Sweden: Growing Interest in Ethics

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Sweden: Growing Interest in Ethics

Since the publication of the first doctoral thesis in Sweden on medical ethics, Clarence Blomquist's Medicinsk etik (Medical Ethics) in 1971,[1] the medical ethics books of scholarly interest have been few and far between in Sweden.[2] In the 1980s a number of books have been published, however, indicating a growing interest in the field.

To some extent these books are an outflow of ongoing debates focused by public policy concerns. During the 1960s and 70s the questions of abortion and euthanasia were preeminent. In the 80s developments in reproductive medicine and genetics and the question of introducing brain-related criteria for death have been the center of attention. These discussions led to the current Swedish abortion act (1975), improved official recommendations for the care of patients in the terminal phase of life (1978-79), a new law on artificial insemination (1985), and the adoption of brain-death criteria (1988). Regulation of in vitro fertilization (IVF) and genetic research is presently under intense discussion.

One of the most successful recent publications is Medicinsk etik och manniskosyn (Medical Ethics and View of Man), edited by Holsten Fagerberg,[3] which is widely used as a textbook in both medical and nursing curriculae. The contributors, two theological ethicists and two physicians, succeed in combining a general introduction to medical ethics with the development of a normative ethics and a theory of human nature. The book starts by presenting the ethical platform, developed from a theory initially formulated by Peter Knauer,[4] that an action is morally right if, on a long view and as a whole, it is not counterproductive. Their view of man is inspired by Arthur Koestler's concept `holon'--the tension between the individual's self-assertion and adaptability--and based on: evidence for freedom of choice and (moral) responsibility from genetic and neurophysiological research. The topics treated, such as the concepts `health' and `disease', the use of contraceptives, abortion, prenatal diagnostics, artificial insemination, IVF, organ transplantation, euthanasia, suicide, psychiatric care, alcohol and drug abuse, and issues in medical research, are placed in their historical and medical context.

Most of these topics are also treated in Gert Wretmark, et al., Etik i varden: teori, praktik, forskning (Ethics in Medical Care: Theory, Practice, Research.)[5] Written in the style of personal reflections by two physicians and a hospital priest, the book is imbued with life by examples based on their everyday experiences. Besides medical ethics issues like truthfulness, respect for human life, euthanasia, suicide, abortion, artificial insemination by donor, IVF, prenatal diagnostics, and research ethics, the authors address psychological aspects of the care of patients. One chapter is devoted to ethics in the medical care of children, where attention is called to how our views on children and children's rights have changed in recent decades. In Sweden the increased legal protection of children has manifested itself not only in the prohibition of corporal punishment and in the right and obligation of medical personnel to suspend professional secrecy when there is evidence of assault or battery of children, but also in the stipulation that parents (guardians) shall increasingly take the child's wishes and viewpoints into consideration as he or she grows and develops.[6]

A valuable complement to these two books is Medicinsk etik. En praktisk exempelsamling som utgangspunkt for diskussioner (Medical Ethics. A Practical Selection of Examples as Point of Departure for Discussion) by Ake Andren-Sandberg.[7] The author approaches ethical problems in twenty-five concrete, mostly clinical examples partly based on his own experience as a clinician. …