Medium-Range Narratives as a Complementary Tool to Principle-Based Prioritization in Sweden: Test Case “ADHD”

Abstract

In this paper, for the benefit of reflection processes in clinical and in local, regional, and national priority-setting, we aim to develop an ethical theoretical framework that includes both ethical principles and medium-range narratives. We present our suggestion in the particular case of having to choose between treatment interventions for attention deficit hyperactivity disorder (ADHD) and treatment interventions for other conditions or diseases, under circumstances of scarcity. In order to arrive at our model, we compare two distinct ethical approaches: a generalist (principles) approach and a particularist (narratives) approach. Our focus is on Sweden, because in Sweden prioritization in healthcare is uniquely governmentally regulated by the “ethics platform.” We will present a (fictional) scenario to analyse the strengths and weaknesses of the generalist principled perspective of the ethics platform and the particularist perspective of narrative ethics. We will suggest an alternative (moderately particularist) approach to prioritization, which we dub a “principles plus medium-range narratives” approach. Notwithstanding the undeniably central role of principles in distributive justice, we claim that medium-range narratives concerning individuals or groups who stand to benefit or lose from ADHD prioritization practices should also be read or listened to and taken into account at all levels of priority-setting. These narratives are expected to ethically optimize clinical priority-setting, as well as that undertaken at local, regional, and national levels.

Two cases of nursing older nursing home residents during COVID-19

“…The cases were translated and adapted to improve readability and are presented in this paper—not only to illustrate the identified challenges but also to function as medium-range narratives. 7 “Medium-range” means here that these narratives allow us to focus on both the individual and societal implications of moral decisions without sacrificing one perspective for the other from the very beginning. The cases in this paper are deduced from separate events narrated by two nursing home nurses, respectively, in the study.…”

To Your Good Health! Going to the Pub With Friends, Nursing Dying Patients, And ‘ER’ Receptionists: the Ubiquitous Rise of Risk Management and Maybe A ‘Prudential’ Bioethics?

“…Shahvisi argues that the use of 'alternative' medicine by women is driven by the neglect of their needs by mainstream 'scientific' health services (Shahvisi 2019). Jaarsma and Gelhaus examine the policy settings in Sweden for access to ADHD treatments, and the role of narratives in this process (Jaarsma and Gelhaus 2019).…”