Newsletter

CURRENT WORK

A number of end-of-life issues, emphasizing decision-making and patient autonomy, is currently being considered. The Council hosted a conference on end-of-life decision-making in January 2008, attended by medical experts and other representatives from several health care areas. The discussions and the work of the Council is expected to be summarized in an opinion in 2008.

Equal access to health care for asylum seekers and undocumented people has been debated in Sweden in the last two years. The council has closely monitored the debate and also discussed the issue with several invited experts in the field.  In March this year the Council in a letter proposed the government to improve the health care for asylum seekers and undocumented people in Sweden.

The Council has recently started to work on the following topics; hybrids and chimeras, priorities and ethical principles in health care, prenatal diagnosis by means of  analysis of ‘fetal cells’ in maternal blood.
 

RECENT OPINIONS

Opinion on Risk of violations of childrens’ rights in health care due to ambiguous regulations, 2008-01-08
The Swedish Council on Medical Ethics proposes in a letter to the Swedish government that a review of the legal options to promote children’s rights in health care be undertaken.
Sweden lacks explicit general regulations concerning young people’s status as patients in healthcare. The Swedish healthcare act does consider principles of the Convention on Children’s Rights, such as a respect for the best interests of the child. But there are uncertainties in the legislation and in the implementation of the Convention in the sector.
According to the Council, there is a risk that the ambiguity of the regulations might lead to violations of the integrity of young patients. Furthermore, the Council expresses a concern that healthcare, protection and support is unsatisfactorily provided to these patients.
Clarifying the regulations about young people in healthcare would make their needs more visible and strengthen their autonomy and rights.

Opinion on new method for risk assessment as a basis for decision-making in prenatal diagnosis, 2007-11-06
The Council has analysed a new method for assessing the risk of chromosomal anomalies in the foetus. The method is a combination of ultrasound and maternal biochemistry, (CUB) The result of this combined test contributes to the decision whether to offer genetic prenatal diagnosis.
The method entails a risk assessment based on an early ultra sound screening (10-14th week), a blood sample and the age of the pregnant woman. It aims at giving a pregnant woman the best possible basis for her decision  whether to undertake a genetic prenatal diagnosis, PND. PND requires samples to be taken either from the amniotic fluid or the placenta, and carries a risk for miscarriage.
The combined test is an alternative to the method currently in use. The current method, hereafter termed “age indication”, is based on how chromosomal anomalies vary statistically with the age of the pregnant woman. Genetic prenatal diagnosis is currently offered to women above 35 years of age.
Several counties are presently considering an introduction of the combined test. In the report, the Council discusses ethical aspects to consider when choosing between the two methods.
The Council concludes that the combined test is preferable to age indication. According to the Council, the combined test does not threaten human dignity as long as it is made clear that both the combined test and the genetic prenatal diagnosis are offers that the woman can accept or decline at her own discretion. How this information is communicated with the pregnant woman and her partner is of great importance. The appropriate procedure for this is discussed in the report.
It is likely that a large scale introduction of the combined test will lead to a higher frequency of identified foetuses with chromosomal anomalies such as Down’s syndrome. This, in turn, might lead to fewer births of children with those anomalies. The Council emphasises that steps towards a more accurate prenatal diagnosis should not undermine society’s support for functionally disabled people.
Continued advances in prenatal diagnosis can be expected, e.g. methods based on the analysis of foetal cells or free foetus DNA extracted from the blood of the pregnant. The Council intends to monitor the development in this area and stresses the importance that careful attention be given to the ethical aspects of new methods prior to their introduction.