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T Nilstun

Publications and source records attributed to T Nilstun.

At least 37 records · Page 2Linked to original sources
PubMed2000

Values and technology assessment in psychiatry.

Economic resources for health care are limited and they should be distributed as fairly and effectively as possible. But the basis for such a distribution is far from clear. What interests are involved? What kind of provision of care is most efficient? How far should the distribution be left to market solutions? What is the proper role of health care politicians and authorities? In technology assessment a promising combination of value premises and empirical knowledge is used in answering such questions. The aim of this introductory article is to explore issues related to values and value conflicts that have implications for technology assessment. Ethical principles are discussed and related to problematic issues in mental health care such as the absence of psychiatry, the abuse of psychiatry, the definition of mental illness, diagnostic activities, treatment decisions, priority setting as well as research and development.

Ethics, Medical↗
PubMed2000

Priority setting, justice, and health care: conceptual analysis.

In this paper, priority setting in health care is defined as distributional decisions at the individual level involving clear and direct limitation of access to beneficial health care according to some categorical criterion other than the market. The justification of a particular rule of priority setting depends on conceptual issues as well as on the choice of value premises. Especially important is the type of scarcity involved (whether the imbalance between supply and need can be overcome or not) and the concept of justice used or presupposed (for instance, whether the conception of justice emphasizes efficiency or fairness or both). The proposal put forward is that the task of medical ethics is to provide conceptual clarification and value premises relevant to justify rules of priority setting. The actual choice of such rules belongs primarily to the domain of politics.

Ethics, Medical↗
PubMed1999

Withdrawal of life support--who should decide? Differences in attitudes among the general public, nurses and physicians.

OBJECTIVE: To examine the attitudes of the general public regarding who should decide about the withdrawal of life support and to compare these attitudes with those of intensive care personnel. DESIGN: Nationwide postal questionnaire survey. SETTING: Sweden. PARTICIPANTS: One thousand one hundred ninety-six randomly selected persons from the Swedish population register, 339 nurses and 121 physicians from 29 randomly selected intensive care units (ICUs). MEASUREMENTS AND RESULTS: Respondents' answers to questions related to two clinical scenarios: one with a conscious and competent patient and one with an unconscious patient. The response rates were 64 % for the general public, 86 % for the nurses and 88 % for the physicians. Concerning the competent patient, 48 % of the public, 31 % of the nurses and 8 % of the physicians were of the opinion that a decision about continued ventilator treatment should be made by the patient alone or together with the family, but without the physician. The vast majority of physicians (87 %) wanted to make the decision themselves, either alone or together with the patient or family. Concerning the incompetent patient, 73 % of the general public and 70 % of the nurses advocated a joint decision made by the family and the physician together. The majority of the physicians (61 %) regarded themselves as the sole decision-maker, a view supported by only 5 % of the public and 20 % of the nurses. CONCLUSIONS: While existing Swedish guidelines recommend that the physician should be the sole decision-maker, the general public favour more patient and family influence on the decision to withdraw life support as compared with intensive care physicians.

Adult↗
PubMed1999

Should the ventilator be withdrawn? Attitudes of the general public, nurses and physicians.

In a Swedish nation-wide study, 1196 members of the general public, and 121 physicians and 339 nurses drawn from 29 intensive care units were questioned about the use of ventilator treatment for severely ill patients. Response rates were 64%, 88% and 86%, respectively. Two typical case history scenarios were presented: one describing a conscious and competent patient with pneumonia and severe cancer, and the other describing a patient who had been comatose for 1 month following head trauma. In the case of the cancer patient, 49% of the general public, 63% of the physicians and 59% of the nurses answered that they would wish that the ventilator treatment be discontinued, if they were the patient. In the case of the comatose patient, 48% of the general public, 82% of the physicians and 70% of the nurses answered that they would wish that the ventilator treatment to be discontinued, if they were a relative of the patient. Respondents own preferences, in the three groups, for life support favoured withdrawal of ventilator treatment.

Adult↗
PubMed1998

[Ethics in sports medicine--health and/or performance?].

Ethics in the field of sports medicine embraces a number of issues of general human interest. While it is important to determine the salubrious potential of exercise and sports, it is open to question whether it is reasonable to invest massive research resources in attempts to induce high-performance elite athletes to perform yet better, or to remedy sports injuries to enable athletes to continue exposing themselves to the risk of further injuries. When such questions arise as the extent to which physicians should attempt to modify unhealthy lifestyle factors, for example the use of doping, or whether it is right that athletes should take precedence in waiting lists for health care, it is important to be aware of the singular practical potential of sports medicine.

Athletic Injuries↗
PubMed1998

["Meaningless treatment" in terminal care. Importance of declaring do-not-resuscitate orders].

The word futile (from the Latin futilis) means incapable of producing any result, serving no useful purpose. For several decades the concept of futile treatment has been discussed internationally. The underlying assumptions of the debate are discussed in this article, as are the goals of medical treatment, the uncertainty of effects, current practice and attitudes to such issues as foregoing life-sustaining treatment. Despite exhaustive debate, there seems to be no consensus as to the definition of 'futile treatment,' mainly because the expression lacks unique, intrinsic purport. The expression is used to indicate the existence of, and the relationship between conditions (i.e. under what circumstances is a treatment to be considered futile--and by whom?) and consequences (i.e. if a treatment is considered to be futile in a particular situation, does this imply that it is permissible to withhold the treatment or that it would be wrong to give the treatment?).

Humans↗
PubMed1998

Informing patients and relatives about do-not-resuscitate decisions. Attitudes of cardiologists and nurses in Sweden.

OBJECTIVES: To survey the attitudes of Swedish cardiologists and nurses regarding information given to patients and relatives concerning do-not-resuscitate (DNR) status. METHOD: Questionnaire. SETTING: Nationwide, 2 years after the publication of a proposal of guidelines on DNR. SUBJECTS: 10% random sample of members of the Swedish Cardiac Society, 104 physicians and 196 nurses. Response rate 73%. RESULTS: According to most Swedish cardiologists and cardiac nurses, patients and relatives should be honestly informed about a patient's DNR status if they ask for information. Almost all (97%) answered that the relatives of a noncompetent patient should be informed when they ask and (67%) believe that the relatives should be informed even if they do not ask. Most of the respondents (61%) stated that the patient, if mentally competent, should be informed about the DNR status first and decide if the information should be passed on to relatives. Only 12% of the respondents were of the opinion that if the relatives asked for this information to be withheld from the patient, this should be respected even if the patient asked for information, and 45% believed it should be respected if the patient did not ask. With reference to the latter, many (31%) were uncertain. The cardiologists and cardiac nurses expressed almost identical opinions in the matter of informing patients and relatives about DNR status. CONCLUSIONS: Current guidelines recommend honest answers to questions and that priority should be given to the autonomy of the patient. However the guidelines do not offer any assistance when no questions are asked. In such cases, there may be an ethical conflict between two requirements: respect for the person and do not harm. Many health care professionals believe that the information could, in some cases, harm the patient. This conflict can hardly be solved by referring to more basic ethical values. More training in informing patients and relatives about delicate matters is probably required, together with more knowledge about the wishes of very ill patients.

Attitude of Health Personnel↗
PubMed1998

Neonatal death and parents' grief. Experience, behaviour and attitudes of Swedish nurses.

The aim of the present study was to survey the experience, behaviour and attitudes of nurses in Swedish neonatal wards towards parents who refuse or are reluctant to see, touch or hold their dying or dead baby. A questionnaire was distributed to 173 nurses, of whom 144 responded. The questionnaire contained questions about the nurses' own experience of such situations, their behaviour, and their attitude towards influencing the parents. Seventy-four percent answered that they had experience of such situations, 59% that they often tried to persuade or in other ways influence the parents to change their mind, and 60% were of the opinion that the parents mourning-process is always facilitated when they touch or hold their dead baby. Most nurses (83%) were of the opinion that the conflict between beneficence and autonomy was difficult but not impossible to solve. A majority of the nurses were inclined to give priority to the principle of beneficence. But is this inclination ethically justified? A well-founded answer to this question requires more knowledge about the experiences of parents who have lived through such traumatic situations.

Adult↗
PubMed1997

The difference between withholding and withdrawing life-sustaining treatment.

OBJECTIVES: First, to present the position on the distinction between withholding and withdrawing life-sustaining treatment as expressed in guidelines and examine its relation to the attitudes of health care professionals. Second, to examine the possible ethical justification of this distinction. DESIGN, SETTING, AND PARTICIPANTS: Critical analysis of guidelines on life-sustaining treatment and questionnaire administered to 148 health care professionals--physicians and nurses at the intensive care unit (ICU), University Hospital MAS, Malmö, Sweden. RESULTS: In contrast to the guidelines, which emphasize that there is no ethical difference between withholding and withdrawing life-sustaining treatment, not less than 50 per cent of the professionals in the ICU were of the opinion that there is an ethical difference. All attempts to justify this difference with reference to an inherent distinction between withholding and withdrawing seem to be controversial. CONCLUSIONS: We recommend a change in emphasis in professional guidelines. Such guidelines should avoid the controversial issue about the possible inherent ethical difference between withholding and withdrawing life-sustaining treatment. What should be underlined is that the particular situation and the consequences of withholding as well as withdrawing life-sustaining treatment should always be taken into account.

Ethics, Medical↗
PubMed1997

Do-not-resuscitate orders--should the patient be informed?

OBJECTIVES: To analyse the ethical implications of informing patients about their do-not-resuscitate status (DNR). DESIGN: Questionnaire. SETTING: Nationwide, 6 months after the publication of guidelines on DNR in 1994. SUBJECTS: A 10% random sample of the members of the Swedish Cardiac Society. 104 physicians and 196 nurses. MAIN OUTCOME MEASURES: To what extent are patients, physicians and nurses involved in decisions about DNR, and how should the ethical conflict involved in informing patients about their DNR status be described and analysed? RESULTS: Of 73% responding, 84% of the physicians and 8% of the nurses had made a DNR decision. The decision was regarded as ethically right and well timed and it was discussed with 33% of the competent patients. Half of the respondents believed that DNR orders should be discussed with the competent patient. but still only one third of the patients are involved. The ethical conflict is analysed using the principles of autonomy and nonmaleficence as value premises. CONCLUSIONS: Many physicians are still reluctant to find out what the patient wants. Being ignorant they risk harming the patient. It is recommended that information about DNR status should be given incrementally and that the attitudes of the old and chronically ill in-hospital patients are studied. Do they want to be informed, and if so, how and when do they want it to be done?

Attitude of Health Personnel↗
PubMed1997

The parent between the child and the professional--some ethical implications.

In this paper ethical implications of parental participation in paediatric care are discussed. The paper is based on interviews with 20 parents, whose children were admitted and operated on at a paediatric surgery department in Sweden. In one part of the interview the parent was invited to speak about situations experienced as problematic during the hospitalization. Three different types of situations were described by the parents as especially problematic. In the first situation the parents' ability to influence their own situation was limited. Parents got upset when staff did not treat them as autonomous persons. In the second type of situation things 'had to be done' to the child, for example the surgery, the anaesthesia, removing an indwelling catheter and giving an enema. The parents understood and accepted this, but the child was sometimes unable to agree usually because of anxiety and fear. In the third type of situation parents felt that professionals did not take them or their child seriously. In order to avoid or alleviate such situations, the professionals ought to mediate a permissive attitude to the expressions of concern. Thus, when the parents worry, the professionals ought to listen more attentively and, whenever possible and adequate, respect their concerns.

Adult↗