Centre for Research Ethics & Bioethics (CRB)

Publications from CRB


OUR PUBLICATIONS


We publish the results of our research in international peer-reviewed scientific journals and in books. Roughly our research covers three main areas: research ethics, clinical ethics and bioethics.

You will find the most recent publications by researchers active at CRB with abstracts and links to journals below. Our staff pages also contains publication lists.


On Teachers’ Education in Sweden, school curriculums, and the Sámi People

Svalastog AL, in Gärdebo J, Öhman M-B, Maruyama H (eds.) Re:Mindings. Co-Constituting Indigenous/Academic/Artistic Knowledges, Uppsala University: Uppsala Multiethnic Papers 55 / The Hugo Valentin Centre, Uppsala 2014, pp.153-171

Striving for good nursing care: Nurses' experiences of do not resuscitate orders within oncology and hematology care

Pettersson M, Hedström M and Höglund AT, Nursing Ethics published online 9 June 2014, DOI: 10.1177/0969733014533238

Abstract: Background: Within oncology and hematology care, patients are sometimes considered to have such a poor prognosis that they can receive a do not resuscitate order from the physician responsible, stipulating that neither basic nor advanced coronary pulmonary rescue be performed in the event of a cardiac arrest. Studies on do not resuscitate decisions within oncology and hematology units, focusing on the specific role of the nurse in relation to these decisions, are scarce.

Objective: The aim of this study was to investigate hematology and oncology nurses' experiences and perceptions of do not resuscitate orders, in order to achieve a deeper understanding of the nurses' specific role in these decisions.

Research design: A qualitative, descriptive methodology with individual semi-structured interviews was used.
Participants and research context:
A total of 15 nurses from eight hematology/oncology wards in four hospitals in Sweden were interviewed individually.

Ethical considerations: In accordance with national regulations, an ethical review was not required for this study. The research followed international guidelines for empirical research, as outlined in the Helsinki Declaration.

Findings: The nurses strived for good nursing care through balancing harms and goods and observing integrity and quality of life as important values. Experienced hindrances for good care were unclear and poorly documented decisions, uninformed patients and relatives, and disagreements among the caregivers and family. The nurses expressed a need for an ongoing discussion on do not resuscitate decisions, including all concerned parties.

Conclusion: In order to provide good nursing care, nurses need clear and well-documented do not resus- citate orders, and patients and relatives need to be well informed and included in the decisions. To increase the understanding for each other's opinions within the medical team, regular ethical discussions are required.


Fuzzy logic and preconceptional genetic carrier screening

Inthorn J, APHSC, 2014;1

Abstract: Medical screening programs have been established based on the idea of early treatment and prevention. The selection of tests as well as the diseases tested for that are included in a screening need to be ethically justified. This article looks at criteria for screening such as severity of a disease and efficiency of a test and their applicability for newly developed preconceptional genetic carrier screening. Preconceptional genetic carrier screening can be used by couples planning a pregnancy in order to learn it they are both carriers of a recessive inherited diseases und thus have an increased risk of having an affected child. It is argued that introducing fuzzy logic helps to overcome a binary logic of ethical decisions and to discuss ethical problems connected to the selection of diseases for preconceptional genetic carrier screening in a more nuanced way. With ongoing research about the relationship between genotype and phenotype as well as current development of new genetic screening methods the selection of tests and diseases will have to deal with knowledge deficits which fuzzy logic can help to handle.


Rare Disease Research: Breaking the Privacy Barrier

Mascalzoni D, Paradiso A, Hansson M, Applied & Translational Genomics, Available online 18 April 2014

Abstract: Due to the few patients affected, rare disease research has to count on international registries to exist in order to produce significant research outputs. Data sharing of registries is therefore a unique resource to allow rare disease research to flourish and any lost data will jeopardize the quality of an already extremely difficult research. The rules usually applied to research such as the right to withdraw or the need for specific consent for every use of data can be detrimental in order to get effective results. Privacy rights regulated through traditional informed consent mechanisms have been regarded as a major barrier in order to effectively share data worldwide. Some authors argue that this barrier hampers results that could be beneficial to the patients so that another right will be overstated: the right to quality healthcare. We argue in this paper that privacy has been often interpreted just one-sided as the right to secrecy but it can entail another meaning: the right to manage one’s own private sphere. Managing it pertains, not only to the right to deny access, but also to the right to grant access. At the same time research on patient participation and transparency shows that new forms of IT-based informed consent can provide a good balance between the right of individuals to be in control of their data and the opportunity for science to pursue international research.


Perspectives on open science and scientific data sharing: an interdisciplinary workshop

Destro Bisol G, Anagnostou P, Capocasa M, Bencivelli S, Cerroni A, Contreras J, Enke N, Fantini B, Greco P, Heeney C, Luzi C, Manghi P, Mascalzoni D, Molloy J, Parenti F,  Wicherts JM & Boulton G, Journal of Anthropological Science, 2014;92:1-22

Summary: The process of making scientific knowledge and data open to the whole scientific community and the public is vigorously underway owing to the combined efforts of researchers and stakeholders. A workshop designed to foster dialogue about open science and open data between scholars from different scientific domains, and entitled “Scientific data sharing: an interdisciplinary workshop”, was held in Anagni, Italy, 2-4 September 2013. We here report summaries of the presentations and discussions at the meeting. They deal with four sets of issues: (i) setting a common framework, a general discussion of open data principles, values and opportunities; (ii) insights into scientific practices, a view of the way in which the open data movement is developing in a variety of scientific domains (biology, psychology, epidemiology and archaeology); (iii) a case study of human genomics, which was a trail-blazer in data sharing, and which encapsulates the tension that can occur between large-scale data sharing and one of the boundaries of openness, the protection of individual data; (iv) open science and the public, based on a round table discussion about the public communication of science and the societal implications of open science. There were three proposals for the planning of further interdisciplinary initiatives on open science. Firstly, there is a need to integrate top-down initiatives by governments, institutions and journals with bottom-up approaches from the scientific community. Secondly, more should be done to popularize the societal benefits of open science, not only in providing the evidence needed by citizens to draw their own conclusions on scientific issues that are of concern to them, but also explaining the direct benefits of data sharing in areas such as the control of infectious disease. Finally, introducing arguments from social sciences and humanities in the educational dissemination of open data may help students become more profoundly engaged with Open Science and look at science from a broader perspective.


Developing an interactive mobile phone self-report system for self-management of hypertension. Part 2: Content validity and usability

Bengtsson U, Kjellgren K, Höfer S, Taft C, Ring L, Blood Press 2014 May 1 [Epub ahead of print]

Abstract: Self-management support tools using technology may improve adherence to hypertension treatment. There is a need for user-friendly tools facilitating patients' understanding of the interconnections between blood pressure, wellbeing and lifestyle. This study aimed to examine comprehension, comprehensiveness and relevance of items, and further to evaluate the usability and reliability of an interactive hypertension-specific mobile phone self-report system. Areas important in supporting self-management and candidate items were derived from five focus group interviews with patients and healthcare professionals (n = 27), supplemented by a literature review. Items and response formats were drafted to meet specifications for mobile phone administration and were integrated into a mobile phone data-capture system. Content validity and usability were assessed iteratively in four rounds of cognitive interviews with patients (n = 21) and healthcare professionals (n = 4). Reliability was examined using a test-retest. Focus group analyses yielded six areas covered by 16 items. The cognitive interviews showed satisfactory item comprehension, relevance and coverage; however, one item was added. The mobile phone self-report system was reliable and perceived easy to use. The mobile phone self-report system appears efficiently to capture information relevant in patients' self-management of hypertension. Future studies need to evaluate the effectiveness of this tool in improving self-management of hypertension in clinical practice.


The value of bio-objects and policy discourses in Europe

Svalastog AL, Croat Med J. 2014;55:167-70

Abstract: In a series of texts (primarily published in the Croatian Medical Journal ) new entities, identified and/or produced by new technology, have been analytically defined as bio-objects. Bio-objects derive from innovative knowledge, they are generated through a "bio-objectification" process, and continuously negotiat ed in the intersection of science, politics, and society. Identification and construction of bio-objects are conducted in a variety of practices and discourses inside and outside of scientific laboratories, and configured in science, policy, and media. Information-over-loaded knowledge landscapes (KL) are in turn characterized by open-source distribution, and are both depoliticizing and (re-)politicizing the content and function of bio-objects. In this article, the focus is on the value of bio-objects, and includes an inquiry into the history of the changeable value of bio-objects as a scientific and economic project in Europe.

The organization and governance of research played an important role in the fundamental reorganization of science after World War II (WWII). Costs for research and treatment based on new technology were inevitable to achieve new knowledge, diagnostics, and treatments. Outcomes of the investments were uncertain, at the same time as priorities in the health care system became a more and more pressing issue to handle, for government as well as for individual hospitals, patient groups, and the European public. In this article, the relation between value production and society is emphasized, in particular the relative value of bio-objects, its close relation to the process of reorganizing science in post-war Europe, and the present situation of relative value generated by priority challenges.


Developing an interactive mobile phone self-report system for self-management of hypertension. Part 1: Patient and professional perspectives

Bengtsson U, Kasperowski D, Ring L, Kjellgren K, Blood Press 2014 Feb 24 [Epub ahead of print]

Abstract: Low adherence remains a struggle in hypertension management, despite improvement efforts. Presuming that increased patient participation is a possible approach, we collaborated with patients and healthcare professionals to design a self-report system to support self-management. The study aimed to explore and describe relevant aspects of hypertension and hypertension treatment, for use in the development of an interactive mobile phone self-report system. It further aimed to suggest which clinical measures, lifestyle measures, symptoms and side-effects of treatment would be meaningful to include in such a system. Five focus group interviews were performed with 15 patients and 12 healthcare professionals, and data was analysed using thematic analysis. Patients suggested trust, a good relationship with caregivers, and well-being as important aspects of hypertension self-management. Furthermore, they regarded blood pressure, dizziness, stress, headache and tiredness as important outcomes to include. Patients sought to understand interconnections between symptoms and variations in blood pressure, whilst healthcare professionals doubted patients' ability to do so. Healthcare professionals emphasized accessibility, clear and consistent counselling, complication prevention and educational efforts. The study presents aspects of importance for follow-up to understand the interplay between blood pressure and daily life experiences for patients with hypertension.


Possibilities and limits of mind-reading: A neurophilosophical perspective

Evers K & Sigman M, Consciousness and Cognition, 2014;22:887–897

Abstract: Access to other minds once presupposed other individuals' expressions and narrations. Today, several methods have been developed which can measure brain states relevant for assessments of mental states without 1st person overt external behavior or speech. Functional magnetic resonance imaging and trace conditioning are used clinically to identify patterns of activity in the brain that suggest the presence of consciousness in people suffering from severe consciousness disorders and methods to communicate cerebrally with patients who are motorically unable to communicate. The techniques are also used non-clinically to access subjective awareness in adults and infants. In this article we inspect technical and theoretical limits on brain–machine interface access to other minds. We argue that these techniques hold promises of important medical breakthroughs, open up new vistas of communication, and of understanding the infant mind. Yet they also give rise to ethical concerns, notably misuse as a consequence of hypes and misinterpretations.


In Need of Meta-Scientific Experts?

Farisco M, AJOB Neuroscience 2014, 5(2):20-52

Abstract: A recent Italian case shows that the interpretation of neuroscientific evidence is often uncertain and debated. Judges and courts have to deal with this uncertainty. We suggest as a strategy to assess it the involvement of meta-scientific experts who can help lay people (as judges and juries presumably are, in science) to understand the formal and conceptual limitation of neuroscience.


Making researchers moral: Why trustworthiness requires more than ethics guidelines and review

Johnsson L, Eriksson S, Helgesson G & Hansson MG, Research Ethics 2014;10(1):29-46

Abstract: Research ethics, once a platform for declaring intent, discussing moral issues and providing advice and guidance to researchers, has developed over time into an extra-legal regulatory system, complete with steering documents (ethics guidelines), overseeing bodies (research ethics committees) and formal procedures (informed consent). The process of institutionalizing distrust is usually motivated by reference to past atrocities committed in the name of research and the need to secure the trustworthiness of the research system. This article examines some limitations of this approach. First, past atrocities cannot provide the necessary justification unless institutionalized distrust is a necessary or efficient means to prevent future ones – and there are several reasons to doubt this. Second, the efficacy of ethics review in safeguarding morally acceptable research depends on the moral competence and integrity of individual researchers – the very qualities that institutionalized distrust calls into question. Third, ethics guidelines cannot, as is sometimes assumed, educate or guide researchers in moral behaviour unless they already possess considerable capacity for moral judgment. Fourth, institutionalized distrust is a potential threat to the moral competence and integrity of researchers by encouraging a blinkered view of ethical issues, inducing moral heteronomy through incentives, and alienating them to research ethics. We conclude that the moral problem posed by inappropriate short-term behaviour on behalf of researchers is dwarfed by the potential long-term consequences if their moral competence is allowed to deteriorate. Measures must therefore be taken to ensure that researchers are equipped to take their individual responsibility and are not obstructed from so doing.


Distortion, confusion, and impasses: could a public dialogue within Knowledge Landscapes contribute to better communication and understanding of innovative knowledge?

Svalastog AL, Allgaier J, Martinelli L, Gajovic S:, Croat Med J. 2014;55:54-60, doi: 10.3325/cmj.2014.55.54

Summary: Researchers and scientists need to communicate new knowledge to society. Previously, the discussion on this communication process has focused on dialoge between scientists on the one hand, and policy makers and the public on the other. The authors suggest that today, researchers, PR consultants, interest groups, policy makers and lay people interact on the Internet, creating "knowledge landscapes" where knowledge is interrelated, framed and shaped. The focus of this article is on "bio objects" (such as stem cells and chimeras) and science communicaiton in relation to citizenship and personalized medicine.


Hope for a cure and altruism are the main motives behind participation in phase 3 clinical cancer trials

Godskesen T, Hansson MG, Nygren P, Nordin K, Kilhlbom U, European Journal of Cancer Care, 2014; doi: 10.1111/ecc.12184. Published  2 January 2014.

Abstract: It is necessary to carry out randomised clinical cancer trials (RCTs) in order to evaluate new, potentially useful treatments for future cancer patients. Participation in clinical trials plays an important role in determining whether a new treatment is the best therapy or not. Therefore, it is important to understand on what basis patients decide to participate in clinical trials and to investigate the implications of this understanding for optimising the information process related to study participation. The aims of this study were to (1) describe motives associated with participation in RCTs, (2) assess if patients comprehend the information related to trial enrolment, and (3) describe patient experiences of trial participation. Questionnaires were sent to 96 cancer patients participating in one of nine ongoing clinical phase 3 trials at the Department of Oncology, Uppsala University Hospital in Sweden. Eighty-eight patients completed the questionnaire (response rate92%); 95% of these were patients in adjuvant therapy and 5% participated in clinical trials on palliative care. Two main reasons for participation were identified: personal hope for a cure and altruism. Patients showadequate understanding of the information provided to them in the consent process and participation entails high patient satisfaction.


Enhancing Research Ethics Capacity in the Middle East: Experience and Challenges of a Fogarty-Sponsored Training

Siverman H, Edwards H, Shamoo A & Matar A, Journal of Empirical Research on Human Research Ethics: An International Journal, 2013;8(5):40-51

Abstract: We describe the research ethics capacity needs of the countries from the Middle East region. Against this background, we relate the experience of an international training program focused on providing long-term training in research ethics to individuals from low- and middle-income countries in the Middle East area. We describe our pedagogical approach to training, program changes to address challenges faced, and accomplishments of trainees. Many former trainees developed research ethics curricula in their home institutions, established or enhanced their institutions' research ethics committees, provided leadership to national research ethics systems, and conducted research in research ethics. Based on our analysis, we make recommendations for how trainees can further address current regional research ethics needs in the Middle East and conduct future research. This paper is part of a collection of papers analyzing the Fogarty International Center's International Research Ethics Education and Curriculum Development program.


ERIC - A new governance tool for Biobanking

Reichel J, Lind A-S, Hansson MG, Litton, J-E, European Journal of Human Genetics advance online publication 5 February 2014; doi: 10.1038/ejhg.2014.6

Abstract: In 2009, the EU introduced a new governance tool for research, the European Research Infrastructure Consortium, commonly referred to as ERIC. On 22nd November 2013, an ERIC within biobanking research was established, the BBMRI-ERIC, with its seat in Graz, Austria. This article analyses what use the ERIC can be to researchers in biobanking, focusing on legal and ethical perspectives. Our conclusion is that the main advantages with the ERIC are its functions as a platform, creating opportunities for long-term cooperation between the Member States involved and their researchers. Within the platform, research groups can develop functional standards for technical, legal and ethical purposes, set up criteria for biobanks, and so on. The ERIC also creates a platform for the involved researchers to communicate with policymakers in the EU and the Member States. However, when it comes to addressing the diverse regulatory framework for biobanking in the EU, one of the more important hurdles today, the ERIC does not provide for any substantial tools.


A big step for Finnish biobanking

Stjernschantz Forsberg J, Soini S, Nature Reviews Genetics, doi:10.1038/nrg3646. Published online 10 December 2013

Abstract: Human tissue samples and their associated data have become increasingly important in biomedical research. This development has led to a debate about the appropriate ethical and legal standards for their use, which has focused largely on the issue of informed consent. The traditional consent requirements of clinical research demand that individuals are informed about the specific details of every study, which presents substantial challenges for biobank research. A key question has therefore been how to weigh the interests of the individuals whose samples are used against the interests of research.


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Biobank and registry ethics

Biobank and registry ethics publications from CRB with abstracts

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By request: Final report from the project The use of human biobanks, Hansson, M.G. & Levin, M. (eds.), 2003: Biobanks as Resources for Health

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Nursing ethics

Nursing ethics publications from CRB with abstracts

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