New paper online: Ethical Hazards in Monitoring and Addressing Patient Decision Capacity in Clinical Practice

Just a little heads-up about a new research paper now being online (free to read and download). This one is lead by my Ph.D. student, Thomas Hartvigsson (presently visiting at Queen's University, Canada) and addresses aspects of his thesis topic about the normative roles of decision competence, for instance, in areas such as law or health care.

Together with Gun Forsander, chief senior clinical consultant at a childhood diabetes clinic, we use studies made in the area of teenage diabetes care, to argue that patient educational interventions meant to monitor and promote patients' intellectual understanding of general facts about their disease and the treatment brings ethical hazards likely to undermine some patient's decision-making capacities rather than enhancing or safeguarding them. At the same time, we find a strong general case for the idea of monitoring and addressing decision competence in patient groups where there is good reason to suspect especially fragile decision capacities, and sketch some challenges regarding staff competence and care organisation related to that.

The paper is freely available online for reading and download here.

New Article on the Ethics, Philosophy and Practice of Person-centred Care and Shared Decision-making

One topic that's been part of my research activities for some years now is the ethical and philosophical implications of movements to transform health care practices towards more of what's often called a "patient-" or "person-centred" perspective, sharing clinical decisions with patients to a larger extent. I've been lucky to publish a few analytical works in this area in collaboration with, e.g., Lars Sandman and Daniela Cutas, which have attracted quite some attention, partly as an outcome of an ongoing research collaboration with the pediatric diabetes centre at the Sahlgrenska University Hospital, involving medicine, psychology, organisation, communication, care and human factors risk research, besides philosophy and ethics. Now I'm happy to announce the first of a number of planned articles coming out of empirical and multi-disciplinary investigations of communicative aspects of adolescent diabetes care undertaken in this project, authored by Anders Herlitz, myself, Marianne Törner and Gun Forsander. This article uses outtakes from a video-study of continuous doctor-patient consultation sessions forming the bulk of adolescent diabetes inpatient care (the rest is self-care performed by the younsters themselves) to question received assumptions in standard notion of what person-centredness and shared decision-making should involve, basing our arguments in received results from behavioural science and moral psychology. Instead, we advocates a new approach for patients who are at risk of suffering from weak decision capacities when performing self-care, while being in need of significant portions of such care. We also argue, that this new model exposes an hitherto ignored ethical tension within the person-centredness and shared decision-making advocacy, which needs to be adressed and managed for care to be defensible.

The article is entitled "The Counselling, Self-care, Adherence Approach to Person-centred Care and Shared Decision-making: Moral Psychology, Executive Autonomy and Ethics in Multi-dimensional Care Decisions", and has been accepted for publication in the journal Health Communication, to appear shortly. Meanwhile, interested parties may sample our final draft after the critical review that lead to acceptance (a so-called postprint), which has been made available here. In the pipeline are at least two more works based on this study, one of which on the role of parents and family in adolescent care, and one on conrete strategies to promote what in the article promoted here is called "robust decision capacity". In the future lingers further yet undecided things, as I am part of a group that has just received a nice bit of funding for continuing working on this topic.