The Ethics Blog

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

Author: Pär Segerdahl (Page 3 of 39)

Encourage children to take responsibility for others?

30 May, 2023 / / 1 Comment

It happens that academics write visionary texts that highlight great human challenges. I blogged about such a philosophically visionary article a few years ago; an article in which Kathinka Evers discussed the interaction between society and the brain. In the article, she developed the idea that we have a “proactive” responsibility to adapt our societies to what we know about the brain’s strengths and weaknesses. Above all, she emphasized that the knowledge we have today about the changeability of the brain gives us a proactive responsibility for our own human nature, as this nature is shaped and reshaped in interaction with the societies we build.

Today I want to recommend a visionary philosophical article by Jessica Nihlén Fahlquist, an article that I think has points of contact with Kathinka Evers’ paper. Here, too, the article highlights our responsibility for major human challenges, such as climate and, above all, public health. Here, too, human changeability is emphasized, not least during childhood. Here, too, it is argued that we have a responsibility to be proactive (although the term is not used). But where Kathinka Evers starts from neuroscience, Jessica Nihlén Fahlquist starts from virtue ethics and from social sciences that see children as social actors.

Jessica Nihlén Fahlquist points out that we live in more complex societies and face greater global challenges than ever before in human history. But humans are also complex and can under favorable circumstances develop great capacities for taking responsibility. Virtue ethics has this focus on the human being and on personal character traits that can be cultivated and developed to varying degrees. Virtue ethics is sometimes criticized for not being sufficiently action-guiding. But it is hard to imagine that we can deal with major human challenges through action-guiding rules and regulations alone. Rules are never as complex as human beings. Action-guiding rules assume that the challenges are already under some sort of control and thus are not as uncertain anymore. Faced with complex challenges with great uncertainties, we may have to learn to trust the human being. Do we dare to trust ourselves when we often created the problems?

Jessica Nihlén Fahlquist reasons in a way that brings to mind Kathinka Evers’ idea of a proactive responsibility for our societies and our human nature. Nihlén Fahlquist suggests, if I understand her correctly, that we already have a responsibility to create environments that support the development of human character traits that in the future can help us meet the challenges. We already have a responsibility to support greater abilities to take responsibility in the future, one could say.

Nihlén Fahlquist focuses on public health challenges and her reasoning is based on the pandemic and the issue of vaccination of children. Parents have a right and a duty to protect their children from risks. But reasonably, parents can also be considered obliged not to be overprotective, but also to consider the child’s development of agency and values. The virus that spread during the pandemic did not cause severe symptoms in children. Vaccination therefore does not significantly protect the child’s own health, but would be done with others in mind. Studies show that children may be capable of reasoning in terms of such responsibility for others. Children who participate in medical research can, for example, answer that they participate partly to help others. Do we dare to encourage capable children to take responsibility for public health by letting them reason about their own vaccination? Is it even the case that we should support children to cultivate such responsibility as a virtue?

Nihlén Fahlquist does not claim that children themselves have this responsibility to get vaccinated out of solidarity with others. But if some children prove to be able to reason in such a morally complex way about their own vaccination, one could say that these children’s sense of responsibility is something unexpected and admirable, something that we cannot demand from a child. By encouraging and supporting the unexpected and admirable in children, it can eventually become an expected responsibility in adults, suggests Jessica Nihlén Fahlquist. Virtue ethics makes it meaningful to think in terms of such possibilities, where humans can change and their virtues can grow. Do we dare to believe in such possibilities in ourselves? If you do not expect the unexpected you will not discover it, said a visionary Greek philosopher named Heraclitus.

Jessica Nihlén Fahlquist’s article is multifaceted and innovative. In this post, I have only emphasized one of her lines of thought, which I hope has made you curious about an urgent academic text: Taking risks to protect others – pediatric vaccination and moral responsibility.

In summary, Jessica Nihlén Fahlquist argues that vaccination should be regarded as an opportunity for children to develop their sense of responsibility and that parents, schools, healthcare professionals and public health authorities should include children in debates about ethical public health issues.

Pär Segerdahl

Written by…

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

Jessica Nihlén Fahlquist, Taking Risks to Protect Others – Pediatric Vaccination and Moral Responsibility, Public Health Ethics, 2023;, phad005, https://doi.org/10.1093/phe/phad005

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Approaching future issues

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When ordinary words get scientific uses

Neuron
16 May, 2023 / / 1 Comment

A few weeks ago, Josepine Fernow wrote an urgent blog post about science and language. She linked to a research debate about conceptual challenges for neuroscience, challenges that arise when ordinary words get specialized uses in science as technically defined terms.

In the case under debate, the word “sentience” had been imported into the scientific study of the brain. A research group reported that they were able to determine that in vitro neurons from humans and mice have learning abilities and that they exhibit “sentience” in a simulated game world. Of course, it caused quite a stir that some neurons grown in a laboratory could exhibit sentience! But the research team did not mean what attracted attention. They meant something very technical that only a specialist in the field can understand. The surprising thing about the finding was therefore the choice of words.

When the startling choice of words was questioned by other researchers, the research team defended themselves by saying that they defined the term “sentience” strictly scientifically, so that everyone should have understood what they meant, at least the colleagues in the field. Well, not all people are specialists in the relevant field. Thus the discovery – whatever it was that was discovered – raised a stir among people as if it were a discovery of sentience in neurons grown in a laboratory.

The research group’s attitude towards their own technical language is similar to an attitude I encountered long ago in a famous theorist of language, Noam Chomsky. This is what Chomsky said about the scientific study of the nature of language: “every serious approach to the study of language departs from the common-sense usage, replacing it by some technical concept.” Chomsky is of course right that linguistics defines its own technical concepts of language. But one can sense a certain hubris in the statement, because it sounds as if only a linguistic theorist could understand “language” in a way that is worthy of serious attention. This is untenable, because it raises the question what a technical concept of language is. In what sense is a technical concept a concept of language? Is it a technical concept of language in the common sense? Or is it a technical concept of language in the same inaccessible sense? In the latter case, the serious study of language seems to degenerate into a navel-gazing that does not access language.

For a technical concept of language to be a concept of language, our ordinary notions must be taken into account. Otherwise, the technical concept ceases to be a concept of language.

This is perhaps something to consider in neuroscience as well. Namely to the extent that one wants to shed light on phenomena such as consciousness and sentience. Of course, neuroscience will define its own technical concepts of these phenomena, as in the debated case. But if the technical concepts are to function as concepts of consciousness and sentience, then one cannot neglect our ordinary uses of words.

Science is very serious and important. But if the special significance of science goes to our heads, then our attitude risks undermining the great importance of science for humanity. Here you can read the views of three neuroethicists on these important linguistic issues: Conceptual conundrums for neuroscience.

Pär Segerdahl

Written by…

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

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Minding our language

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Resolving conflicts where they arise

snowball fight
9 May, 2023 / / 3 Comments

I believe that many of us feel that the climate of human conversation is getting colder, that it is becoming harder for us to talk and get along with each other. Humanity feels colder than in a long time. At the same time, the global challenges are escalating. The meteorological signs speak for a warmer planet, while people speak a colder language. It should be the other way around. To cool the planet down, humanity should first get warmer.

How can humanity get warmer? How can we deal with the conflicts that make our human climate resemble a cold war on several fronts: between nations, between rich and poor, between women and men, and so on?

Observe what happens within ourselves when the question is asked and demands its answer. We immediately turn our attention to the world and to the actions we think could solve the problem there. A world government? Globally binding legislation? A common human language in a worldwide classless society that does not distinguish between woman and man, between skin colors, between friend and stranger?

Notice again what happens within ourselves when we analyze the question, either in this universalist way or in some other way. We create new conflicts between ourselves as analysts and the world where the problems are assumed to arise. The question itself is a conflict. It incriminates a world that must necessarily change. This creates new areas of conflict between people who argue for conflicting analyses and measures. One peace movement will fight another peace movement, and those who do not take the necessary stand on these enormous issues… well, how should we handle them?

Observe for the third time what happens within ourselves when we have now twice in a row directed our attention towards ourselves. First, we noted our inner tendency to react outwardly. Then we noted how this extroverted tendency created new conflicts not only between ourselves and an incriminated world that must change, but also between ourselves and other people with other analyses of an incriminated world that must change. What do we see, then, when we observe ourselves for the third time?

We see how we look for the source of all conflict everywhere but within ourselves. Even when we incriminate ourselves, we speak as if we were someone other than the one analyzing the problem and demanding action (“I should learn to shut up”). Do you see the extroverted pattern within you? It is like a mental elbow that pushes away a problematic world. Do you see how the conflicts arise within ourselves, through this constant outward reactivity? We think we take responsibility for the world around us, but we are only projecting our mental reflexes.

There was once a philosopher named Socrates. He was likened to an electric ray as he seemed to numb those he was talking to with his unexpected questions, so that they could no longer react with worldly analyses and sharp-witted arguments. He was careful to point out that he himself was equally numbed. He saw the extroverted tendency within himself. Every time he saw it, he became silent and motionless. Sometimes he could stand for hours on a street corner. He saw the source of all conflict in the human mind that always thinks it knows, that always thinks it has the analysis and all the arguments. He called this inner numbness his wisdom and he described it like this: “what I do not know, I do not think I know either.”

Naturally, a philosopher thus numbed could not harbor any conflict, because the moment it began to take shape, he would note the tendency within himself and be numbed. He mastered the art of resolving conflicts where they arise: within ourselves. Free from the will to change an incriminated world, he would thereby have revolutionized everything.

Socrates’ wisdom may seem too simple for the complex problems of our time. But given our three observations of how all conflict arises in the human mind, you see how we ourselves are the origin of all complexity. This simple wisdom can warm a humanity that has forgotten to examine itself.

Pär Segerdahl

Written by…

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

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We care about communication

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Does the severity of an illness qualify the moral motivation to act?

18 April, 2023 / / 1 Comment

I have to admit that I had a little trouble cracking the code in the article which I will now try to summarize briefly. I hope that the title I have chosen is not already a misunderstanding. Moral philosophy is not easy, but the subject of the article is urgent so I still want to try.

Illness is generally perceived as something bad, as an evil. If we are to speak in terms of value, we can say that illness has negative value. Individual cases of illness usually create a moral motivation in us to mitigate the ill person’s negative condition. How strong this motivation is depends on several factors, but the severity of the disease is a relevant factor. The motivation to act typically increases with the severity of the disease.

This of course comes as no surprise. The motivation to alleviate a person’s cold is not very strong because a cold is not a severe condition. A runny nose is nothing to complain about. But in the face of more severe conditions such as blood poisoning, diabetes and cancer, the moral drive to act increases. “This condition is very severe” we say and feel that it is very important to act.

So what is the problem that motivates the article? If I am interpreting the authors correctly, the problem is that it is not so easy to convert this obvious use of language into a rule to follow. I recently bought a kettle that came with this warning: “Do not fill the kettle with an excessive amount of water.” The warning is, in a way, self-evident. Of course, you should not fill the kettle with an excessive amount of water! The motivation to pour should have stopped before the water level got excessively high. Even though the language is perfectly obvious, the rule is not as obvious, because when is the water level excessively high? When should we stop pouring?

The problem with the word “severity” is similar, or at least that is my interpretation. “Severity” is an obvious linguistic tool when we discuss illness and the need to do something about it. But at the same time, it is difficult to define the term as a description of when conditions are (more or less) severe and when it is (more or less) motivated to do something about them. Some philosophers have therefore criticized the use of “severity” in discussions about, for example, priority setting in healthcare. The situation would become somewhat paradoxical, since an obviously relevant concept would be excluded because it is unclear how it can be transformed into a description that can be followed as if it were a simple rule.

If I understand the article correctly, the authors want to defend the concept of severity by showing that severity qualifies our moral motivation to act when someone is ill. They do this by describing six other concepts that it is more generally accepted should qualify how morally important it is to do something about a condition, including the concepts of need and lack of well-being. None of the six concepts coincides completely with the concept of severity, but when we try to assess how they affect the need to act, we will often simultaneously assess the severity. And when we assess the severity of an illness, we will often at the same time assess how the illness affects well-being, for example.

The authors’ conclusion is that the concept of severity is a morally relevant concept that should be considered in future discussions, as severity qualifies the moral motivation to act. However, I may have misunderstood the reasoning, so if you want to be on the safe side, you can read the article here: Severity as a moral qualifier of malady.

I want to end the post with a personal side note: I am inclined to say that the philosophical difficulty in defining the concept of severity (when we talk about disease) is similar to the difficulty in defining the concept of excess (when we talk about water levels). What makes these concepts so useful is their great pliability. It is difficult to say what “severe disease” or “excessively high water level” is, because it depends on so much. Pliable words like these are like tracking dogs that sensitively move through the terrain in all possible relevant directions. But if we try to reconstruct the tracking dog’s sensitivity in general intellectual terms, without access to the dog’s sense of smell, experiences and instincts, we run into great difficulties.

Should these philosophical difficulties motivate us to get rid of the dog? Of course not! Just as we learn incredibly much from following a tracking dog, we learn incredibly much from following the words “severe disease,” even if the journey is arduous. This underlines the authors’ conclusion: severity should be considered a morally significant concept that continues to deserve our attention.

Pär Segerdahl

Written by…

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

Solberg, C.T., Barra, M., Sandman, L. et al. Severity as a moral qualifier of malady. BMC Medical Ethics 24, 25 (2023). https://doi.org/10.1186/s12910-023-00903-2

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We like challenging questions

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The significance of the academic seminar

Grass. Photo by Philippe Leone on Unsplash
11 April, 2023 / / 1 Comment

Ever since I was a doctoral student in philosophy, I have experienced the seminar, usually held once a week, as the heart of the academic environment. Why is the seminar so important?

If we are to stick to the etymology of the word, we should use a different image than that of the heart. The seminar is the nursery where seeds germinate and seedlings grow strong in a favourable environment, to then be planted out. That image fits well with doctoral education. The seminar is the place where doctoral students get training in presenting and discussing their scientific work. They get the opportunity to present their studies and texts and receive constructive criticism from senior researchers and from other doctoral students. In this way, their theses will be as brilliant as possible and they can practice the academic forms of giving and receiving constructive criticism, of defending their positions and changing their minds.

But there are also other seedlings in the academy than doctoral students and thesis drafts. Even senior researchers’ studies and texts are originally seedlings. Even these need to grow before they can be planted in scientific journals or at book publishers. The seminar never ceases to be a nursery. I dare say that the seminar is just as important for established researchers as it is for doctoral students.

The seminar is also the weekly event where something finally happens together with others. Academics often work in a certain solitude, especially when writing. Colleagues who may not have met since the last seminar reunite and continue the conversation in the familiar seminar room. Is the seminar like a recurring dance arrangement for lonely academics? Yes, the seminar probably also resembles an academic dance palace. In addition, sometimes you can invite presenters to the seminar, maybe even stars, then the event will be really brilliant.

The seminar is not least one of every academic institution’s most important places for discussion where colleagues meet regularly and learn to understand each other. Despite working from different theoretical, methodological and linguistic starting points. The academy is not homogenous, but is full of theories, methods and languages, even within the same discipline. If we do not meet every week and continue the conversation together, we soon become strangers who do not understand each other.

All these images reveal essential aspects of the academic seminar: the image of nursery as well as the image of the dance palace and the image of the place of discussion. Yet they do not reveal the significance of the seminar that I experience most strongly. I must return to the image of the heart, of the life-sustaining centre. I want to say that the seminar is the place where an academic subject becomes alive and real. The subject can be philosophy or literature, mathematics or neuroscience, law or economy. What can such strange subjects mean in the heart of a human being? At the seminar, living philosophers, literary scholars, mathematicians, lawyers or economists meet each other. At the seminar, they bring their academic subjects to life, for themselves and for younger researchers in the making. Each seminar pumps new reality into the subject, which would otherwise be pale and abstract. At the seminar you can see, hear and even smell what philosophy and other academic subjects really are. They never become more real than in the seminar.

I think we could go on forever looking for different meanings of the academic seminar.

Pär Segerdahl

Written by…

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

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We care about education

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Ethical challenges when children with cancer are recruited for research

28 March, 2023 / / 1 Comment

Cancer is a common cause of death among children, but improved treatments have significantly increased survival, especially in high-income countries. A prerequisite for this development is research.

When we think of a hospital, we think mainly of the care given to patients there. But care and research are largely developed together in the hospitals. Treatments given in the hospitals are tested in research carried out in the hospitals. This overlap of care and research in the same setting creates ethical challenges. Not least because it can be difficult to see and maintain the differences when, as I said, the activities overlap.

Kajsa Norbäck, PhD student at CRB, investigates in an interview study Swedish healthcare professionals’ perceptions and experiences of ethical challenges when children with cancer are recruited for research in the hospitals where they are patients. Research is needed for future childhood cancer care, but what are the challenges when approaching children with cancer and their parents with the question of research participation?

The interview material is rich and difficult to summarize in a blog post, but I want to highlight a few findings that particularly impressed me. I recommend those interested to take the time to read the entire article in peace and quiet. Interview studies provide a living direct contact with reality from the perspective of the interviewees. Kajsa Norbäck writes that interview studies give us informative examples of ethical challenges. Such examples are needed to give the ethical reflection concreteness and grounding in reality.

The interviewed healthcare professionals particularly emphasized the importance of establishing a trusting relationship with the family. Only when you have such a relationship does it make sense to discuss possible research participation. Personally, I cannot help but interpret it as meaning that the care relationship with patient and family must be established first. It is within the framework of the care relationship that possible research participation can be discussed in a trusting manner. But trust can also be a dilemma, the interviews show. The interviewees stated that many families had so much trust in healthcare and research that it could feel too easy and predictable to get consent for research participation. They also had the impression that parents could sometimes give consent to research out of fear of not having done everything they could to save the child, as if research was a last chance to get effective care.

The challenge of managing the overlap of care and research also extends to the professional role of the physician. Physicians have a care responsibility, but since the care they can offer rests on research, they also feel a research responsibility: they feel a responsibility to recruit research participants from among their patients. This dual responsibility can naturally create conflicts of interest, of which they give informative examples in the interviews.

In the middle of this force field of challenges we have the child, who may have difficulty making itself heard, perhaps because many of us have difficulty being a listener. Here is what one of the interviewees says: “We often talk about informing and I think that’s a strange word. I think the greatest competence is to listen.” There is a lot to listen to in Kajsa Norbäck’s interview study as well, more than I can reproduce in a blog post. Read her article here: Ethical concerns when recruiting children with cancer for research: Swedish healthcare professionals’ perceptions and experiences.

Pär Segerdahl

Written by…

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

Norbäck, K., Höglund, A.T., Godskesen, T. and Frygner-Holm, S. Ethical concerns when recruiting children with cancer for research: Swedish healthcare professionals’ perceptions and experiences. BMC Medical Ethics 24, 23 (2023). https://doi.org/10.1186/s12910-023-00901-4

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Ethics needs empirical input

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Digital biomarkers to test new drugs for mental health

14 March, 2023 / / 1 Comment

Somewhat simplified, we usually understand biomarkers as substances in the body that can be detected, for example, through blood or urine tests, and that indicate a biological state, such as cancers or diabetes. Biomarkers can be used to make a diagnosis, predict disease risks and to monitor an ongoing treatment.

Nowadays, people also talk about digital biomarkers. To get an idea of what it is all about, think of the smartphone applications that can record movement patterns, heart rate and more. The new digital biomarkers are measurable physiological or behavioural data that are collected in a similar way and where the measuring equipment is usually portable or placed in the body. This data can be followed in real time to monitor the patient’s health status and recovery, without the need for the patient to make repeated hospital visits. However, the question of how these digital data can be understood as biomarkers does not seem completely clear.

Some concurrently published articles in the journal Frontiers in Psychiatry discuss the possibility of using digital biomarkers to test the safety and efficacy of new drugs in mental health. For this to work, these new ways of collecting data and monitoring changes in real time must of course also work safely and effectively. They must moreover satisfy ethical and legal demands on data protection and oversight. The articles discuss these and other challenges. In one article, for example, the question of how we should understand “bio” when we go from traditional biomarkers to digital ones is discussed. Another paper presents results from an attempt to use a digital biomarker to predict cognitive function.

In the editorial introducing the articles, Deborah Mascalzoni, among others, emphasizes that the use of digital biomarkers still lacks a satisfactory regulated context and that issues of data protection and risks of discrimination when data of this kind are collected must be addressed. You can find the editorial here: Digital biomarkers in testing the safety and efficacy of new drugs in mental health: A collaborative effort of patients, clinicians, researchers, and regulators. There you will also find a link to all articles.

Pär Segerdahl

Written by…

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

Johanna Maria Catharina Blom, Cristina Benatti, Deborah Mascalzoni, Fabio Tascedda and Luca Pani. Editorial: Digital biomarkers in testing the safety and efficacy of new drugs in mental health: A collaborative effort of patients, clinicians, researchers, and regulators. Frontiers in Psychiatry, 2023. https://doi.org/10.3389/fpsyt.2022.1107037

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We recommend readings

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Philosophers in democratic conversations about ethics, research and society

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7 March, 2023 / / 1 Comment

Philosophers have an ambiguous position in the knowledge society which could support democratic conversations where truth and openness are united. On the one hand, philosophers are driven by a strong desire for the truth. They ask questions more often than they give answers, and they do not give answers until they have thoroughly explored the questions and judged that they can establish the truth, to speak a little pompously. On the other hand, philosophers cannot communicate their conclusions to society with the same authority that empirical scientists can communicate their findings. Philosophical reasoning, however rigorous it may appear to be, does not function as scientific evidence. It would be doubtful if a philosopher said, “A very clear reasoning which I recently carried out shows that…,” and expected people to accept the conclusion, as we expect people to accept the results of empirical studies.

Despite their strong desire to find the truth, philosophers can thus rarely “inform” about the truths they believe they have found, but must exercise restraint and present these truths as proposals, and then appeal to their interlocutors to judge the proposal for themselves. That is, to think for themselves. The desire to communicate one’s philosophical conclusions to others thus results in conversations on more or less equal terms, where more or less clear reasoning is developed together during the course of the conversation. The philosopher’s ambiguous position in the knowledge society can here act as a catalyst for conversations where the aspiration to think correctly, and the will to think freely, support each other.

The ambiguous position of philosophy in the knowledge society is evident in medical ethics, because here philosophy is in dialogue with patients, healthcare professionals and medical researchers. In medical ethics, there are sometimes so-called “ethics rounds,” where an ethicist visits the hospital and discusses patient cases with the staff from ethical perspectives. The role of the ethicist or philosopher in these conversations is not to draw the correct ethical conclusions and then inform the staff of the morally right thing to do. By striving for truth and by asking questions, the philosopher rather supports the staff’s own ethical reasoning. Of course, one or another of the philosopher’s own conclusions can be expressed in the conversation, but as a suggestion and as an invitation to the staff to investigate for themselves whether it can be so. Often the most important thing is to identify the crucial issues. The philosopher’s ambiguous standing can in these contexts act as a catalyst for good conversations.

Another area where the ambiguous position of philosophy in the knowledge society is evident is in research communication of ethics research, like the one we do here at CRB. Ethicists sometimes conduct empirical studies of various kinds (surveys, interviews and experiments). They can then naturally expect people (the general public or relevant groups) to take the results to heart. But these empirical studies are usually done to shed light on some ethical difficulty and to draw ethical, normative conclusions on good grounds. Again, these conclusions can rarely be communicated as research findings, so the communicator also has to exercise restraint and present the conclusions as relevant proposals to continue thinking and talking about. Research communication becomes not only informative and explanatory, but also thoughtful. It appeals to people to think for themselves. Awareness of the ambiguous position of philosophy can thus support research communication that raises open questions, in addition to disseminating and explaining scientific findings.

Since political conclusions based on scientific studies seem to have a similar ambiguous status to ethical and philosophical conclusions, philosophy could also inspire wiser democratic conversations about how research should be implemented in society. This applies not least to controversial issues, which often polarize and encourage debaters to make strong claims to possess the best evidence and the most rigorous reasoning, which they believe justifies their positions. But such a truth authority on how we should live and organize society hardly exists, even if we strive for the truth. As soon as we talk to each other, we can only make suggestions and appeal to our interlocutors to judge the matter for themselves, just as we ourselves listen to our interlocutors’ objections, questions and suggestions.

Strong pursuit of truth requires great openness. When we philosophize, these aspects are at best united. In this way, philosophy could inspire democratic conversations where people actually talk to each other and seek the truth together. Not just make their voices heard.

Pär Segerdahl

Written by…

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

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We care about communication

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Longer hospital stays can worsen self-injurious behaviour

21 February, 2023 / / 1 Comment

Can a hospital stay make the disease worse? It sounds paradoxical, but of course it can occur as a result of, for example, misdiagnosis and negligence, or of overtreatment. When it comes to psychiatric illnesses and ailments, which are often sensitive to the interaction with the environment, it can be difficult to see how the situation at the hospital affects the illness. Therefore, it is important to be attentive.

A new study by Antoinette Lundahl, carried out together with Gert Helgesson and Niklas Juth, draws attention to the problem in the care of patients who self-harm. They did a survey with healthcare staff at psychiatric clinics in Stockholm. The respondents answered questions about experiences of care longer than a week with this patient group. A majority of the respondents believed that it had detrimental effects on self-injurious behaviour if the patients stayed longer than a week in their ward. They also considered that the patients often stayed too long in the ward and that the reasons for the extended length of stay were in several cases non-medical.

How are we to understand this? How might hospitalization increase the risk of the behaviour to be treated? In the discussion part of the article, various possible explanations are suggested, for example conflicts on the ward or that patients spread self-injurious behaviours to each other. Another possible explanation is that the hospital stay is used by the patient to transfer responsibility for handling painful feelings and thoughts to others. Such avoidance strategies only have a short-term effect and increase the pain in the long term. The self-injurious behaviour can be reinforced as a way to get more care and attention. A kind of “care addiction” develops in the patient, you could say.

How should we understand the extended hospital stays? The respondents mentioned several non-medical reasons, such as uncertainty about the patient’s housing, or that patients who look fragile or are assertive influence the staff to extend the length of care. Another reason for extended care times was assumed to be doctors’ fear of being held responsible for suicide or attempted suicide after discharge, a fear which paradoxically could increase the risk.

Read Antoinette Lundahl’s article here: Hospital staff at most psychiatric clinics in Stockholm experience that patients who self-harm have too long hospital stays, with ensuing detrimental effects.

Then you can also read more about the respondents’ suggestions for improvements, such as giving patients clear care plans with fixed discharge dates, short treatment times (a few days), and information about what is expected of them during the hospital stay. Better collaboration with outpatient care was also recommended, as well as more non-medical treatments in inpatient care.

Pär Segerdahl

Written by…

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

Antoinette Lundahl, Gert Helgesson & Niklas Juth (2022) Hospital staff at most psychiatric clinics in Stockholm experience that patients who self-harm have too long hospital stays, with ensuing detrimental effects, Nordic Journal of Psychiatry, 76:4, 287-294, DOI: 10.1080/08039488.2021.1965213

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Misuse of co-authorship remains a problem despite educational measures

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31 January, 2023 / / 1 Comment

In science, correctly stated co-authorship is essential. Being transparent about who did what can be said to belong to the documentation of the research. Incorrectly stated co-authorship does not only give a distorted picture of the research, however. It also creates injustice between researchers and unfairly affects who gets employment or research grants. This also affects which research will be conducted and by whom.

There are internationally recommended rules for what counts as co-authorship, for example the Vancouver rules for medical publications. Despite the importance of correctly stated co-authorship, and despite international guidelines, several studies show that deviant practices are common. One way to deal with the problem is, of course, educational efforts. Doctoral students at medical faculties in Scandinavia increasingly receive instruction in publication ethics, and thus in these rules. Are the efforts effective?

Recently, results were published from an online survey aimed at people who have recently obtained a doctorate at medical faculties in Denmark, Norway and Sweden. The aim of the study was to explore experiences of and attitudes towards handling of authorship. Almost half of the respondents stated that the Vancouver rules were not fully respected in at least one of the studies included in the thesis. About a quarter of the respondents reported inappropriate handling of authorship order in at least one study. Nevertheless, the majority (96.7%) stated that it is important that the Vancouver rules are followed.

The study’s conclusion is that despite increased educational efforts in publication ethics at Scandinavian universities, the handling of co-authorship continues to be a problem in medical research. One can ask why the problem persists despite the efforts, and despite the positive attitude towards the authorship rules among the vast majority of respondents in the study.

In the discussion of the results, the authors suggest that it is probably not the doctoral students themselves who transgress the authorship rules, but supervisors and other more senior researchers, to whom the doctoral student is subordinate. The educational efforts thus miss a very relevant target group. The authors therefore mention a new trend at medical faculties in Sweden to introduce compulsory teaching in research ethics for supervisors of doctoral students. At the same time, they doubt the effectiveness of increased educational efforts alone, since authorship can be considered an academic currency. As long as authorship functions as a kind of career capital for researchers, deviant practices will remain common.

If you want to know more, read the study here: Misuse of co-authorship in Medical PhD Theses in Scandinavia: A Questionnaire Survey.

Then you can also read about another important result. A larger proportion of women responded that authorship order did not correctly reflect contribution in their thesis. A greater proportion of women also emphasized the importance of following the authorship rules. This may indicate that women are treated worse than men in matters of authorship and therefore place more importance on fair action, the authors suggest.

Pär Segerdahl

Written by…

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

Helgesson, G., Holm, S., Bredahl, L., Hofmann, B., Juth, N. Misuse of co-authorship in Medical PhD Theses in Scandinavia: A Questionnaire Survey. Journal of Academic Ethics (2022). https://doi.org/10.1007/s10805-022-09465-1

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