Abstracts fra Bibliotek for Læger 1/2014

 

Originalartikel: »Nudging« i den kliniske kontekst

Libertariansk paternalisme, informeret samtykke og sundhed
Thomas Ploug

’Nudging’ in the clinical context. Libertarian paternalism, informed consent and health. 

Bibl Læger 2014;206;4-27.

This article considers the ethics of using ’nudging’ in the clinical context. The notion of nudging, choice-architecture and different nudging-strategies are introduced and explored along with the underlying philosophical framework of Libertarian Paternalism. The concept of personal autonomy and its links to the standard requirements of a valid informed consent is briefly introduced and explored. On this basis it is argued 1) that the use of nudging techniques grounded in Libertarian Paternalism will not in itself protect personal autonomy and informed consent, and moreover 2) that the use of nudging techniques grounded in Libertarian Paternalism is hard to reconcile with the requirement of informed consent. The article goes on to distinguish three types of Libertarian Paternalism – welfare-, preference- and liberty-enhancing Libertarian Paternalism – and argues that the latter two interpretations to different extents may be reconciled with the requirements of informed consent. In the end, it is argued that widespread nudging in the health care sector is likely to have adverse effects on the general trust and confidence in the health care personnel.

Originalartikel: Sygehusene i den islamiske verden i den klassiske tid
Philippe Provençal

Hospitals in the islamic world during the classic period. 

Bibl Læger 2014;206:28-41.

The Arabic hospital was one of the major improvements in the health caring in society compared to earlier times. This paper describes the Arabic hospital in the Classical Islamic culture (approximately 750 – 1500 AD) its origins, functions and place in contemporary society. The Arabic hospitals in medieval times were secular institutions, in which health care was practised along Hippocratic/Galenic lines. They were financed by endowment and sometimes also by direct funding by the ruler. They served in three major fields namely helping and curing of patients, teaching and education of physicians and development of drugs and medical methods. The chief of the medical staff was always a trained physician, and the physicians working at the hospitals often were among the best medical names in contemporary society. Medical students were encouraged and often required to use practice at a hospital as part of their medical formation, and the empirical knowledge acquired by the daily work at the hospital was systematised. The Arabic hospital was therefore an important part of the urban health system in the Arabic and Islamic world in medieval times.

Kvartalets genstand
Morten A. Skydsgaard

Originalartikel: Etablering af klinisk etiske komitéer i Danmark

En praksis-filosofisk tilgang til klinisk etik 
Uffe Juul Jensen, Carsten Hædersdal & Mogens Kim Skadborg

A practice-philosophical approach to clinical ethics. Establishment of clinical ethics committees in Denmark

Bibl Læger 2014; 206:44-61

This article presents the work currently being done in connection with the establishment of clinical ethics committees in Denmark. Based on the historical, medical and philosophical background for why there has developed a need for clinical ethics committees, it is described how a practice-philosophical clinical ethical approach to the ethical problems, that may constitute a necessary contribution in establishing the clinical ethics committees. It is illustrated how applied ethics differs from ethics in practice (practical ethics), when using a case-based ethical analysis in an effort to reflect on clinical ethical dilemmas. The various phases of the case-based practice-oriented analysis model are reviewed. The model includes five steps: It starts with a survey and assessment of the facts, followed by an ethical diagnostic phase. The third stage describes elements containing a debate and resolution on the goals of treatment. The last two phases are descriptions of possible evaluations of the work of the ethics investigation, both simultaneously with the study and retrospectively. The article ends with a brief description of the structural and organizational issues related to the work of clinical ethics committees, and it is concluded, inter alia, that there is a need for members of the clinical ethics committees to be trained in ethical reflection.

Et billede fra min hverdag
Egon Toft

Originalartikel: Etiske overvejelser i forbindelse med hjemmerespiratorbehandling af mennesker med kronisk respirationsinsufficiens

Mogens Kim Skadborg & Uffe Juul Jensen

Ethical considerations for home mechanical ventilation of people with chronic respiratory insufficiency.

Bibl Læger 2014;206:64-81

This article presents some ethical issues for consideration in connection with invasive mechanical ventilation of patients with chronic respiratory deficient. Based on presentation of different case scenarios, the analysis of the use of home invasive mechanical ventilation shows that ethical issues today can not be divorced from health and social policy issues. When people need invasive mechanical ventilation at home, they will also need a large number of other (helping) measures which extend the scope and extent of the practices that health care should be able to coordinate and establish. The examination of the ethical perspectives shows that not only the individual's good life is a theme in health care. Furthermore, dilemmas are discussed between different options in the relationship between the human in need of home mechanical ventilation, his aides and community resources. It is demonstrated that an ethical analysis based purely on applied ethical considerations is insufficient to solve the dilemmas of these practical ethical issues. There are no ethical principles that can solve the dilemmas and conflicts that can arise in this relationship. Dealing with ethical problems is often a matter of negotiation and mediation. This requires learning and education, a task such as might be provided by clinical ethics committees.

Originalartikel:Ludvig Jacobsons opdagelse af det vomeronasale organ i 1813

Hvad har vi sidenhen lært om organets funktion?
Aage Kristian Olsen Alstrup & Tobias Wang

Ludvig Jacobson’s discovery of the vomeronasal organ in 1813. 

What have we since learned about its function?

Bibl Læger 2014;206;82-92.

In 1813 the Danish surgeon and zoologist Ludvig Levin Jacobson (1783-1843) published his discovery of a new organ in the nasal cavity in mammals. Two years prior to this publication, Jacobson described the organ in a letter to the French anatomist Cuvier, who only published a short note about the discovery. Ludvig Jacobson published his article in Danish and in a veterinary journal, so the article never gained ground. The organ was, however, eventually named the Jacobson’s organ, but is now better known as the vomeronasal organ.

Interview: Filmene om den tabte tid 

En samtale med filminstruktøren og lægen Nils Malmros om at skabe film om sit eget liv.
Eva Hammershøy