Monday October 13
09:30 – 09:35 Welcome
09:35 – 10:35 Krister Bykvist (IFFS/Stockholm)
The value of transformative health states
Among health economists, who think that preferences are the correct standard of the value of health states, it is common to assume, at least implicitly, that the correct criterion of this value takes the following schematic form: H1 is a better health state than H2 iff the members of group S prefer (on average) being in H1 to being in H2. Various candidates for members of S have been proposed, including medical experts, the general public, H1-patients, H2-patients, former H1-patients, former H2-patients, or combinations of these groups. I shall argue that criteria of this form run into serious problems, when the health states are transformative in the sense that people’s fundamental preferences change when they enter them. I shall also show that these problems afflict hybrid views, according to which preferences are only one determinant of the value of health, the objective value of health states being another. Finally, I shall argue that a better subjectivist criterion, according to which, the value of a health state is determined by the absolute attitudes (favouring, disfavouring, neutrality) people would have towards a health state were they to be in it. Along the way, I will also present and make use of an attitude matrix framework that enables us to represent in a simple way complex information about attitudes. With this framework at hand, we can easily see the advantages and disadvantages of different subjectivist accounts of the value of health.
10:35 – 10:45 Break
10:45 – 11:45 Anna Mahtani (LSE)
The tragedy of irreversibility
In cases of preference change – including cases of dementia – we sometimes want things for our future selves that we no longer want when that future time arrives. I consider whether we are ever justified in fulfilling the preferences of a past self at the expense of fulfilling the preferences of a present or future self. I argue that cross-temporal compensation arguments - justifying present harms by pointing to past benefits - only work when past decisions cannot be reversed. This creates perverse incentives toward irreversible self-binding, even when such binding is costly or harmful. I conclude by considering whether cognitive decline in dementia cases provides grounds for an alternative approach.
11:45 – 11:55 Break
11:55 – 12:55 Ulrik Kihlbom (KI)
Transformative and informed consent to medical treatment. What requirements can reasonably be put on patients’ abilities to know and evaluate future events?
Patients may face decisions with outcomes that involve transformative experiences—situations where their fundamental values and aspects of their personality may change over time and along the trajectory of the disease. Some scholars argue that such future experiences cannot be rationally evaluated because they are, by nature, inaccessible until lived: you need to be in them to truly understand them. Others contend that it is the very transformation of fundamental values that prevents meaningful evaluation of these experiences. In this talk, using a patient case as a point of departure, I will argue that such considerations have limited relevance for patients who are potentially facing decisions that may lead to transformative experiences.
12:55 – 14:00 Lunch (at IFFS)
14:00 – 15:00 Lars Sandman (Linköping)
Does the equivalence between withdrawing and withholding treatment hold for transformative experiences?
A commonly held opinion in medical ethics is that withdrawing and withholding treatment is ethically equivalent, here in the formulation of Wilkinson and Savulescu (2014):
“Other things being equal, it is permissible to withdraw a medical treatment that a patient is receiving if it would have been permissible to withhold the same treatment (not already provided), and vice versa.”
Schmidt (2016) have argued that withdrawing an option is a stronger interference in a person’s freedom than simply witholding it, both since an existing option might become and integral part of the person’s identity, but also (and perhaps mainly) since it increase the person’s option set. Especially if the available option is a so called fecund option, i.e. opening up for even more choices. If this is true, there would seem to be a higher price to withdrawing a treatment or option, than only withholding it. Schmidt’s view can be questioned, first because a person might start to change their identity, simply by knowing there is a fecund option available, even if it is later withheld. Second, it would seem that the the actual option set for the person is equally affected by withdrawing and withholding treatment. But is this also true of transformative experiences, or do they imply a radically different change in identity and option sets? If so, does this make it normatively more problematic to withdraw a transformative treatment than a non-transformative treatment from a patient? In the talk I will explore these issues.
15:00 – 15:10 Break
15:10 – 16:10 Borgar Jølstad (Institute of Health and Society, Oslo)
Prioritizing transformative treatment
On what I call the Claims view of healthcare priority setting priority setting is the process of adjudicating between claims on healthcare resources. Healthcare interventions that have transformative properties, such as psychedelically assisted therapies, present a problem for this view. Choosing whether to receive these treatments may be an instance of what L.A. Paul has called transformative choice. When facing a transformative choice, it is dubious whether we can make a rationally informed decision from an authentic first-person perspective. It is therefore hard to argue that the patient ought to make a claim on healthcare resources. This is a problematic conclusion, since we intuitively ought to fund treatments such as psychedelically assisted therapy. I will discuss whether we should reject the claims view in favor of an impersonal view of priority setting, if claims can be made from an impersonal view, and finally whether the problem is Paul’s account of transformative experience.
16:10 – 16:40 Fika at IFFS
16:40 – 17:40 Collaboration session
18:30 – Dinner
Participants
Krister Bykvist (IFFS/Stockholm University)
Tim Campbell (IFFS)
Julia Mosquera (IFFS)
Orri Stefansson (IFFS/Stockholm University)
Anders Herlitz (IFFS/Lund University)
David Lindquist (Linköping University)
Daniel Ramöller (IFFS)
Niklas Juth (Centre for Research Ethic and Bioethics, Uppsala University)
Ulrik Kihlbom (Karolinska Institute)
Sven Ove Hansson (KTH Royal Institute of Technology)
Barbro Fröling (KTH Royal Institute of Technology)
Erik Gustavsson (Linköping University)
Lars Sandman (Linköping University)
Anna Mahtani (LSE)
Borgar Jølstad (Institute of Health and Society, Oslo University)
William Bülow (CRB)
Gert Helgesson (Karolinska Institute)