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  • 51.
    Sandman, Lars
    University of Borås, School of Health Science.
    Eugenik och sortering av människor: inverkan på den moderna svenska medicin-etiska debatten2009Report (Other academic)
  • 52.
    Sandman, Lars
    [external].
    Health Care Priorities and Diagnostics2009Conference paper (Refereed)
  • 53.
    Sandman, Lars
    University of Borås, School of Health Science.
    How to avoid a paternalistic value theory within Occupational Therapy2012Conference paper (Refereed)
  • 54.
    Sandman, Lars
    University of Borås, School of Health Science.
    Woods, S (Editor)
    Idéer om god död inom palliativ vård2003In: God palliativ vård: etiska och filosofiska aspekter, Studentlitteratur AB, 2003, p. 29-53Chapter in book (Other academic)
  • 55.
    Sandman, Lars
    University of Borås, School of Health Science.
    Immortality2009In: Encyclopedia of Death and Human Experience / [ed] Clifton D. Bryant, Dennis L. Peck, Sage Publications, Inc , 2009Chapter in book (Other academic)
  • 56.
    Sandman, Lars
    University of Borås, School of Health Science.
    Implementering av palliativt vårdprogram i livets slut2008Report (Other academic)
  • 57.
    Sandman, Lars
    [external].
    Individual responsibility as a ground for priority setting in a patient centred environment2011Conference paper (Other academic)
  • 58.
    Sandman, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Prioriteringscentrum, Linköpings universitet.
    Is uterus-transplantation an example of unwarranted medicalization?2015Conference paper (Refereed)
  • 59.
    Sandman, Lars
    University of Borås, School of Health Science.
    La Quality of Life come fine nella filosofia dell'Hospice svedese1999In: Vivere 'bene' nonostanto tutto / [ed] S Privitera, Acireale: ISB , 1999, p. 97-116Chapter in book (Other academic)
  • 60.
    Sandman, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Prioriteringscentrum, Linköpings universitet.
    Nya dyra läkemedel kräver eftertanke och översyn - snäv tolkning av den etiska plattformen.2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112Article in journal (Other (popular science, discussion, etc.))
  • 61.
    Sandman, Lars
    University of Borås, School of Health Science.
    Om det naturliga i att dö vid hög ålder2004In: Att vara äldre : "- man har ju sina krämpor -" / [ed] A-K Edberg, K Blomqvist, Lund: Studentlitteratur , 2004, p. 71-83Chapter in book (Other academic)
  • 62.
    Sandman, Lars
    University of Borås, School of Health Science.
    On the Autonomy Turf. Assessing the value of autonomy to patients2004In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 7, no 3, p. 261-268Article in journal (Refereed)
    Abstract [en]

    Within the western health-care context autonomyis a central value. Still, as it is used withinthis context it is far from clear what we areactually talking about. In this article theauthor outlines four different uses or aspectsof autonomy: self-determination, freedom,desire-fulfilment and independence. Oneimportant conclusion will be that in order tobe able to respect autonomy in a way thatactually brings value to the patient’s life weneed to clearly assess what aspect of autonomythe patient values and for what reason it isvalued by the patient.

  • 63.
    Sandman, Lars
    University of Borås, School of Health Science.
    Palliative care in Sweden2001In: Palliative care in Europe: Concepts and policies / [ed] Henk ten Have, Rien Janssens, Amsterdam: IOS press , 2001, p. 69-84Chapter in book (Other academic)
    Abstract [en]

    The concepts of palliative care and palliative medicine are relatively new in the Swedish health care context, but have become popular during the last decade to label care for the dying (earlier concepts used and to some extent still in user are 'care at the end of life' and 'terminal care').

  • 64.
    Sandman, Lars
    [external].
    Rättvis ransonering. Prioriteringar i vården -om konsten att bygga broar2009Conference paper (Refereed)
  • 65.
    Sandman, Lars
    University of Borås, School of Health Science.
    Shared decision-making and priority setting: a conflicting marriage2012Conference paper (Refereed)
  • 66.
    Sandman, Lars
    University of Borås, School of Health Science.
    Should different checklist be used for different health technologies (screening vs. intervention vs. diagnostic technologies, pharmaceuticals vs. non-pharmaceuticals, etc.)?2013Conference paper (Other academic)
  • 67.
    Sandman, Lars
    University of Borås, School of Health Science.
    Should people die a natural death?2005In: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 13, no 4, p. 275-287Article in journal (Refereed)
    Abstract [en]

    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 decisionmaking, 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 the quality of life cost of the intervention in relation to the quality and length of life benefits of the same intervention. In referring to the concept of natural death we risk to blur these considerations and end up in difficult distinctions between what is a natural and non- or un-natural death, a distinction which it is argued is of no real moral interest.

  • 68.
    Sandman, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Prioriteringscentrum, Linköpings universitet.
    Ställer oss livmodertransplantationer inför speciella prioriteringsproblem?2015In: Patients, values, and medicine: hommage à Niels Lynøe / [ed] Niklas Juth, Gert Helgesson, Stockholm: Karolinska institutet , 2015Chapter in book (Refereed)
  • 69.
    Sandman, Lars
    University of Borås, School of Health Science.
    Säkerhetens risker: om etiska aspekter på att använda larm- och övervakningssystem för personer med demens2010In: Vetenskap för profession, ISSN 1654-6520, no 13, p. 87-105Article in journal (Other academic)
    Abstract [sv]

    Inom demensvården återfinner man personer med demens (PMD) som vandrar omkring, något som kan fylla viktiga behov, som att få utlopp för aktivitetslust, dämpa ångest etc. (Lai & Arthur 2003). Vandrandet kan ge upphov till problem, eftersom PMD dels kan ha fysiska funktionsnedsättningar, som gör att de lider större risk att ramla och skada sig, dels har nedsatt kognitiv förmåga, som gör att de lider risk att gå vilse och hamna i situationer, som de inte reder ut. Svensk tvångsvårdslagstiftning tillåter normalt inte att PMD tvångsvårdas, vilket implicerar att man inte kan begränsa deras rörelsefrihet genom att låsa in dem eller genom att använda bälten etc. (LPT 1991:1128). Ur denna situation uppkommer behovet av andra lösningar för att ge PMD möjlighet att få utlopp för sitt behov av att vandra, samtidigt som riskerna minimeras (Niemeijer et al. 2010). Inom heldygnsvård för PMD (dvs. den vård som sker på institution och inte i personens hem) är konstant övervakning av professionella vårdare omöjlig, eftersom det är alltför resurskrävande. Ett sätt att hantera denna situation är att använda sig av olika tekniska larm- eller övervakningssystem Detta intryck förstärks av personliga möten med professionella vårdare inom fältet. Niemeijer et al. (2010) pekar också på att huvuddelen av den vetenskapliga litteraturen uttrycker etiska uppfattningar utan att göra en mer fördjupad analys av dessa uppfattningar eller av de värden och normer som hänvisas till. , vilket har givit upphov till en debatt kring huruvida användningen av dessa larm- och övervakningssystem är etiskt acceptabel eller inte. En nyligen publicerad reviewartikel noterar att denna debatt i många fall är polariserad och antingen ser dessa system som en etiskt oproblematisk lösning eller förkastar all form av sådan användning (Niemeijer et al. 2010).

  • 70.
    Sandman, Lars
    University of Borås, School of Health Science.
    The concept of negotiating in shared decision-making2009In: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 17, no 3, p. 236-243Article in journal (Refereed)
    Abstract [en]

    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 so on both descriptive and normative grounds. At the end some notes on further analysis is given and it is suggested that the interaction is more accurately described in terms of an internal balancing of values like patient best interest, patient autonomy and patient adherence by the professional that is accepted by the patient.

  • 71.
    Sandman, Lars
    University of Borås, School of Health Science.
    Tvärvetenskap, vårdvetenskap och etik2013Report (Other academic)
    Abstract [sv]

    Denna text baseras på ett kortare seminarieinlägg på temat tvärvetenskap och ska ses som en uppsättning personliga reflektioner kring detta tema (med viss teoretisk förankring) utifrån min erfarenhet av att ha verkat i två mycket olika akademiska miljöer – den vårdvetenskapliga som jag verkar i nu och den filosofisk-etiska där jag har min utbildningsbakgrund. Två miljöer där man förefaller förhålla sig olika till frågan om tvärvetenskap när det gäller det egna ämnesområdet. Samtidigt har jag som vårdetiker nästan genomgående i min akademiska karriär verkat inom ramen för tvärvetenskapliga projekt och oftast varit tvungen att i min egen forskning förhålla mig till andra ämnesområden – framför allt vårdvetenskap och medicin.

  • 72.
    Sandman, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Prioriteringscentrum, Linköpings universitet.
    Vilken vägledning ger den etiska plattformen för prioriteringar i konkreta prioriteringssituationer?: En översikt av tolknings- och tillämpningssvårigheter2015Report (Other academic)
  • 73. Sandman, Lars
    Värdig död: något för palliativ vård?2002In: Omsorg: Nordisk tidsskrift for Palliativ Medisin, ISSN 0800-7489, Vol. 4Article in journal (Other (popular science, discussion, etc.))
  • 74.
    Sandman, Lars
    University of Borås, School of Health Science.
    Määttä, Sylvia (Editor)
    University of Borås, School of Health Science.
    Vårdens tjocka språk2007In: Vårdens språk – en antologi. / [ed] Sylvia Määttä, Kerstin Segesten, Liber , 2007, p. 39-61Chapter in book (Other academic)
  • 75. Sandman, Lars
    What’s the use of Human Dignity within Palliative Care?2002In: Nursing Philosophy, ISSN 1466-7681, E-ISSN 1466-769X, Vol. 3, no 2, p. 177-181Article in journal (Refereed)
    Abstract [en]

    n discussions on palliative care and in palliative care we often hear references to the idea of a ‘death with dignity’ or a ‘dignified death’ in different forms. Dignity is obviously one of the more central concepts in discussions on the topic of a good death, and it is frequently used to label good dying and death, and good care for dying people.† Still, a problem in relation to the concept of dignity is that it is used in a number of different ways and it is far from clear what it implies to talk in terms of dignity in relation to death and dying. In Saunders & Baines (1983) it is even argued that this lack of clarity should result in us not using the concept. In this short paper I will outline and develop some ideas concerning this developed in my thesis A good death. On the value of death and dying (Sandman, 2001). First I will present a number of different uses and connotations of the term ‘dignity’ found in the palliative (and other) care contexts. Then I will focus specifically on the idea of human dignity and its relevance to palliative care. The first part of that discussion will be devoted to the basis of such a human dignity and the second part to the implications that accepting such a dignity will have for palliative care.

  • 76.
    Sandman, Lars
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Etik inom ambulanssjukvården2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud & Lars Lundberg, Stockholm: Liber , 2016, 2, p. 26-39Chapter in book (Other academic)
  • 77.
    Sandman, Lars
    et al.
    University of Borås, School of Health Science.
    Bremer, Anders
    University of Borås, School of Health Science.
    Svensson, Leif (Editor)
    Etik inom ambulanssjukvården2009In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Leif Svensson, Stockholm: Liber , 2009, p. 167-179Chapter in book (Other academic)
  • 78.
    Sandman, Lars
    et al.
    University of Borås, School of Health Science.
    Broqvist, Mari
    Gustafsson, Erik
    Arvidsson, Eva
    Ekerstad, Niklas
    Carlsson, Per
    Vård som inte kan anstå: Tolkning i relation till den etiska plattformen och nationella modellen för prioriteringar.2014Report (Other academic)
    Abstract [sv]

    Uppdraget från Socialstyrelsen består av tre sammanhängande delar. I den första delen presenteras olika tolkningar av begreppet vård som inte kan anstå utifrån en analys av hur begreppet används i den aktuella propositionen och lagtexten. Dessa tolkningar specificeras i ett antal kriterier. I den andra delen analyseras dessa tolkningar utifrån den etiska plattformen. Den tredje delen syftar till att analysera hur begreppet vård som inte kan anstå förhåller sig till den nationella modellen för öppna prioriteringar inom hälso- och sjukvård och diskutera om denna kan användas för att ge stöd vid prioritering och ransonering. Den teoretiska analysen kompletteras med några exempel på praktiska beslutssituationer avseende vård av papperslösa hämtade från kliniskt verksamma personer.

  • 79.
    Sandman, Lars
    et al.
    [external].
    Bäckman, K
    Etiska problem med statens styrprinciper?2011Conference paper (Other academic)
  • 80.
    Sandman, Lars
    et al.
    University of Borås, School of Health Science.
    Granger, Bradi
    Ekman, Inger
    Munthe, Christian
    Adherence, shared decision-making and patient autonomy2012In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 15, no 2, p. 115-127Article in journal (Refereed)
    Abstract [en]

    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 this implies in terms of the importance that we have reason to attach to (non-)adherence and how has, however, not been explained. In this article, we explore the relationship between different forms of shared decision-making, patient autonomy and adherence. Distinguishing between dynamically and statically framed adherence we show how the version of shared decision-making advocated will have consequences for whether one should be interested in a dynamically or statically framed adherence and in what way patient adherence should be assessed. In contrast to the former compliance paradigm (where non-compliance was necessarily seen as a problem), using observations about (non-)adherence to assess the success of health care decision making and professional-patient interaction turns out to be a much less straightforward matter.

  • 81.
    Sandman, Lars
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Gustavsson, Erik
    Linköping Universitet.
    Beyond the Black Box Approach to Ethics!: Comment on "Expanded HTA Enhancing Fairness and Legitimacy"2016In: International Journal of Health Policy and Management, ISSN 2322-5939, E-ISSN 2322-5939, Vol. 5, no 6, p. 393-394Article in journal (Refereed)
    Abstract [en]

    In the editorial published in this journal, Daniels and colleagues argue that his and Sabin's accountability for reasonableness (A4R) framework should be used to handle ethical issues in the health technology assessment (HTA)-process, especially concerning fairness. In contrast to this suggestion, it is argued that such an approach risks suffering from the irrrelevance or insufficiency they warn against. This is for a number of reasons: lack of comprehensiveness, lack of guidance for how to assess ethical issues within the "black box" of A4R as to issues covered, competence and legitimate arguments and finally seemingly accepting consensus as the final verdict on ethical issues. We argue that the HTA community is already in a position to move beyond this black box approach.

  • 82.
    Sandman, Lars
    et al.
    University of Borås, School of Health Science.
    Heintz, Emelie
    Assessment vs. appraisal of ethical aspects of health technology assessment: can the distinction be upheld?2014In: GMS Health Technology Assessment, ISSN 1861-8863, E-ISSN 1861-8863, Vol. 10Article in journal (Refereed)
    Abstract [en]

    An essential component of health technology assessment (HTA) is the assessment of ethical aspects. In some healthcare contexts, tasks are strictly relegated to different expert groups: the HTA-agencies are limited to assessment of the technology and other actors within the health care sector are responsible for appraisal and recommendations. Ethical aspects of health technologies are considered with reference to values or norms in such a way that may be prescriptive, or offer guidance as to how to act or relate to the issue in question. Given this internal prescriptivity, the distinction between assessment and appraisal seems difficult to uphold, unless the scrutiny stops short of a full ethical analysis of the technology. In the present article we analyse the distinction between assessment and appraisal, using as an example ethical aspects of implementation of GPS-bracelets for people with dementia. It is concluded that for HTA-agencies with a strictly delineated assessment role, the question of how to deal with the internal prescriptivity of ethics may be confusing. A full ethical analysis might result in a definite conclusion as to whether the technology in question is ethically acceptable or not, thereby limiting choices for decision-makers, who are required to uphold certain ethical values and norms. At the same time, depending on the exact nature of such a conclusion, different action strategies can be supported. A positive appraisal within HTA could result in a decision on mandatory implementation, or funding of the technology, thereby making it available to patients, or decisions to allow and even encourage the use of the technology (even if someone else will have to fund it). A neutral appraisal, giving no definite answer as to whether implementation is recommended or not, could result in a laissez-faire attitude towards the technology. A negative appraisal could result in a decision to discourage or even prohibit implementation. This paper presents an overview of the implications of different outcomes of the ethical analysis on appraisal of the technology. It is considered important to uphold the distinction between assessment and appraisal, primarily to avoid the influence of preconceived values and political interests on the assessment. Hence, as long as it is not based on the subjective value judgments of the HTA-agency (or its representative), such an appraising conclusion would not seem to conflict with the rationale for the separation of these tasks. Moreover, it should be noted that if HTA agencies abstain from including full ethical analyses because of the risk of issuing an appraisal, they may fail to provide the best possible basis for decision-makers. Hence, we argue that as long as the ethical analysis and its conclusions are presented transparently, disclosing how well-founded the conclusions are and/or whether there are alternative conclusions, the HTA-agencies should not avoid taking the ethical analysis as close as possible to a definite conclusion.

  • 83.
    Sandman, Lars
    et al.
    University of Borås, School of Health Science.
    Heintz, Emelie
    Ethics checklists currently in use in HTA: how were they developed, what are the components of these checklists, and what has been the experience of those who use them?2013Conference paper (Other academic)
  • 84.
    Sandman, Lars
    et al.
    University of Borås, School of Health Science.
    Heintz, Emelie
    "Är du nyttig lille vän?": om produktionsopåverkan, konsumtionspåverkan och den svenska etiska plattformen för prioriteringar.2013In: Prioriteringar inom hälso- och sjukvården / [ed] Nils-Eric Sahling, Region Skånes etiska råd , 2013, p. 63-94Chapter in book (Refereed)
  • 85.
    Sandman, Lars
    et al.
    University of Borås, School of Health Science.
    Heintz, Emelie
    Hultkrantz, Monica
    Jacobsson, Stella
    Lintamo, Laura
    Levi, Ragnar
    Munthe, Christian
    Tranaeus, Sofia
    Östlund, Pernilla
    Etiska aspekter på åtgärder inom hälso- och sjukvården. En vägledning för att identifiera relevanta etiska frågor.2014Report (Other academic)
  • 86.
    Sandman, Lars
    et al.
    University of Borås, School of Health Science.
    Kjellström, Sofia
    Etikboken: Etik för vårdande yrken2013Book (Other academic)
  • 87.
    Sandman, Lars
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Prioriteringscentrum, Linköpings universitet.
    Molander, Ulla
    Benkel, Inger
    Developing organisational ethics in palliative care: a three level approach.2015In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 24, no 2, p. 138-150, article id 0969733015595542Article in journal (Refereed)
  • 88.
    Sandman, Lars
    et al.
    University of Borås, School of Health Science.
    Munthe, C
    Shared Decision-Making, Paternalism and Patient Choice2010In: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 18, no 1, p. 60-84Article in journal (Refereed)
    Abstract [en]

    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 are explored, versions compatible with paternalism and patient choice as well as versions that go beyond these traditional decision making models. Whenever SDM is discussed or introduced it is of importance to be clear over which of these different versions are being pursued, since they connect to basic values and ideals of health care in different ways. It is further argued that we have reason to pursue versions of SDM involving, what is called, a high level dynamics in medical decision-making. This leaves four alternative models to choose between depending on how we balance between the values of patient best interest, patient autonomy, and an effective decision in terms of patient compliance or adherence: Shared Rational Deliberative Patient Choice, Shared Rational Deliberative Paternalism, Shared Rational Deliberative Joint Decision, and Professionally Driven Best Interest Compromise. In relation to these models it is argued that we ideally should use the Shared Rational Deliberative Joint Decision model. However, when the patient and professional fail to reach consensus we will have reason to pursue the Professionally Driven Best Interest Compromise model since this will best harmonise between the different values at stake: patient best interest, patient autonomy, patient adherence and a continued care relationship.

  • 89.
    Sandman, Lars
    et al.
    University of Borås, School of Health Science.
    Munthe, Christian
    Shared Decision-Making and Patient Autonomy2009In: Theoretical Medicine and Bioethics, ISSN 1573-1200, Vol. 30, no 4, p. 289-310Article in journal (Refereed)
    Abstract [en]

    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; (2) preference satisfaction; (3) self-direction; (4) binary autonomy of the person; (5) gradual autonomy of the person. It is argued that both individually and jointly these aspects will support the models called shared rational deliberative patient choice and joint decision as the preferred versions from an autonomy perspective. Acknowledging that both of these models may fail, the professionally driven best interest compromise model is held out as a satisfactory second-best choice.

  • 90. Sandman, Lars
    et al.
    Nordmark, A
    Ethical conflicts in pre-hospital emergency care2006In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 6, p. 592-607Article in journal (Refereed)
    Abstract [en]

    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 selfdetermination, the patient’s best interest, the carer’s professional ideals, the carer’s professional role and self-identity, significant others and bystanders, other care professionals, organizational structure and resource management, societal ideals, and other professionals. It is often argued that prehospital care is unique in comparison with other forms of care. However, in this article we do not find support for the idea that ethical conflicts occurring in prehospital care are unique, even if some may be more common in this context.

  • 91.
    Sandman, Lars
    et al.
    University of Borås, School of Health Science.
    Tinghög, G
    Att tillämpa den etiska plattformen vid ransonering: Fördjupad vägledning och konsekvensanalys2011Book (Other academic)
  • 92.
    Sandman, Lars
    et al.
    University of Borås, School of Health Science.
    Woods, S
    God palliativ vård: etiska och filosofiska aspekter2003Collection (editor) (Other academic)
  • 93.
    Sandman, Lars
    et al.
    University of Borås, School of Health Science.
    Woods, S
    Woods, S (Editor)
    Introduktion2003In: God palliativ vård: etiska och filosofiska aspekter, Studentlitteratur , 2003, p. 10-27Chapter in book (Other academic)
  • 94.
    Sandman, Lars
    et al.
    University of Borås, School of Health Science.
    Ågren-Bolmsjö, Ingrid
    Westergren, Albert
    Ethical considerations of refusing nutrition after stroke2008In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 15, no 2, p. 147-159Article in journal (Refereed)
    Abstract [en]

    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 deal with the different kinds of refusal of nutritional treatment? We argue that patients' autonomy should be respected as far as possible, while also considering that those who have suffered a stroke might re-evaluate their life as a result of a beneficial prognosis. However, if patients persist with their refusal, health care professionals should force nutritional treatment only when it is clear that the patients will re-evaluate their future life.

  • 95. Sjostrand, Manne
    et al.
    Karlsson, Petter
    Sandman, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Prioriteringscentrum, Linköpings universitet.
    Helgesson, Gert
    Eriksson, Stefan
    Juth, Niklas
    Conceptions of decision-making capacity in psychiatry: interviews with Swedish psychiatrists2015In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 16, article id 34Article in journal (Refereed)
  • 96. Sjöstrand, Manne
    et al.
    Sandman, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Prioriteringscentrum, Linköpings universitet.
    Karlsson, Petter
    Helgesson, Gert
    Eriksson, Stefan
    Juth, Niklas
    Ethical deliberations about involuntary treatment: interviews with Swedish psychiatrists2015In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 16, article id 37Article in journal (Refereed)
    Abstract [en]

    Background: Involuntary treatment is a key issue in healthcare ethics. In this study, ethical issues relating toinvoluntary psychiatric treatment are investigated through interviews with Swedish psychiatrists.

    Methods: In-depth interviews were conducted with eight Swedish psychiatrists, focusing on their experiences ofand views on compulsory treatment. In relation to this, issues about patient autonomy were also discussed. Theinterviews were analysed using a descriptive qualitative approach.

    Results: The answers focus on two main aspects of compulsory treatment. Firstly, deliberations about when andwhy it was justifiable to make a decision on involuntary treatment in a specific case. Here the cons and pros ofordering compulsory treatment were discussed, with particular emphasis on the consequences of providingtreatment vs. refraining from ordering treatment. Secondly, a number of issues relating to background factorsaffecting decisions for or against involuntary treatment were also discussed. These included issues about theSwedish Mental Care Act, healthcare organisation and the care environment.

    Conclusions: Involuntary treatment was generally seen as an unwanted exception to standard care. The respondents’judgments about involuntary treatment were typically in line with Swedish law on the subject. However, it was alsoargued that the law leaves room for individual judgments when making decisions about involuntary treatment. Muchof the reasoning focused on the consequences of ordering involuntary treatment, where risk of harm to thetherapeutic alliance was weighed against the assumed good consequences of ensuring that patients received neededtreatment. Cases concerning suicidal patients and psychotic patients who did not realise their need for care weretypically held as paradigmatic examples of justified involuntary care. However, there was an ambivalence regarding theissue of suicide as it was also argued that risk of suicide in itself might not be sufficient for justified involuntary care. Itwas moreover argued that organisational factors sometimes led to decisions about compulsory treatment that couldhave been avoided, given a more patient-oriented healthcare organisation.

  • 97. Sjöström, David
    et al.
    Rampou, Marietta
    Sandman, Lars
    University of Borås, School of Health Science.
    Sandsjö, Leif
    University of Borås, School of Engineering.
    A Tablet Application for Clinical Ethical Reflection within Palliative Care2013Conference paper (Other academic)
  • 98. Woods, S
    et al.
    Sandman, Lars
    University of Borås, School of Health Science.
    Continental Philosophy and Nursing Ethics2002In: Ethics In Nursing Education, Research And Management. Perspectives from Europe / [ed] W Tadd, Palgrave , 2002, p. 14-34Chapter in book (Other academic)
  • 99. Ågrén-Bolmsjö, I
    et al.
    Edberg, A-K
    Sandman, Lars
    University of Borås, School of Health Science.
    Everyday Ethical Problems in Dementia Care: A teleological Model2006In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 4, p. 340-359Article in journal (Refereed)
    Abstract [en]

    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 nurses’ ethical competency. The model contains the following main steps: identifying and describing the normative situation; identifying and describing the different possible alternatives; assessing and evaluating the different alternatives; and deciding on, implementing and evaluating the chosen alternative. Three ethically difficult situations from dementia care were used for the application of the model. The model proved useful for the analysis of nurses’ everyday ethical dilemmas and will be further explored to evaluate how well it can serve as a tool to identify and handle problems that arise in nursing care.

  • 100. Ågrén-Bolmsjö, I
    et al.
    Sandman, Lars
    University of Borås, School of Health Science.
    Andersson, E
    Everyday ethics in the care of elderly people2006In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 3, p. 249-263Article in journal (Refereed)
    Abstract [en]

    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 the same world without meeting’. Two themes and four subthemes emerged from the analysis. Three different ethical problems were analysed. The outcome of using the decision-making model highlighted the discrepancy between the solutions used and well-founded solutions to these problems. An important conclusion that emerged from this study was the need for a structured tool for reflection.

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