren 2022. På de følgende sider fortsetter vi undersøkelsen av det feltet og den problemstillingen som ble satt opp i det første temanummeret. Denne teksten blir derved en fortsettelse i tillegg til å være en introduksjon. Det gjelder også i høy grad for artiklene – av Lau & Møllebæk, Thoresen & Rugseth, og Andersen & Of- fersen – som kan sees som en fordypelse i en del av det større landskapet som ble skissert i det forrige nummeret.

Vi lever i en brydningstid, hvor de etiske aspekter af sundhedsarbejdet bliver til- tagende synlige i det daglige kliniske arbejde. De store bevægelser i verdenssam- fundets udvikling med pandemier, krige og flygtningsstrømme – og de markante demografiske ændringer med aldrende befolkninger og centraliseringer, der ska- ber supersygehuse såvel som hospitalstomme udkantsområder – både viser og konsoliderer grundlæggende etiske spørgsmål om, hvad mennesker opfatter som godt, sandt, rigtigt og forkert i forhold til lidelse. Tidens mange og store problemer anskues typisk som determinanter for fremtidens sygdom og lidelse (Baer, Singer & Susser, 2003), og vi har naturligt nok en trang til at finde løsninger på denne li- delse på det strukturelle og samfundsmæssige plan. Alligevel er det i patienternes levede liv og i deres konkrete møder med sundhedsvæsenets aktører, at lidelsen bliver synlig, fortalt, fortolket, håndteret og løst. Samfundets værdier, vurderin- ger og prioriteringer træder for alvor frem her og bliver til små etiske praksisser i hverdagen og i klinikken. Det er disse praksisser – der forholder sig til det store i det små – som vi ønsker at sætte fokus på med dette temanummer.

Background: Research integrity has obtained much attention in research communities, but also in the general public. To improve research integrity is difficult as it involves complex systems of knowledge, attitudes, and practices. The objective of this study is to investigate the knowledge, attitudes, and practices of cohorts of PhD candidates at one faculty (of medicine) over time and compare this to finished PhDs of the same cohorts. Material and method: Researchers (n  =  186) awarded the degree PhD at the Faculty of Medicine at the University of Oslo in 2019 were invited to answer a questionnaire about knowledge, attitudes and actions related to scientific dishonesty. 94 responded (50.5%). The results were compared with results among first-year PhD candidates who responded to the same questionnaire during 2010–20 (n  =  536) and to those who finished PhDs in 2016 (n  =  86). Results: For the years 2010–2020 1.1% of the PhD candidates report to have engaged in severe scientific misconduct (FFP) while 0.9% report to have presented results in a misleading way. 2.3% report that they know of persons at their department who have engaged in FFP the last 12 months. In total 1.5% report to have experienced pressure to engage in severe scientific misconduct (FFP) while 2.1% report to have experienced pressure to present results in a misleading way. On average 12.8% report to have been exposed to unethical pressure concerning inclusion or ordering of authors during the last 12 months, and 28.8% report to have knowledge about their department's written policies about research integrity. While some attitudes improve over the years, attitudes in general are not much changed from 2010–2020. None of the PhDs that received a PhD from the Faculty of Medicine at the University of Oslo in 2019 reported to have engaged in FFT or having experienced pressure to do so.1.1% experienced pressure to present results in other misleading ways, while 26.6% of respondents had experienced unethical pressure in relation to authorship during the course of the PhD fellowship. 4.3% knew about someone at their department who had presented results in a misleading manner. Some attitudes were not in line with traditional conceptions of research integrity, but most agreed that their research environment displayed research integrity. Conclusion: This long-term follow up study shows that few PhD-candidates report to engage in severe scientific misconduct, that they experience little pressure to do so, and with some exceptions, attitudes in in line with good research integrity. However, pressure in relation to authorship is relatively common. There is some improvement in research integrity from PhD candidates to recently finished PhDs, but in general research integrity is stable over time.

Background Overuse, underuse, and significant variation in the utilisation of radiological services are well documented in the literature. Several radiological examinations are identified as low-value examinations as they do not lead to a change in diagnosis or course of treatment. Even so, such examinations are frequently performed. Many measures for reducing low-value imaging have been carried out with variable outcomes. While there is little evidence as to why some measures work and others do not, adjusting to the context seems important for success. The objective of this study was to investigate which measures stakeholders consider appropriate for reducing the use of low-value imaging and what it takes to make them work. Methods Semi-structured interviews were conducted among radiographers, radiologists, radiological department managers, hospital clinicians, general practitioners, and health government/authorities' representatives. The interview guide covered two broad areas: Experience with low-value services, and possible future measures deemed appropriate for reducing low-value services. Data were analysed in line with a qualitative framework analysis. Results The analysis included information from 27 participants. All participants acknowledged that low-value imaging was a problem, but few had very specific suggestions on reducing this in practice. Suggested measures were to stop referrals from being sent, provide support in assessing referrals, or change the healthcare system. Identified facilitators were categorised as management and resources, evidence, and experienced value. In general, appropriate measures should be practical, well-founded, and valuable. Conclusions This study provides insight into various stakeholders' perceptions of suitable interventions to reduce low-value imaging. While many measures for reducing low-value imaging are available, contextual sensitivity is crucial to make them work.

As we need knowledge about the prevalence of scientific dishonesty, this study investigates the knowledge of, experiences with, and attitudes toward various forms of scientific dishonesty among PhD students at the main medical faculties in Sweden and Norway. An anonymous questionnaire was distributed to all post-graduate research students attending basic PhD courses at the medical faculties in Stockholm and Oslo during the fall 2014. The responding doctoral students reported to know about various forms of scientific dishonesty from the literature, in their department, and for some also through their own experience. Some forms of scientific misconduct were considered to be acceptable by a significant minority. There was a high level of willingness to report misconduct but little awareness of relevant policies for scientific conduct.

This cross-sectional study evaluates the knowledge, attitudes, experiences, and behavior of final year medical students, PhD students, and supervisors at the School of Medicine of the University of Zagreb in relation to research misconduct, questionable research practices, and the research environment. The overall response rate was 36.4% (68%–100% for the paper survey and 8%–15% for the online surveys). The analysis reveals statistically significant differences in attitude scores between PhD students and supervisors, the latter having attitudes more in concordance with accepted norms. The results overall show a nonnegligible incidence of self-reported misconduct and questionable research practices, as well as some problematic attitudes towards misconduct and questionable research practices. The incidence of problematic authorship practices was particularly high. The research environment was evaluated as being mostly supportive of research integrity.