Carl Tollef Solberg

University of Oslo · Faculty of Medicine

In the Global Burden of Disease study, disease burden is measured as disability-adjusted life years (DALYs). The paramount assumption of the DALY is that it makes sense to aggregate years lived with disability (YLDs) and years of life lost (YLLs). However, this is not smooth sailing. Whereas morbidity (YLD) is something that happens to an individua...

Death is something we mourn or fear as the worst thing that could happen—whether the deaths of close ones, the deaths of strangers in reported accidents or tragedies, or our own. And yet, being dead is something that no one can experience and live to describe. This simple truth raises a host of difficult philosophical questions about the negativity...

Caveat: The first posted pdf of this paper contained extensive misreferencing. Please download this updated version. Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concer...

Døden er et mysterium. Vi vet vi skal dø, men ikke når og hvordan. Vi vet heller ikke hva som skjer når vi dør. Forfatterne hevder at døden har gjennomgått en sekularisering som åpner opp nye problemstillinger. Hvordan skal døden håndteres? Er vi dømt til å leve med dødsangst? Og kan døden være positiv? Boken innbyr til filosofisk refleksjon, og be...

In recent years, it has become commonplace among the Global Burden of Disease (GBD) study authors to regard the disability-adjusted life year (DALY) primarily as a descriptive health metric. During the first phase of the GBD (1990-1996), it was widely acknowledged that the DALY had built-in evaluative assumptions. However, from the publication of t...

Despite Norway's long history of open priority setting in healthcare, formal priority setting in municipal health and care services had been lacking prior to the publication of a Norwegian official report (English: Green paper, Norwegian: NOU) on the topic in 2018 (the Blankholm report). This article examines the reception of the report's proposals...

Målet med denne artikkelen er å undersøke spesifikke utfordringer knyttet til prioriteringer i primaerhelsetjenesten, og deretter fremme argumenter for hvorfor dette likevel er nødvendig. Artikkelen begynner med å omtale priori-teringsdiskursen i spesialisthelsetjenesten. Jeg argumenterer for at primaerhelsetjenesten skiller seg fra spesialisthel-s...

It has become increasingly common to conduct research on popular views on ethical questions. In this paper, we discuss when and to what extent popular views should be included in a reflective equilibrium process, thereby influencing normative theory. We argue that popular views are suitable for inclusion in a reflective equilibrium if they approxim...

The practical goal of preventing premature death seems uncontroversial. But the term ‘premature death’ is vague with several, sometimes conflicting definitions. This ambiguity results in several conceptions with which not all will agree. Moreover, the normative rationale behind the goal of preventing premature deaths is masked by the operational de...

Palliativ virksomhet er i ekspansjon. Kan palliasjonen e"er hvert bidra i psykiatrien? Målet med denne artikkelen er å foreta en overordnet diskusjon om hva psykiatrisk palliasjon skulle inne- bære. Som vi skal se, kan palliativ psykiatri innebære alt fra mer humanisme i psykiatrien, til forventningsavklaring, til taktski#e i behandling og til beha...

The aim of this article is to show that philosophy can con- tribute to improving the last part of life in that it may allevi- ate the fear of death. We begin with a short presentation of what we mean when we talk of palliative care and hospices, then proceed with a presentation of ancient philosophers that may contribute to improving the "nal part...

En problemstilling i dødshjelpsdeba"en er hvordan dødshjelp kan forenes etisk med rollen som helsepersonell, og spesielt med rollen som behandlende lege. Andelen leger som stø"er legalisering av dødshjelp er økende, og en prosess for å avklare legens mulige oppgaver ved livets slu" er derfor betimelig. Legeyrket innebærer #ere faglige roller, en av...

This article discusses the fairness of geographically targeted vaccinations (GTVs). During the initial period of local and global vaccine scarcity, health authorities had to enact priority-setting strategies for mass vaccination campaigns against COVID-19. These strategies have in common that priority setting was based on personal characteristics ,...

If the expectations for psychiatry increase faster than the access to resources, the expectation gap will only continue to grow, leading to a crisis in psychiatry. We can manage this gap by reducing expectations, increasing efficiency or increasing resources.

The overarching aim of this article is to scrutinize how severity can work as a qualifier for the moral impetus of malady. While there is agreement that malady is of negative value, there is disagreement about precisely how this is so. Nevertheless, alleviating disease, injury, and associated suffering is almost universally considered good. Further...

Hvis forventningene til psykiatrien øker raskere enn ressurstilgangen, vil forventningsgapet bare fortsette å øke. Da blir det krise i psykiatrien. Vi kan håndtere dette gapet ved å redusere forventninger, effektivisere behandlingen eller øke ressursene.

During the recent debates on whether to prioritize health care workers for COVID-19 vaccines, two main lines of arguments emerged: one centered on maximizing health and one centered on reciprocity. In this article, we scrutinize the argument from reciprocity. The notions of fittingness and proportionality are fundamental for the act of reciprocatin...

The aim of this article is to study the relationship between Epicureanism and pandemic priority-setting and to explore whether Epicurus's philosophy is compliant with the later developed utilitarianism. We find this aim interesting because Epicurus had a different way of valuing death than our modern society does: Epicureanism holds that death—unde...

A growing number of doctors in Norway no longer support the Norwegian Medical Association's view on assisted dying. A number of medical associations internationally have taken a neutral stance. The Norwegian Medical Association should consider doing the same.

Background: In an ideal world, everyone would receive medical resources in accordance with their needs. In reality, resources are often scarce and have an alternative use. Thus, we are forced to prioritize. Although Norway is one of the leading countries in normative priority setting work, few descriptive studies have been conducted in the country....

Background Priority setting involves the practice of ranking interventions in order of their importance. In principle, the same priority setting criteria may be used across all levels of decision-making in health care. This may include decision-making on the macro (cabinet and the health ministry), meso (resource allocation within hospitals and hea...

Introduction Norway has a long tradition of open priority setting in health care services. However, the principles and instruments for priority setting have mainly been used in specialist health care. In 2017, an official committee was commissioned to evaluate if and how to adopt the three Norwegian priority-setting criteria – health benefit, resou...

Den norske debatten om psykisk helsevern avdekker stor avstand mellom forventninger og virkelighet. I somatikken godtar vi at sykdommer er kroniske og dødelige. Hvorfor gjelder ikke det i psykiatrien?

The Norwegian discourse on mental health care has revealed a wide gap between expectations and realities. In somatic medicine, it is accepted that some diseases are chronic and terminal. Why is this different in psychiatry?

Bakgrunnen for dette oppdraget er at Det kongelige barne- og familieverndepartementet har forespurt undertegnede om å foreta noen ytterligere betraktninger omkring kremering av hjerteimplantater (oppdrag: 9210ILL). Det bes om at dette blir vurdert mer utførlig: (I). graden av uverdighet/verdighet ved kremering med implantat (trykkutladning) sammenl...

Prioritering av koronavaksine: Råd og prosess Michael 2021; 18: Supplement 28: 49-59. Høsten 2020 inviterte Folkehelseinstituttet oss til å delta i en ekstern gruppe som skulle gi råd om prioritering av koronavaksiner i Norge. Gruppens mandat var å utarbeide mål for det norske koronavaksinasjonsprogrammet, samt gi overordnede anbefalinger om priori...

In Norway, priority for health interventions is assigned on the basis of three official criteria: health benefit, resources, and severity. Responses to the COVID-19 pandemic have mainly happened through intersectoral public health efforts such as lockdowns, quarantines, information campaigns, social distancing and, more recently, vaccine distributi...

Sammendrag I denne artikkelen tar vi for oss meningens filosofi og psykologi med Einar Duenger Bøhns teori om mening som utgangspunkt. I den populærfilosofiske boken «Meningen med livet» (Bøhn, 2019) har Bøhn nemlig brakt meningsdebatten på banen i norsk filosofi. Den positive teorien er at meningen med livet er forbedring. Målet med denne artikkel...

In the autumn of 2020, the Norwegian Institute of Public Health invited us to participate in an external group that would be advising on COVID-19 vac- cine priority-setting in Norway. The group’s mandate was to set goals for the Norwegian National Coronavirus Immunisation Programme, as well as to provide general recommendations regarding priority g...

In recent years, multifetal pregnancy reduction (MFPR) has increasingly been a subject of debate in Norway. The intensity of this debate reached a tentative maximum when the Legislation Department delivered their interpretative statement, Section 2 - Interpretation of the Abortion Act, in 2016 in response to a request from the Ministry of Health (2...

Koronapandemien har synliggjort nødvendigheten av prioriteringer i helsetjenesten vår. Helseprioriteringer i Norge skal gjøres etter de tre kriteriene nytte, ressurs og alvorlighetsgrad. Nytte-og ressurskriteriene utgjør til sammen et kostnadseffektivitetskriterium: Høyere prioritet tilfaller tiltak som skaper mye helse med få ressurser. Alvorlighe...

2020 became the year in which Norway was hit by a worldwide pandemic. The pandemic has reinforced well-known moral challenges and brought new ones center stage. In this article, we look at moral challenges with regard to infection control, experimental vaccination, fair distribution of the corona vaccine, as well as virtues and vices during a crisi...

https://www.fhi.no/publ/2020/rad-om-prioriterte-grupper-for-koronavaksinasjon-i-norge/ Folkehelseinstituttet har fått i oppdrag fra Helse- og omsorgsdepartementet å organisere koronavaksinasjonsprogrammet. Som en delleveranse av oppdraget har Folkehelse- instituttet etablert en ekstern ekspertgruppe i etikk og prioritering. Denne etikk- rådgivning...

The Norwegian Ministry of Health and Care Services has commissioned the Norwegian Institute of Public Health to organise the national coronavirus immunisationation programme. As a partial delivery of the assignment, the Norwegian Institute of Public Health has established an external expert group in ethics and prioritisation (henceforth: the ethics...

Har leger en moralsk plikt til å gi helsehjelp selv om de skulle mangle tilstrekkelig smittevernutstyr under en pandemi? Verken Genève-deklarasjonen, Legeforeningens etiske retningslinjer eller Norges lover gir oss noe presist svar. Vi vil argumentere for at svaret er nei. Leger som yter helsehjelp uten mulighet for adekvat smittevern, gjør mer enn...

Do doctors have a moral obligation to provide medical care if they lack adequate personal protective equipment during a pandemic? Neither the Declaration of Geneva, the Norwegian Medical Association’s ethical guidelines nor the Norwegian laws give us a precise answer. We will argue that the answer is no. Doctors who provide medical care without suf...

The aim of this article is to examine the arguments for and against the practice of discounting future health benefits. A more general, but related, question is whether we should discount future well-being. We begin with an explanation of what discounting means and how it is used as a method in the evaluation of health interventions. Next, we consi...

Målet med denne artikkelen er å undersøke de viktigste argumentene for og imot diskontering av fremtidige helsegevinster. Et mer generelt spørsmål dreier seg om hvorvidt vi bør diskontere fremtidig velferd (eng. well-being). Vi begynner med en redegjørelse av hva diskontering er, og hvordan diskontering påvirker evaluering av helsetiltak. Deretter...

I en ideell verden ville vi alle fått medisinsk behandling etter behov. Men i virkeligheten danner ressursknapphet selve rammen for vår eksistens: Vi må prioritere, og velge noe foran noe annet.

Systematic public vaccination constitutes a tremendous health success, perhaps the greatest achievement of biomedicine so far. There is, however, room for improvement. Each year, 1.5 million deaths could be avoided with enhanced immunisation coverage. In recent years, many countries have introduced mandatory childhood vaccination programmes in an a...

In a recent extended essay, philosopher Daniel Hausman goes a long way towards dismissing severity as a morally relevant attribute in the context of priority setting in healthcare. In this response, we argue that although Hausman certainly points to real problems with how severity is often interpreted and operationalised within the priority setting...

Forebygging er i vinden. Men hvordan bør egentlig forebyggingens etikk se ut?

In the art of medicine of the future, it will be important to know when to use artificial intelligence and when we should let natural intelligence work undisturbed.

I fremtidens legekunst vil det være viktig å vite når vi skal bruke kunstig intelligens og når vi bør la den naturlige intelligensen få virke uforstyrret.

measures of health or well-being must assign a value to averting death and relate it to the value of preventing or curing morbidity. The authors address two key questions about how to value the prevention of death: (1) how the age at which someone dies affects how bad their death is and (2) at what age death starts to be bad for the decedent. Curre...

Abstract Since the 1970s, a distinctive and sophisticated discourse on the badness of death has developed within analytical philosophy. This debate arose as a result of a direct response to the Epicurean secular philosophy of death. Epicurus indirectly argued that death cannot be an evil to the one who dies. The core of this so-called badness of d...

In a recent paper—The disvalue of death in the global burden of disease—we question the commensurability of the two components of the disability-adjusted life year (DALY)—years lived with disability (YLDs) and years of life lost (YLLs)—and offer a tentative solution to this problem. In an exciting and constructive reply—Is consistency overrated?—ph...

An authors' English translation of the article published in the Nordic Journal of Applied Ethics.

In global health, several practices rely on the assumption that death has a disvalue for those who die. This includes the fact that we prioritize extending human lives rather than creating new ones, the combination Y ears Lived with Disability (YLD) and Years of Life Lost (YLL) into Disability-Adjusted Life Years (DALYs), as well as managing the tr...

There have been debates in both philosophy and the field of population health on the issue of how mortality can and should be measured. In population health, the intention has been to produce measures of public health that can guide the formulation of policies governing the distribution of health care resources. However, there are many questions co...

(English translation available as supplementary material/linked file) De siste årene har fosterreduksjon i økende grad vært gjenstand for debatt i Norge, og intensiteten nådde et foreløpig maksimum da Lovavdelingen leverte tolknings-uttalelsen § 2 - Tolkning av abortloven i 2016 som svar på at Helse- og omsorgs-departementet (i 2014) ba Lovavdelin...

An ethical comparison of multifetal pregnancy reduction and abortion on healthy fetuses, within the context of recent Norwegian public debate (in Norwegian) Accepted for publication in Nordic Journal of Applied Ethics; undergoing proof-editing.

Du som leser denne teksten, og vi som har skrevet den, har én ting til felles. Vi skal dø. Den vissheten lever vi med gjennom størsteparten av livene våre. For en som er religiøs, betyr døden gjerne kun slutten på det jordiske livet. Sjelen vandrer videre, og noen utvalgte mennesker er så heldige å få et etterliv. Det er i hvert fall det de tror. F...

One aim of the Sustainable Development Goals is to end the epidemics of neglected tropical diseases by 2030. A multifaceted approach is needed to tackle leishmaniasis, keeping in mind the parasite, as well as its vector, host and reservoir. Attention should be focused on sustainable and achievable solutions rather than fairytale goals, and biology...

Hva vil det si å være faglig dyktig? Svare er ikke gitt. Hva vi definerer som faget og hvilket kvaliteter en faglig dyktig lege skal inneha, røper mye om oss selv.

What does it mean to be an accomplished professional? The answer is not self-evident. What we define as our profession and what qualities we think an accomplished doctor should have reveal a great deal about us.

Kommer på trykk i tidskriftet Røyst #5: Moral, august 2016.

Det er mye som gjør et liv verdt å leve, som for eksempel venner, lykkefølelse og utdannelse. Men selv dype vennskap, eufori og utmerket utdannelse hjelper oss lite hvis vi dør tidlig. Bare den som er i live kan ta del i godene som livet har å by på, og siden flere goder er bedre enn færre goder, så er et langt liv nesten alltid bedre enn et kort l...

Døden er et av filosofiens klassiske temaer. Den er et faktum ved vår eksistens, den betyr slutten på livet, og er noe vi alle må forholde oss til før eller siden. Filosofer har gjennom tidene behandlet ulike sider ved døden, fra psykologiske til eksistensfilosofiske betraktninger. Et aspekt ved vårt endelikt som derimot har vært lite gjenstand for...

Background The state of the world is one with scarce medical resources where longevity is not equally distributed. Given such facts, setting priorities in health entails making difficult yet unavoidable decisions about which lives to save. The business of saving lives works on the assumption that longevity is valuable and that an early death is wor...

Det er et faktum at helseressurser er begrensede. Dette gjør det nødvendig å prioritere. Vår påstand er at viktige beslutninger om helseprioriteringer forut- setter en nærmere avklaring av når det er verst å miste sitt liv. Formålet med denne artikkelen er derfor tredelt: (1) å tilby et helt nytt perspektiv på helsepri- oriteringer. (2) Redegjøre f...