Göran Hermerén

The purpose of the present paper is: (1) to outline a conceptual framework useful for the analysis of ethical issues raised by goal-directed activities, (2) to apply this framework to nanoscale research, (3) identify some of the main challenges in the evaluation of such research, and (4) exemplify what is needed for a positive answer to the question “How can nanoscale research improve the quality of life?” A basic idea of the paper is that nanoscale research can improve the conditions and quality of life of large groups in society, provided that: (a) this research is directed at certain generally accepted goals, (b) at least some of the opportunities are exploited for the good of mankind, (c) the key obstacles on the road are eliminated, reduced or circumvented, and (d) this is done in ethically acceptable ways.

The principle of proportionality is used in many different contexts. Some of these uses and contexts are first briefly indicated. This paper focusses on the use of this principle as a moral principle. I argue that under certain conditions the principle of proportionality is helpful as a guide in decision-making. But it needs to be clarified and to be used with some flexibility as a context-dependent principle. Several interpretations of the principle are distinguished, using three conditions as a starting point: importance of objective, relevance of means, and most favourable option. The principle is then tested against an example, which suggests that a fourth condition, focusing on non-excessiveness, needs to be added. I will distinguish between three main interpretations of the principle, some primarily with uses in research ethics, others with uses in other areas of bioethics, for instance in comparisons of therapeutic means and ends. The relations between the principle of proportionality and the precautionary principle are explored in the following section. It is concluded that the principles are different and may even clash. In the next section the principle of proportionality is applied to some medical examples drawn from research ethics and bioethics. In concluding, the status of the principle of proportionality as a moral principle is discussed. What has been achieved so far and what remains to be done is finally summarized

Purpose: To survey the attitudes of the general public in Sweden to biobank research and to discuss the findings in the light of some well-known ethical principles.Methods: A questionnaire was used to survey the opinions of the general public in Sweden, and an ethical analysis (using the principles of autonomy, non-maleficence, beneficence and justice) was performed to discuss the possible conditions of such research.Findings: Between 3 and 9% answered that they did not want their samples to be collected and stored in a biobank. Many respondents required information about the purpose of the research and wanted to be able to consent or refuse. About one third of the respondents said they would have answered differently if financial gain was involved and those who commented indicated a more negative attitude. The principle of autonomy maintains that the right to self-determination should be respected, and the principles of non-maleficence and beneficence that the probable harms and benefits resulting from a particular project by using samples from a biobank should be balanced. The general public disagree about how these principles are to be balanced. Interpretation: In the light of the findings different interpretations of the situation as well as possible alternatives are discussed in this paper

The aims of this article are to consider (1) whether there are medical and societal differences among diseases regarding which patient groups should be asked to participate in first-in-human (FIH) trials of stem-cell-based therapies; (2) any differences in the light of values generally endorsed by different types of ethical theories, since the question in the title of this article is value laden, and its answer depends on which values one wants to promote and protect, and how they are ranked in importance; (3) whether the answer to that question is disease-specific, or whether it depends on factors common to several diseases. To illustrate these problems, we use Parkinson’s disease (PD) and Huntington’s disease (HD), between which there are important medical and societal differences. Moreover, research on stem-cellbased therapies for these diseases is being translated from research to practice. This approach to the problem can be applied to decision making about similar problems raised by other diseases that exhibit the same types of differences.

The overriding question discussed in this Element can be stated simply as: Can computers create art? This Element presents an overview of the controversies raised by various answers to this question. A major difficulty is that the technology is developing rapidly, and there are still many uncertainties and knowledge gaps as to what is possible today and in the near future. But a number of controversial issues are identified and discussed. The position taken on controversial issues will depend on assumptions made about the technology, about the nature and location of consciousness, about art and creativity. Therefore, a number of hypothetical answers are outlined, related to the assumptions made.

The research literature suggests that physicians’ attitudes regarding disclosing a diagnosis of cancer have changed, from nondisclosure to full disclosure. Physicians’ attitudes towards disclosing a patient’s prognosis are likewise said to have changed, although not to the same degree.The aim of this study was to identify inherent challenges in communicating information about imminent death. It included one set of interviews with patients and another set with doctors, and subsequent discussions of ways to overcome obstacles to patients’ understanding their situation. Patients were diagnosed with leukemia, myeloma, or lung cancer; the doctors were hematologists and lung oncologists. The two sets of interviews were analyzed separately using a content analysis model developed by Graneheim and Lundman. For each set of interviews, eight content areas were defined as belonging to an area of interest and scrutinized for the information they included regarding communicating prognoses to patients.The main finding was a discrepancy between patients’ desire to be fully informed regarding their prognosis and physicians’ reluctance to offer a prognosis until a patient had overt signs of approaching death. We conclude that existing guidelines for disclosure of bad news should be modified to encourage disclosure and discussion of uncertain prognostic information, unless a patient is clearly opposed to receiving such information or otherwise not a suitable partner for dialogue.

The role of mothers in prenatal research has been discussed extensively. Significantly less work has been done on the father’s role. In this article, focusing on ethical issues, we seek to redress this imbalance. Examining the father’s position in research conducted on pregnant women, we ask whether or not paternal consent ought to be required in addition to that of the pregnant woman. Having distinguished between different concepts of father and mother, we proceed by giving an overview of the reasons for requiring consent of the woman who is carrying the child. We then examine which of these reasons apply to the biological father, and show that some of them are relevant to the father. The case, roughly speaking, revolves around privacy issues, the father’s future legal responsibilities, and the likelihood that he will care about the health and wellbeing of his future child. These factors in the decision problem should all be recognized, as should the fact that they can in principle be trumped by other considerations.

This paper discusses the future of migrants with acute heart problems and without permanent permission to remain in the country where they are seeking asylum. What does the country they have traveled to owe them? Specifically, what healthcare services are they entitled to? This may seem a niche problem, but numbers of migrants with acute heart problems could increase in the future. Besides, similar problems could be raised by, for instance, traumatized migrants with acute needs for healthcare services for other serious conditions. The paper identifies the issues and some positions on them. Arguments for and against these positions are explored. This particular set of problems in healthcare ethics creates several challenges, at both national and international levels, concerning access to transplantation, public willingness to donate organs, optimal use of organs, justice and fairness, and potential conflicts of law, politics and ethics, as well as issues revolving around interaction and communication between agencies and professions.

The achievement of optimal therapeutic results presupposes the use of appropriate treatment combined with maximal utilization of placebo effects. These aims may sometimes be difficult to satisfy in randomized clinical trials (RCTs). The question thus arises whether there is a conflict between the goals of therapy and those of experimental research; and if so, to what extent, and how is it handled in practice by clinicians and researchers. Various ethical problems have been discussed in several reports connected with RCTs. But we have found no discussion concerning the conflict between obtaining informed consent and promoting optimal placebo effects. Information about RCTs can be given in various ways. Sometimes appropriate information about RCTs to patients involves non-optimal utilization of placebo effects. This gives rise to ethical and methodological problems, which are discussed in this article.

This is a systematic study of the conceptual framework used by critics and scholars in their discussions of influence in art and literature. Göran Hermerén explores the key questions raised in scholarly debate on the topic: What is meant by "influence"? What methods can be used to settle disagreements about influence? What reasons could be used to support or reject statements about artistic and literary influence? The book is based on descriptive analyses in which the author has tried to make explicit what is said or implied in a number of quotations from scholarly writings on art and literature. Throughout, the emphasis is on clarifying the assumptions on which the use of the concept of influence is based, thus describing the limitations and merits of this kind of comparative research for critics and scholars. Originally published in 1975. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905.

In this study, 10 hematologists and 10 lung oncologists were interviewed regarding the information they provide to patients in four situations of uncertainty: determining the treatment that is in the patient’s best interest; recurrence or progression of the patient’s disease; determining when to withdraw life-prolonging treatment; discussing death, addressing questions such as whether the patient will die from the disease, and when. The primary finding is that delivery of information to patients with low survival rates can be improved by more and better disclosure by physicians at an earlier stage. The crucial point for physicians is to ascertain the wishes of patients, to learn what to reveal about what patients should expect, short term and long term, as death approaches.

After a brief sketch of the historical background, the current political situation in Sweden is outlined. Since 1985 the National Council on Medical Ethics has played an important role in the biopolitical debate in Sweden, and its activities and influence are described. Religious teachings are often combined with moral precepts. But what makes a statement religious is not easy to say, especially in societies where religious concerns have been intertwined with humanitarian common sense morality for a long time. Summing up, it can be said that the debate in Sweden on biopolitical issues has not shown many signs of the influence of religious arguments, though some religious actors are active in this debate.

In this article I focus on some of Joseph Margolis's contributions to medical ethics. I first discuss some of Margolis's normative and metaphysical views on death and abortion, particularly in his early work Negativities, as well as some of his metaphysical assumptions. Then these views and assumptions are related to his theory of persons and, by implication, his theory of culture, set forth in a number of later works. In the course of the discussion, I call attention to some controversial issues of today, such as embryonic stem cell research and the creation of embryos for the sole purpose of research, and ask for Margolis's views on them, given his earlier contributions and assumptions. Finally, I comment on his relativism and his program for research in aesthetics and ethics.