The Ethics Blog

A research blog from the Centre for Resarch Ethics & Bioethics (CRB)

Author: Pär Segerdahl (Page 1 of 42)

Conditions for studies of medicine safety during breastfeeding

Breastfeeding mother and baby, photo by Monica Turlui
18 November, 2025 / / 0 Comments

Reliable information on medicine safety during breastfeeding is lacking for many medications. In order to avoid the risk of harming the baby, mothers taking medication for various diseases may be advised by their doctor to discontinue the medication during breastfeeding (or the woman herself may choose to discontinue). Alternatively, the woman may be advised to continue the medication but refrain from breastfeeding. Both options are unfortunate. The mother needs the prescribed medication and breastfeeding has benefits for both the baby and the mother.

Why is there a lack of reliable information on medicine safety during breastfeeding? This is because breastfeeding mothers are usually excluded from clinical studies. Therefore, there is limited knowledge of the extent to which different drugs are transferred to the baby via breast milk. The lack of reliable safety information applies to both already approved and new drugs. However, since many mothers take medications while breastfeeding, it should be possible to establish lactation studies that systematically provide scientific evidence for better safety information. Which drugs can be used during breastfeeding?

A new article with Mats G. Hansson as lead author and Erica Sundell as one of the co-authors describes how, within the framework of current regulatory requirements, two breastfeeding studies have been started that can help solve the dilemma that breastfeeding mothers and their doctors often face. One study concerns a drug for diabetes, the other a drug for inflammation and rheumatic disorders. The studies are part of the European project ConcePTION, which will produce evidence on drug safety during pregnancy and breastfeeding. Breast milk samples from the mother and blood samples (plasma) from the mother and child are analyzed to measure how much of the drugs are transferred to the child during breastfeeding. The samples are stored in a biobank for future research, and the studies thus contribute to creating an infrastructure for lactation studies of medicine safety.

Recruitment of research participants and sample collection started in the spring of 2024 and will end at the turn of the year 2025/2026. The purpose of the article is to use the experiences from setting up the two studies as a template for initiating clinical lactation studies. What should be considered? What are the conditions for this type of research? The article concisely describes relevant conditions and procedures for informed consent, sampling, transport and storage of samples, and laboratory analysis. The article also discusses the different conditions for studies of already approved drugs and for new drugs.

The article is important reading for researchers and others who can in one way or another contribute to initiating studies for better information on medicine safety during breastfeeding. Because it so concisely describes the conditions for new studies, the article is also interesting as a concrete example of how problems can be solved by starting new research.

Read the article here: Setting up mother–infant pair lactation studies with biobanking for research according to regulatory requirements.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Hansson M, Björkgren I, Svedenkrans J, et al. Setting up mother–infant pair lactation studies with biobanking for research according to regulatory requirements. British Journal of Clinical Pharmacology. 2025; 1-6. https://doi.org/10.1002/bcp.70201

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Part of international collaborations

Paediatric nurses’ experiences of not being able to provide the best possible care

Stuffed bunny nurse
14 October, 2025 / / 1 Comment

Inadequate staffing, competing tasks and unexpected events can sometimes make it difficult to provide patients with the best possible care. This can be particularly stressful when caring for children with severe diseases. For a nurse, experiencing situations where you cannot provide children with cancer with the best possible care (which means more than just the best possible medical treatment) is an important cause of stress.

To provide a basis for better support for paediatric nurses, a research group interviewed 25 nurses at three Swedish paediatric oncology units. The aim of the interview study was to understand what the nurses experienced as particularly important in situations where they felt they had not been able to provide the best possible care, and how they handled the challenges.

The most important concern for the nurses was to uphold the children’s best interests. One thing that could make this difficult was lack of time, but also disagreements about the child’s best interests could interfere with how the nurses wanted to care for the children. The researchers analyze the paediatric nurses’ handling of challenging situations as a juggling of compassion and competing demands. How do you handle a situation where someone is crying and needs comfort, while a chemotherapy machine somewhere in the ward is beeping and no colleagues are available? What do you do when the most urgent thing is not perceived as the most important?

In the analysis of how the nurses juggled compassion and competing demands, the researchers identified five strategies. One strategy was to prioritize: for example, forego less urgent tasks, such as providing emotional support. Another strategy was to shift up a gear: multitasking, working faster, skipping lunch. A third strategy was to settle for good enough: when you can’t provide the best possible care, you strive to at least provide good enough care. A fourth strategy was acquiescing in situations with different perceptions of the patient’s best interests: for example, continuing to treat a patient because the physician has decided so, even though one believes that prolonged treatment is futile. Regarding this strategy, the nurses requested better dialogue with physicians about difficult patient cases, in order to understand the decisions and prevent acquiescing. The fifth and final strategy was pulling together: to support each other and work as a team with a common goal. Often, there was no need to ask for support; colleagues could spontaneously show solidarity by, for example, staying after their work shifts to help.

In their conclusion, the authors write that adequate staffing, collegial support and good interprofessional communication can help nurses deal with challenges in the care of children with cancer. Read the article here: Juggling Compassion and Competing Demands: A Grounded Theory Study of Pediatric Nurses’ Experiences.

While reading, it may be worth keeping in mind that the study focuses only on situations where it was felt that the best possible care could not be given. The authors point out that the interviews overflowed with descriptions of excellent care and good communication, as well as how rewarding and joyful the work of a paediatric nurse can be.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Ventovaara P, Af Sandeberg M, Blomgren K, Pergert P. Juggling Compassion and Competing Demands: A Grounded Theory Study of Pediatric Nurses’ Experiences. Journal of Pediatric Hematology/Oncology Nursing. 2025;42(3):76-84. doi:10.1177/27527530251342164

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Ethics needs empirical input

Interprofessional collaboration in hospital care of patients who self-harm

Four people sitting at a table, and a women in a black shirt sitting in front of a laptop. Photo: Cottonbro, from Pexels.
30 September, 2025 / / 1 Comment

Patients who are treated in hospital for self-harm can sometimes arouse strong emotions in the staff. At the same time, the patients may be dissatisfied with their care, which sometimes involves restrictions and safety measures to prevent self-harm. In addition to such tensions between patients and staff, the healthcare staff is divided into different professions with their own roles and responsibilities. These professional groups may have different perspectives and thus conflicting opinions about what care individual patients should receive. In order for patients to receive good and cohesive care, good interprofessional collaboration is therefore required between, for example, nurses and psychiatrists.

A Swedish interview study examined how nurses and psychiatrists think about their responsibility and autonomy in relation to each other in different situations on the ward. In general, they considered themselves autonomous, they could take their professional responsibility without being influenced by other colleagues. Both groups agreed that psychiatrists had the ultimate responsibility for the patients’ care, and it emerged that the nurses saw themselves as the patients’ advocates. If decisions made by the psychiatrist went against the patient’s wishes, they saw it as their task to explain the patient’s views, even if they did not agree with them.

However, sometimes the scope for action could be affected by decisions made by colleagues. For example, one could experience that the scope for taking responsibility for a patient was reduced if colleagues had already isolated the patient. In other cases, one could experience that colleagues’ decisions increased one’s responsibility, for example if decisions based on ignorance about a patient risked leading to new self-harm that the nurses had to deal with.

An important theme in the interviews was how one could sometimes renunciate some of one’s professional autonomy in order to achieve interprofessional collaboration. The interviewees agreed that one ultimately had to stand united behind decisions and set aside one’s own agendas and opinions. Consensus was considered essential and was sought even if it meant reducing one’s own autonomy and power. Consensus was achieved through discussions in the team where participants humbly respected each other’s professional roles, knowledge and experiences.

In their conclusion, the authors emphasize that the study shows how nurses and psychiatrists are prepared to set aside hierarchies and their own autonomy in order to achieve collaboration and shared responsibility in the care of patients with self-harm. Since this has not been visible in previous studies, they suggest that attitudes and skills towards interprofessional collaboration may have improved. As this is essential for good cohesive care of patients, it is important to continue to support such attitudes and skills.

If you want to see all the results from the interview study and read the authors’ discussion about responsibility and autonomy in interprofessional collaboration, you can find the article here: Navigating consensus, interprofessional collaboration between nurses and psychiatrists in hospital care for patients with deliberate self-harm.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Löfström, E. et al. (2025) ‘Navigating consensus, interprofessional collaboration between nurses and psychiatrists in hospital care for patients with deliberate self-harm’, Journal of Interprofessional Care, 39(3), pp. 479–486. doi: 10.1080/13561820.2025.2482691

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We recommend readings

What is philosophical health and can it be mapped?

Compass. Photo by Ylanite Koppens.
23 September, 2025 / / 2 Comments

Philosophers such as Socrates and philosophical schools such as Stoicism have had a certain influence on psychology and psychotherapy, and thus also on human health. But if philosophy can support human health via psychology, can it not support health more directly, on its own? A growing trend today is to offer philosophical conversations as a form of philosophical practice that can support human health in existential dimensions. The trend to offer philosophical conversations is linked to a concept of health that is not only about physical and mental health, and which does not understand health as merely the absence of disease: philosophical health.

What does it mean to talk about philosophical health? Given all the health ideals that already affect self-esteem, should we now also be influenced by philosophical health ideals that make our lives feel hopelessly ill-conceived and pointless? No, on the contrary, the stress that human ideals and norms create can be an important topic to philosophize about, in peace and quiet. Instead of being burdened by more ideas about how we should live, instead of giving the appearance of fulfilling the ideals, we can freely examine this underlying stress: the daily feeling of being compelled to live the way we imagine we should. No wonder philosophical practice is a growing trend. Finally, we get time to think openly about what other trends usually make us hide: ourselves, when we do not identify with the trends, the norms and the ideals.

Philosophizing sounds heavy and demanding but can actually be the exact opposite. I have written an essay about how philosophical self-examination, in its best moments, can lighten the mind by unexpectedly illuminating our many tacit demands and expectations. Unfortunately, the essay is not published with open access, but here is the link: The Wisdom of Intellectual Asceticism.

A colleague at CRB, Luis de Miranda, has long worked with philosophical health both as a practitioner and researcher. He emphasizes that human health also includes existential dimensions such as harmony, meaning and purpose in life, and that in order to support wellbeing in these intimately universal dimensions, people also need opportunities to reflect on life. In a new article (written with six co-authors), he develops the concept in the form of a research tool that could map philosophical health: a philosophical health compass. The idea is that the compass will make it possible to study philosophical health in more quantitative ways, for example making comparisons between populations and assessing the effects of different forms of philosophical practice.

The compass consists of a questionnaire. Respondents are asked to consider statements about 6 existential dimensions of life, revolving around the body, the self, belonging, possibilities in life, purpose, and finally, their own philosophical reflection. Each dimension is explored through 8 statements. Respondents indicate on a 5-point scale how well the total of 48 statements apply to them.

I cannot judge how well the 48 statements are chosen, or how easy it is for people to take a position on them, but the statements are more concrete than you might think and it will be exciting to see what happens when the compass is put to the test. Will it be able to measure the wisdom of the crowd, can philosophically relevant differences and changes be mapped? If you want to take a closer look at the philosophical health compass, you can find the article here: The philosophical health compass: A new and comprehensive assessment tool for researching existential dimensions of wellbeing.

Luis de Miranda warns that the compass may risk not only supporting philosophical health, but also undermining it if the compass is interpreted as an ideal that determines the qualities that distinguish good philosophical health. Using the compass wisely requires great openness and sensitivity, he emphasizes. Yes, hopefully the compass will raise many philosophical questions about what philosophical health is, and how it can be studied. For what is the great openness and responsiveness that Luis de Miranda emphasizes, if not philosophical inquisitiveness itself?

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Pär Segerdahl; The Wisdom of Intellectual Asceticism. Common Knowledge 1 January 2025; 31 (1): 74–88. doi: https://doi.org/10.1215/0961754X-11580693

de Miranda, L., Ingvolstad Malmgren, C., Carroll, J. E., Gould, C. S., King, R., Funke, C., & Arslan, S. (2025). The philosophical health compass: A new and comprehensive assessment tool for researching existential dimensions of wellbeing. Methodological Innovations, 0(0). https://doi.org/10.1177/20597991251352420

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Thinking about thinking

What does precision medicine and AI mean for the relationship between doctor and patient?

DNA chain link. Photo: Warren Umoh, Unsplash.
9 September, 2025 / / 1 Comment

In a sense, all care strives to be tailored to the individual patient. But the technical possibilities to obtain large amounts of biological data from individuals have increased so significantly that today one is talking about a paradigm shift and a new way of working with disease: precision medicine. Instead of giving all patients with a certain type of cancer the same standard treatment, for example, it is possible to map unique genetic changes in individual patients and determine which of several alternative treatments is likely to work best on the individual patient’s tumor. Other types of individual biological data can also be produced to identify the right treatment for the patient and avoid unnecessary side effects.

Of course, AI will play an increasingly important role in precision medicine. It can help identify relevant patterns in the large amount of biological data and provide support for precision medicine decisions about the treatment of individual patients. But what can all this mean for the relationship between doctor and patient?

The question is examined in a research article in BMC Medical Informatics and Decision Making, with Mirko Ancillotti as main author. The researchers interviewed ten physicians from six European countries. All physicians worked with patients with colorectal cancer. In the interviews, the physicians highlighted, among other things, that although it is possible to compile large amounts of individual biological data, it is still difficult to tailor treatments for colorectal cancer because there are only a few therapies available. The physicians also discussed the difficulties of distinguishing between experimental and conventional treatments when testing new ways to treat colorectal cancer in precision medicine.

Furthermore, the physicians generally viewed AI as a valuable future partner in the care of patients with colorectal cancer. AI can compile large amounts of data from different sources and provide new insights, make actionable recommendations and support less experienced physicians, they said in the interviews. At the same time, issues of trust were evident in the interviews. For example, the physicians wondered how they can best rely on AI results when they do not know how the AI ​​system arrived at them. They also discussed responsibility. Most said that even when AI is used, the physicians and the team are responsible for the care decisions. However, they said that sometimes responsibility can be shared with AI developers and with those who decide on the use of AI in healthcare.

Finally, the physicians described challenges in communicating with patients. How do you explain the difference between experimental and conventional treatment in precision medicine? How do you explain how AI works and how it helps to tailor the patient’s treatment? How do you avoid hype and overconfidence in “new” treatments and how do you explain that precision medicine can also mean that that a patient is not offered a certain treatment?

If you would like to see more results and the authors’ discussion, you can find the article here: Exploring doctors’ perspectives on precision medicine and AI in colorectal cancer: opportunities and challenges for the doctor-patient relationship.

Some of the study’s conclusions are that good integration of AI and precision medicine requires clearer regulation and ethical guidelines, and that physicians need support to meet the challenge of explaining how AI is used to tailor patient treatment. It is also important that AI remains an auxiliary tool and not an independent decision-maker. Otherwise, patients’ trust can be eroded, as can physicians’ autonomy, the authors argue.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Ancillotti, M., Grauman, Å., Veldwijk, J. et al. Exploring doctors’ perspectives on precision medicine and AI in colorectal cancer: opportunities and challenges for the doctor-patient relationship. BMC Med Inform Decis Mak 25, 283 (2025). https://doi.org/10.1186/s12911-025-03134-0

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We have a clinical perspective

Mind the gap between ethics in principle and ethics in practice

train passing station, photo by Ingo Joseph on Pexels
2 September, 2025 / / 1 Comment

When ethical dilemmas are discussed using case descriptions or vignettes, we tend to imagine the cases as taken from reality. Of course, the vignettes are usually invented and the descriptions adapted to illustrate ethical principles, but when we discuss the cases, we tend to have the attitude that they are real. Or at least real possibilities: “What should we do if we encounter a case like this?”

Discussing ethical cases is an extremely good exercise in ethical reasoning and an important part of the education and training of healthcare professionals. But sometimes we may also need to keep in mind that these discussions are adapted exercises in the ethics gym, so to speak. Reality rarely delivers separate dilemmas that can be handled one by one. Often, life is rather a continuous flow of more or less clearly experienced challenges that change faster than we can describe them. We cannot always say what the problem situation actually looks like. Therefore, it may sometimes be wise not to decide or act immediately, but to wait for the situation to take a different and perhaps clearer form. And then the ethical problem may in practice have been partially resolved, or become more manageable, or become obsolete.

Does that sound irresponsible? Judging by two texts that I want to recommend today, responsible healthcare professionals may, on the contrary, experience a friction between ethics in principle and ethics in practice, and that it would be unethical not to take this seriously. The first text is an essay by Joar Björk (who is both an ethicist and a palliative care physician). In the journal Palliative Care and Social Practice, he discusses a fictional patient case. A man with disseminated prostate cancer is cared for by a palliative care team. In the vignette, the man has previously expressed that he wants complete knowledge of his situation and what his death might look like. But when the team has time to talk to him, he suddenly changes his mind and says that he does not want to know anything, and that the issue should not be raised again. How to act now?

According to Joar Björk, the principle-based ethical standard recommendation here would probably be the following. Respect for the patient’s autonomy requires that the team not try to carry out the conversation. Only if there is good reason to believe that a conversation can have great medical benefit can one consider trying to inform the patient in some way.

Note that the principle-based recommendation treats the situation that has arisen as a separate case: as a ready-made vignette that cannot be changed. But in practice, palliative teams care for their patients continuously for a long time: so much is constantly changing. Of course, they are aware that they cannot impose information on patients who state that they do not want it, as it violates the principle of autonomy. But in practice, the unexpected situation is an unclear ethical challenge for the care team. What really happened, why did he change his mind? Does the man suddenly refuse to accept his situation and the proximity of death? Maybe the team should cautiously try to talk more to him rather than less? How can the team plan the man’s care – maybe soon a hospital bed will be needed in his home – if they are not allowed to talk to him about his situation? As palliative care teams develop good listening and communication skills, the situation may very well soon look different. Everything changes!

Joar Björk’s reflections give the reader an idea of ​​how ethical challenges in practice take on different forms than in the vignettes that are so important in ethics teaching and training. How does he deal with the gap between ethics in principle and ethics in practice? As I understand him, Joar Björk does not advocate any definite view on how to proceed. But he is trying to formulate what he calls a palliative care ethos, which could provide better ethical guidance in cases such as the one just described. Several authors working in palliative care have attempted to formulate aspects of such a care ethos. In his essay, Joar Björk summarizes their efforts in 11 points. What previously sounded passive and irresponsible – to wait and see – appears in Joar Björk’s list in the form of words of wisdom such as “Everything changes” and “Adaptation and improvisation.”

Can healthcare professionals then find better ethical guidance in such practical attitudes than in well-established bioethical principles? Joar Björk tentatively discusses how the 11 points taken together could provide guidance that is more sensitive to the practical contexts of palliative care. I myself wonder, however – but I do not know – whether it would not be wise to allow the gap between ethics in principle and ethics in practice to be as wide as it is. The 11 points probably have their origin in an ethical care practice that already functions as the points describe it. The practice works that way without healthcare professionals using the points as some kind of soft guidance. Joar Björk thus describes a palliative care ethics in practice; a description that can help us think more clearly about the differences between the two forms of ethics. Reflecting on the 11 points can, for example, make healthcare professionals more aware of the specifics of their practice, so that they do not wrongly blame themselves if they do not always relate to situations that arise as if they were separate cases that illustrate ethical principles.

Perhaps it is impudent of me to suggest this possibility in a blog post that recommends reading, but Joar Björk’s reflections are so thought-provoking that I cannot help it. Read his essay here: Ethical reflection: The palliative care ethos and patients who refuse information.

You will certainly find Joar Björk’s reflections interesting. Therefore, I would like to mention a new book that also reflects on the gap between ethics in principle and ethics in practice. The book is written by Stephen Scher and Kaisa Kozlowska and is published with open access. You can find it here: Revitalizing Health Care Ethics. The Clinician’s Voice.

So, I think it is difficult to see clearly the difference between ethics in principle and ethics in practice. We tend to transfer characteristics from one to the other, and become dissatisfied when it does not work. The book by Scher and Kozlowska therefore uses the warning “Mind the gap” to draw attention to the difference. If we mind the gap between the platform and the train – if we do not imagine the train as an overly mobile platform, and the platform as an overly stationary train – then perhaps the two forms of ethics can accept and find better support in each other. More often than we think, we are dissatisfied for the simple reason that we fail to keep different things apart.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Björk J. Ethical reflection: The palliative care ethos and patients who refuse information. Palliative Care and Social Practice. 2025;19. doi:10.1177/26323524251355287

Stephen Scher, Kasia Kozlowska. 2025. Revitalizing Health Care Ethics. The Clinician’s Voice. Palgrave Macmillan Cham.

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We recommend readings

What do MS patients consider to be the most important features of treatment?

Nervous Tissue: Spinal Cord Motor Neuron. Photo by Bioscience Image Library by Fayette Reynolds.
17 June, 2025 / / 0 Comments

Multiple sclerosis (MS) is a chronic inflammatory disease that affects the nerves of the brain and spinal cord. Symptoms can vary between individuals and the progression of the disease is difficult to predict. Medications can slow the progression of the disease and relieve symptoms, but they do not cure the disease. Symptoms tend to come and go and need to be monitored so that the patient always receives appropriate treatment.

Because MS is a lifelong disease with symptoms that come and go, and that change throughout life, it is important to know which features of treatment are perceived by patients as particularly important. Such knowledge can help healthcare professionals, in consultation with patients, to better tailor treatment to the individual’s wishes and needs. Patient-centred care is probably particularly important for lifelong diseases such as MS, with unpredictable progression and changing symptoms.

So how can we know which features of treatment are considered most important by patients? Preference studies can be conducted. The approaches in such studies vary. Patients can be interviewed or they can complete surveys. Surveys can ask questions in different ways, for example, the task may be to rank alternatives. Sometimes preference studies resemble experiments in which participants are presented with a series of choice situations that are systematically varied.

A Swedish-Italian collaboration investigated what patients perceive as important features of the treatment by giving them a ranking task. MS patients at an Italian university hospital were asked to rank alternatives for five different features of the treatment, including treatment effect and intervention method. The treatment effect that was ranked highest was preserved cognitive function, and the intervention method that was valued highest was disease-modifying drugs. The patients were also asked to justify their answers.

The research team then evaluated the results of the ranking task. The options that the patients ranked highest were now identified as important features of the treatment. Here is the final list of important features of the treatment:

Physical activity

Cognitive training

Disease-modifying drugs

Emotional support

Treatment effects

Each feature has 3–4 alternatives: different types of physical activity, different types of cognitive training, and so on. This ranking study is a preliminary study for a future, more experimental-like preference study that will be based on the features in the list. The advantage of such a step-by-step work process is that you can ensure that you ask the right questions and include the relevant features when designing the experimental study.

The final results therefore remain to be seen, but the above features can be considered an important step along the way. You can read the article here: What matters to patients with multiple sclerosis? Identifying patient-relevant attributes using a ranking exercise with open-ended answers from an online survey in Italy.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Bywall KS, Kihlbom U, Johansson JV, et al. What matters to patients with multiple sclerosis? Identifying patient-relevant attributes using a ranking exercise with open-ended answers from an online survey in Italy. BMJ Open 2025;15:e095552. doi: 10.1136/bmjopen-2024-095552

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Exploring preferences

Are you a blissfully unaware author of an article you never wrote?

Question marks on paper. Photo: Lee Loo The First, Pexels.
3 June, 2025 / / 3 Comments

Every day, researchers receive a motley of offers from dubious journals to publish in them – for a fee. The fact that researchers do not accept these offers does not prevent them from one day discovering that they have become authors of an article that they never wrote.

This recently happened to four surprised colleagues of mine. Suddenly, they began to receive inquiries from other colleagues about a new article that they were supposed to have written. When they investigated the matter, they discovered that an article actually existed in published form, in their names, even though they had neither written it nor even dreamed of the study described in it. Since they had never submitted a manuscript, they were of course not in communication with the journal’s editorial staff: they received neither peer reviews nor proofs to read. Although the article they read with increasing astonishment seemed to report a study on children with cancer, a vulnerable group, the study lacked both ethical approval and funding, and the location of the study was not disclosed. When my puzzled and concerned colleagues contacted the journal about these oddities, they naturally received no response.

One may wonder how such publicist virgin births can occur. If we rule out the possibility that a deity has begun to communicate with humanity via new electronic forms of publishing, in the name of established researchers, perhaps we should focus on the question of who can profit from the miracles. Could it be a cheating researcher trying to improve their credentials by publishing a fraudulent study? Hardly, the cheater’s name is not included in the list of authors, so the publication would not be of any use in the CV. Or could it be the owners of the journal who are trying to make the journal look more legitimate by borrowing the names of established and credible researchers, so that more researchers will be tempted to accept the offers to publish in the journal – for a fee? With the help of AI, an article can easily be generated that reports research that no real researcher would even dream of. Such as a study on children with cancer without ethics approval and funding, conducted in an unknown location and published without the slightest contact with the journal.

To alert scientific journals to this new challenge, one of my colleagues chose to publish a description of the group’s experience of becoming authors of an article they never wrote. You will find the description here – the author’s name is authentic and not just a generated “probable name”: Fraudulent Research Falsely Attributed to Credible Researchers—An Emerging Challenge for Journals?

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Godskesen, T. (2025), Fraudulent Research Falsely Attributed to Credible Researchers—An Emerging Challenge for Journals? Learned Publishing, 38: e2009. https://doi.org/10.1002/leap.2009

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We like ethics

What influences pregnant women’s decisions about prenatal diagnosis?

Ultrasound monitor. Photo by Mart Production, Pexels.
20 May, 2025 / / 1 Comment

A large proportion of pregnant women in Sweden undergo prenatal diagnosis to assess the likelihood of chromosomal anomalies in the fetus. This initially involves a so-called CUB test, which combines ultrasound with a biochemical test. If the CUB test indicates a high probability of a chromosomal anomaly, further tests are offered. This can be a non-invasive NIPT test, which examines small parts of the fetus’s DNA that are found in a blood sample from the woman, or an invasive test which involves a slightly increased risk of miscarriage.

What influences pregnant women’s decisions about whether or not to undergo prenatal diagnosis? A study investigated the question by interviewing 24 pregnant women in an early stage of pregnancy. Most had not yet been informed by the midwife about prenatal diagnosis and their perceptions in the interviews were therefore probably not influenced by information from healthcare professionals. The study should be highly relevant to prenatal care and genetic counseling as it provides insights into what influences decision-making for pregnant women and deepens the understanding of what they perceive is at stake.

It is instructive to take part in the results and how the interviewees think about prenatal diagnosis. The pregnant women’s reasoning is based on their own experiences, perceptions and values. When they wonder about chromosomal anomalies, they do not wonder about genetics, but about what the anomalies can mean for the child and for themselves. What kind of life can the child have? And how are the conditions for one’s own professional and social life affected? Women who did not consider terminating the pregnancy in the event of a chromosomal anomaly still saw value in prenatal diagnosis, as the knowledge could make it possible to prepare for the birth of the child. Some saw the test as an opportunity to confirm the pregnancy and the health of the fetus, while some were concerned that the CUB test only indicates the probability of a chromosomal anomaly. If a woman can give birth to a completely healthy child despite the test indicating a high risk of anomaly, is it worth the anxiety that the risk assessment would create during pregnancy? Self-perceived risk also influenced the decision-making. Some stated that they would probably choose prenatal diagnosis if they were older, or if there had been a history of chromosomal anomalies in the family.

Furthermore, certain external factors influenced the women’s reasoning about prenatal diagnosis, such as the characteristics of the test. It was very clear that they preferred risk-free tests. Even women who were positive about prenatal diagnosis became hesitant if the testing procedure in question could increase the risk of miscarriage. The accuracy of the test was also important, as was the time between testing and receiving results. For women who could consider terminating their pregnancy in the event of a chromosomal anomaly, early prenatal diagnosis was important. Other people’s perceptions of prenatal diagnosis were another external factor that could influence the decision-making. Although some of the interviewees emphasized that decisions about their bodies were their own, the majority wanted the opportunity to discuss the decision about prenatal diagnosis with their partner. The interviews also revealed that the attitudes of the healthcare professionals influenced the decisions, for example whether the midwife presents prenatal diagnosis as something urgent or not. Finally, the way healthcare services are organized could also influence the decisions. The very fact that prenatal diagnosis is offered was perceived by some women as a recommendation. The fact that the CUB test is subsidized for pregnant women over a certain age meant that older women perceived it as more compelling to choose it, while younger pregnant women might not choose it even if they wanted to.

In addition to the fact that the interview study provides insights into how pregnant women think about prenatal diagnosis, the analysis of the interview material contributes to an overview of how multidimensional the decision-making is. So much is at stake, so many types of factors interact and influence the decisions. When pregnant women are informed about prenatal diagnosis, all of these factors should be taken into account in order to support the women’s decision-making. Healthcare professionals should also be aware that their attitudes and demeanor influence women’s decisions, and that decisions are influenced not only by what they say to the women but also by what they do not say, the authors conclude their article.

To see more results and read the authors’ discussion, you can find the article here: Factors influencing pregnant women’s decision to accept or decline prenatal screening and diagnosis – a qualitative study.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Ternby, E., Axelsson, O., Ingvoldstad Malmgren, C. et al. Factors influencing pregnant women’s decision to accept or decline prenatal screening and diagnosis – a qualitative study. J Community Genet 15, 711–721 (2024). https://doi.org/10.1007/s12687-024-00746-3

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“Consentless measures” in somatic care: how do healthcare staff reason about them?

Zoomed in picture of person in blue scrubs holding a chart, in front of a blue background. Photo: Cottonbro.
6 May, 2025 / / 2 Comments

How do you handle a reluctant patient who may not want to take their medication or who protests against measures that are deemed to be beneficial to the patient, such as inserting a urinary catheter? Do you just give up because the patient does not consent?

Except in acute emergency situations, coercive somatic treatment is not permitted in Sweden. How do healthcare professionals ethically reflect on situations where the patient does not consent to an action that can be considered to benefit the patient and which is therefore attempted anyway? A new interview study with healthcare staff on medical wards at two Swedish hospitals examines the issue in terms of “consentless measures”: ways of getting a reluctant patient to comply with treatment, for example by persuading, coaxing, deceiving or using some form of physical power.

In the interviews, the participants had difficulty finding appropriate words to describe the measures that occurred daily on the wards. They distanced themselves from the word “coercion” and preferred to talk about persuading, coaxing and deceiving. They generally accepted the use of consentless measures. In many cases, the measures were seen as such an obvious part of daily work situations that the measures did not need to be justified, or were justified by being what was best for the patient. Staff who gave up too quickly were seen as uncommitted and unreliable. While trying to avoid coercion, one still did not want to give up measures that the patient was judged to need. More coercive-like measures were in some cases considered acceptable if milder and less coercive measures had first been tried.

Consentless measures were further described as an integral part of the work on the wards, as part of a ward culture where the overall goal is to carry out one’s tasks. Some participants appreciated the culture while others were critical, but all agreed that the ward culture tacitly condones consentless measures. Participants also said that there was a tendency to use such measures more often with older patients, who were perceived as easier to persuade than younger ones. Several participants saw this as ethically problematic. Finally, participants considered it unacceptable to use excessive physical power or to insist on treatments that are of no benefit to the patient.

In their discussion of the interview results, the authors, Joar Björk, Niklas Juth and Tove Godskesen, point out a number of possible ethical problems to be aware of. One of these has to do with the division of labor where physicians make decisions about measures that nurses must then carry out. This can create a conflict of loyalty for nurses. They work closely with patients, but at the same time they are loyal to the system and want to complete the tasks they are given, which can contribute to the acceptance of consentless measures. The ideal of “not giving up” probably needs to be further examined, as does the question of whether good nursing can sometimes hide ethical challenges under the nurse’s warmth, flexibility and communicative ability. Another issue to further examine is the tendency to use consentless measures on older patients to a greater extent than on younger patients. The authors suggest in their conclusion that a strong sense of duty to carry out care interventions and to “get the job done” may lead to healthcare staff taking patients’ autonomy and consent too lightly. Participants generally took non-consent more lightly than might be expected given established norms in medical ethics, they conclude.

You can read the article here: Ethical reflections of healthcare staff on ‘consentless measures’ in somatic care: A qualitative study.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Björk J, Juth N, Godskesen T. Ethical reflections of healthcare staff on ‘consentless measures’ in somatic care: A qualitative study. Nursing Ethics. 2025;0(0). doi:10.1177/09697330251328649

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