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Well, well, I'm not surprised....
As previously reported, the Swedish government this weekend decided not to implement the recommendation by a governmental committee to economically compensate the victims of a deeply repugnant pattern of abuse and mistreatment within the national foster care system. And I was far from the only one reacting against this uncommonly ill-considered decision and the so obviously empty rhetoric with which it was presented. On the contrary, it would appear that ministers Maria Larsson and her colleagues in the government were the only ones in the country actually being in favor of the decision. The storm of criticism has been massive and coming from all angles, from grass-root voters of all political shades to important and influential national politicians of all parties besides the ones presently trying to run a minority government.
It's not very surprising, therefore, that the responsible minister yesterday (joined by the prime minister today) went public expressing her willingness to reconsider the decision. Larsson couldn't quite entirely face up to the fact that she and her mates had made a colossal political blunder – surrounding her statement with conditions about "the entire opposition" having to present an alternative proposal. But these are just empty words. Larsson and her boss Reinfeldt know very well that if they don't roll over, they will be humiliated by parliament and will have to go back to square one to do the job that parliament had decided to have them do in the first instance.
In comments in the Swedish media, representatives of the opposition either laugh off this childish behaviour, or express surprise at the so obviously politically stupid formulations by a responsible minister. So, as it looks right now, the compensation will be forthcoming, regardless of how much that hurts the pride of a minister who should indeed have known better in the first place.
Tuesday, 13 September 2011
Saturday, 10 September 2011
Goverment Decision not to Compensate Abused Swedish Foster Care Children: Hypocritical and Invalid
Early this year, a Swedish government committee revealed a scandalous rate of long-standing and severe abuse of children enrolled in the public foster care system (here, here, here, here, here, here). The deeply repugnant pattern of mistreatment goes way back in time, as far as the 1920's, and is, the committee reported, still ongoing. The committee recommended that the government, besides the obvious task of putting a halt to ongoing abuse and express an official apology to past victims, should offer substantial economic compensation to victims of abuses in the past.
Today, however, Sweden's current minister of children and the elderly, Maria Larsson (Christian Democrat), to big surprise reported that the government will not follow the recommendation of the committee (here, here, here, here, here, here, here, here, here, here, here, here) The given reason is that a compensation scheme would be impossible to implement in a fair and legally secure way. This reason, however, appears to be completely invalid and, in addition, incoherent with established policy.
The suggestion to economically compensate victims of past abuse is consistent with the way that Sweden eventually came to handle victims of the compulsory sterilisation policies that were in operation between 1935 and 1975. These were offered economic compensation (besides an official apology) and this was swiftly implemented. So, obviously, it is possible to set up a satisfactory system for compensating victims of mistreatment resulting from official policy. Maria Larsson is simply not telling the truth here. Even worse: since she is well aware of the compensation in the sterilisation case, she is deliberately holding out a pretext as good reason.
To this may be added that the compulsory sterilisation program, when it ran, was part of officially condoned policy, enjoying broad support all across the political and religious board. It was also accepted as a part of acceptable professional practice by medical doctors. The decision to compensate thus was an ethical decision, based on the assessment that although no formal error had occurred, a serious moral mistake had been made. In the case of the abuse of foster children, however, it is obvious that formal errors have been made. Not least, official agencies responsible for the administration of the system have obviously committed serious errors of neglect. So, here we have something which is both a moral and a formal fault, but then the government decides not to compensate. This is official hypocrisy at the highest level.
And allow me to become a bit personal: Maria Larsson is supposed to represent a political party the stronghold of which is held out to be politics on the basis of christian ethics, with the interests of the weakest and most vulnerable at the center of attention. How she manages to look at herself in the mirror with a straight face when making the decision revealed today is beyond me: the hypocrisy apparently goes far beyond just inconsistent and ill-considered official policy making. This shakes the very fundamentals of our country's supposed "ethical" party.
But it doesn't stop there. At the same time as Maria Larsson deliver her deeply unethical, formally erroneous decision under the smokescreen of an obviously bogus reason, she has the extremely bad taste of offering the victims of the abuses for which Swedish public institutions are both morally and formally responsible a "ceremony" where an official apology is extended, to which the victims will be invited. In short: spit in their faces and make a ceremonial bow.
Shame, shame shame!
Today, however, Sweden's current minister of children and the elderly, Maria Larsson (Christian Democrat), to big surprise reported that the government will not follow the recommendation of the committee (here, here, here, here, here, here, here, here, here, here, here, here) The given reason is that a compensation scheme would be impossible to implement in a fair and legally secure way. This reason, however, appears to be completely invalid and, in addition, incoherent with established policy.
The suggestion to economically compensate victims of past abuse is consistent with the way that Sweden eventually came to handle victims of the compulsory sterilisation policies that were in operation between 1935 and 1975. These were offered economic compensation (besides an official apology) and this was swiftly implemented. So, obviously, it is possible to set up a satisfactory system for compensating victims of mistreatment resulting from official policy. Maria Larsson is simply not telling the truth here. Even worse: since she is well aware of the compensation in the sterilisation case, she is deliberately holding out a pretext as good reason.
To this may be added that the compulsory sterilisation program, when it ran, was part of officially condoned policy, enjoying broad support all across the political and religious board. It was also accepted as a part of acceptable professional practice by medical doctors. The decision to compensate thus was an ethical decision, based on the assessment that although no formal error had occurred, a serious moral mistake had been made. In the case of the abuse of foster children, however, it is obvious that formal errors have been made. Not least, official agencies responsible for the administration of the system have obviously committed serious errors of neglect. So, here we have something which is both a moral and a formal fault, but then the government decides not to compensate. This is official hypocrisy at the highest level.
And allow me to become a bit personal: Maria Larsson is supposed to represent a political party the stronghold of which is held out to be politics on the basis of christian ethics, with the interests of the weakest and most vulnerable at the center of attention. How she manages to look at herself in the mirror with a straight face when making the decision revealed today is beyond me: the hypocrisy apparently goes far beyond just inconsistent and ill-considered official policy making. This shakes the very fundamentals of our country's supposed "ethical" party.
But it doesn't stop there. At the same time as Maria Larsson deliver her deeply unethical, formally erroneous decision under the smokescreen of an obviously bogus reason, she has the extremely bad taste of offering the victims of the abuses for which Swedish public institutions are both morally and formally responsible a "ceremony" where an official apology is extended, to which the victims will be invited. In short: spit in their faces and make a ceremonial bow.
Shame, shame shame!
Sunday, 4 September 2011
Abortion, Mental Health Problems and the Politicisation of Science
Just the other day, several UK newspapers (here, here) reported about a new, ambitious study on the relationship between abortion and mental health problems. Undertaken by Priscilla Coleman, professor at the Bowling Green State University, and published in the well-renowned journal, British Journal of Psychiatry, the study is a so-called meta-analysis where data and results from many different studies in this area are brought together and analysed as a whole. The result is that evidence speaks in favor of a significant statistical correlation between abortion and elevated risks of mental health problems after abortion. Not surprisingly, this news have been ceased on by political campaigners who want to push for more restrictive abortion legislation. Coleman herself is markedly more modest, concluding only that...
First, neither the news reporting, nor the abstract to the actual article reveals if and to what extent Coleman's analysis has controlled for relevant so-called confounders – i.e. other factors contributing to the onset of mental health problems. In particular, it is unclear to what extent the analysis has factored in the presence of mental health problems or risk factors for such problems before abortion and, indeed, pregnancy. When I had reason, several years back, to look at research in this area undertaken in Sweden, a repeated phenomenon was that there indeed were correlations between abortion and mental health problems, but that the occurrence of this problems almost always could be linked to the presence of such problems (or risk factors for them) before abortion or even the actual pregnancy. Now, Coleman's results indeed indicate that women who undergo abortion have elevated risks compared to a substantial control group. However, in lack of controlling for the presence of problems before abortion, this may just as well support the notion that women already suffering from mental health problems or who are victims of risk factors for this are more likely to establish pregnancies that they eventually would prefer to have terminated. Indeed, such a link was suggested by a large Danish study published last year in the highly ranked journal New England Journal of Medicine. This, in turn, may depend on a lot of different things, such as being placed in a dysfunctional psycho-social context (e.g. lack of a reliable partner, poverty, disorganised housing situation, et cetera). Hopefully, time will tell what quality Coleman's study actually possess in this respect and, in the case of deficiencies, that further studies are undertaken to investigate the issue.
However, even if it turns out that Coleman's results hold up to closer scrutiny, the sort of factors just mentioned make the interpretation of Coleman's practical recommendation made in the media quite odd, if not biased – just as the one reported about the reaction of many campaigners against liberal abortion legislation. For suppose that Coleman indeed is right in the strongest sense, is the most obvious conclusion then that we should move to restrict access to legal abortion? Actually not, since there is strong scientific support for the claim that such actions lead to no good (in particular, they do not prevent abortions). How about informing about the risk then? Well this looks more sensible, although, if the underlying explanation of abortion being a risk factor is that a certain portion of abortion seeking women are already burdened by mental health problems that threaten to become more serious if they are exposed to trauma of some kind, one may doubt the efficacy of such actions.
Instead, the practical conclusion that would seem to be gaining the most support would be this: Researchers like Coleman should rapidly proceed to develop instruments to identify those at risk, and abortion services should offer these women special post-abortion care and counseling, or even preventive actions before the procedure is undertaken that may serve to decrease the risk. If such an instrument proves difficult to develop, such care and counseling should become a standard ingredient of good clinical abortion practice all across the board. I must say that I find it a bit odd and worrying that Coleman's own practical suggestion does not focus on this. After all, if women's mental health is what you care about, practical implications should focus on actions directed at promoting that aim.
Consistent with the tenets of evidence-based medicine, this information should inform the delivery of abortion services.In the news reporting, this statement has generally been read as a call for telling abortion seeking women about the risks. Now, if you believe in individual liberty, women's right to decide over their own body or is generally oriented towards pro-choice positions on abortion, this may not appear to be very shocking. After all, abortion is a serious medical or (when undertaken in later stages of pregnancy) surgical procedure that is often undertaken in the context of a personal crisis. If there indeed is a link between undergoing this procedure and suffering mental health problems, this should be explained to women contemplating abortion, shouldn't it? However, there are several question marks surrounding Coleman's result and what conclusions can be inferred from it, both scientifically and with regard to policy.
First, neither the news reporting, nor the abstract to the actual article reveals if and to what extent Coleman's analysis has controlled for relevant so-called confounders – i.e. other factors contributing to the onset of mental health problems. In particular, it is unclear to what extent the analysis has factored in the presence of mental health problems or risk factors for such problems before abortion and, indeed, pregnancy. When I had reason, several years back, to look at research in this area undertaken in Sweden, a repeated phenomenon was that there indeed were correlations between abortion and mental health problems, but that the occurrence of this problems almost always could be linked to the presence of such problems (or risk factors for them) before abortion or even the actual pregnancy. Now, Coleman's results indeed indicate that women who undergo abortion have elevated risks compared to a substantial control group. However, in lack of controlling for the presence of problems before abortion, this may just as well support the notion that women already suffering from mental health problems or who are victims of risk factors for this are more likely to establish pregnancies that they eventually would prefer to have terminated. Indeed, such a link was suggested by a large Danish study published last year in the highly ranked journal New England Journal of Medicine. This, in turn, may depend on a lot of different things, such as being placed in a dysfunctional psycho-social context (e.g. lack of a reliable partner, poverty, disorganised housing situation, et cetera). Hopefully, time will tell what quality Coleman's study actually possess in this respect and, in the case of deficiencies, that further studies are undertaken to investigate the issue.
However, even if it turns out that Coleman's results hold up to closer scrutiny, the sort of factors just mentioned make the interpretation of Coleman's practical recommendation made in the media quite odd, if not biased – just as the one reported about the reaction of many campaigners against liberal abortion legislation. For suppose that Coleman indeed is right in the strongest sense, is the most obvious conclusion then that we should move to restrict access to legal abortion? Actually not, since there is strong scientific support for the claim that such actions lead to no good (in particular, they do not prevent abortions). How about informing about the risk then? Well this looks more sensible, although, if the underlying explanation of abortion being a risk factor is that a certain portion of abortion seeking women are already burdened by mental health problems that threaten to become more serious if they are exposed to trauma of some kind, one may doubt the efficacy of such actions.
Instead, the practical conclusion that would seem to be gaining the most support would be this: Researchers like Coleman should rapidly proceed to develop instruments to identify those at risk, and abortion services should offer these women special post-abortion care and counseling, or even preventive actions before the procedure is undertaken that may serve to decrease the risk. If such an instrument proves difficult to develop, such care and counseling should become a standard ingredient of good clinical abortion practice all across the board. I must say that I find it a bit odd and worrying that Coleman's own practical suggestion does not focus on this. After all, if women's mental health is what you care about, practical implications should focus on actions directed at promoting that aim.
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