17.08.2020: The Abassi case put a spotlight on the role of doctors in forced returns. The role of doctors, their understanding of this role and their professional ethics are all challenged. The Norwegian Directorate of Immigration can make a decision to forcibly return a migrant who does not have legal residence in Norway and refuses to leave the country voluntarily. This is administered by the National Police Immigration Service (NPIS) under the provisions of Section 90 of the Immigration Act (1). The Council for Medical Ethics has received complaints and enquiries from the press about the ethical...

25.02.2019: For a number of years, the Council for Medical Ethics has been working on issues pertaining to aesthetic medicine. Here, the Council responds to specific questions from the Norwegian College of General Practice. In two meetings in 2018, the Council for Medical Ethics deliberated on a complaint from the Norwegian College of General Practice (NCGP) regarding a matter of principle. The complaint was related to the practice of 'aesthetic medicine', here used as a collective term for surgical and non-surgical treatment in which the primary reason to undertake the intervention is of an aesthetic...

10.12.2018: Cases concerning children and adolescents are brought before clinical ethics committees when healthcare personnel find the value choices they face to be particularly challenging. In this article, we describe experiences from discussions of 37 such cases in a clinical ethics committee at a hospital over a ten-year period. Restricting life-prolonging treatment, patient and parent autonomy, the best interests of the child principle, and disagreement about decisions were all key topics of discussion. A growing emphasis on patient autonomy has led to an increased complexity in many issues relating...

03.09.2018: New cancer drugs that have a documented effect and market access in Norway, but are still awaiting assessment by the Decision Forum, put oncologists in a difficult situation from an ethical standpoint. Cancer therapies that have been introduced in recent years, such as precision medicine and immunotherapy, can transform incurable cancer into a chronic disease. With such therapies, some patients can add years to their lives, while their ability to work and quality of life are maintained. The Decision Forum must ensure equal treatment and correct prioritisation, but the long lead times for...

03.09.2018: Equal treatment is an absolute requirement in the Code of Ethics for Doctors. How may oncologists and other doctors handle information on commercial treatment options if the requirement of equal treatment is to be respected? The Medical Ethics Council recently deliberated a case concerning the doctors' duty to inform about medically approved cancer therapies that are not yet paid for by the state. One doctor had stated that no guidelines were available and that he assessed his patients – and their financial situation – before choosing to provide information on such options (1). The council did...

03.09.2018: A new information dilemma has arisen for doctors in public hospitals: Should they inform cancer patients that costly private treatment options are available? In the public health services, prioritisation is a virtue born of necessity if they are to succeed in fulfilling the ambition of helping people enjoy the greatest possible number of years of life, distributed fairly (1). This may entail that effective therapies remain unused because the effect is minor and the costs are high. It came as an unexpected challenge to the Norwegian debate on prioritisation when the private Aleris hospital...

05.03.2018: The Norwegian Medical Association and the Medical Ethics Council advise doctors against participating in the age assessment of young asylum seekers. Current methods are insufficiently accurate, and it is difficult to safeguard the principles of voluntary participation and informed consent. Age is crucial with regard to rights and the further process, and methods of determining age should only be used if they are accurate. Such methods are not available to us today. The Norwegian Directorate of Immigration (UDI) informs us on its website that if there is doubt as to the age of a young asylum...

22.01.2018: Many colleagues find themselves in challenging and unpleasant situations following consultations where the role of the doctor has not been clarified adequately. Doctors have different roles – as treatment provider, expert and administrator of welfare benefits. Ambiguity and misunderstandings about the role often lead to discontent and strong reactions. The Medical Ethics Council regularly receives complaints asserting that doctors have been biased, breached the duty of confidentiality, lacked competence, lacked expertise, or have not undertaken sufficient examinations. There have also been...

02.10.2017: The encounter between patient and doctor is often characterised by lack of time, and the art of communication can be complex. Sometimes things go wrong. The Medical Ethics Council regularly receives complaints from patients that have had an unsatisfactory encounter with a doctor. Often this is related to a feeling of not having been treated with respect, either because the doctor has not taken enough time to listen or because he/she was perceived as being insensitive or arrogant. Complaints of this nature are dealt with in accordance with Chapter 1: General provisions section 2 of the Code of...

31.08.2017: The Council for Medical Ethics discourages doctors from accepting to act as ringside doctor for combat sports that permit knockouts or participating in approvals or appeals boards for such events. These types of assignments may violate the general duty of doctors to protect human health. Sports medicine encompasses all medical aspects of sports. One important task of the sports doctor is to prevent and treat sports injuries (1). In today's elite sports, the body is frequently exposed to stresses that approach and occasionally exceed the limits of what it can tolerate. This was recently thrown...

07.03.2017: Should doctors discuss the health of individuals in the media? The Norwegian Code of Ethics for Doctors, Chapter I, paragraph 11 states the following: «A doctor should according to his or her ability contribute to objective information to the public and the authorities on medical matters» (1). If we take as our basis the biopsychosocial model of understanding of disorder and disease, many factors could be perceived as medical matters. However, when public discussion concerns the health of an individual, the invitation to make public statements may conflict with other paragraphs in the Code of...

23.08.2016: In 2015, the Medical Ethics Council of the Norwegian Medical Association formulated a new clause on so-called active help in dying (in Norwegian: «aktiv dødshjelp»), which was unanimously adopted in the same year by the Representative Body of the association. However, the wording of the clause is unclear and potentially confusing. This is unfortunate for the clinical, ethical and political debate on this topic. This article proposes an alternative wording which is more precise. In recent years, different variants of «active help in dying» have been legalised in several Western countries. In...

15.03.2016: Occasionally, doctors encounter patients in situations where professional ethics come into conflict with the law. Our Code of Ethics stipulates that we have a duty to protect the health of our patients and that we have a responsibility even if we deny care. Members of the Norwegian Medical Association are duty bound to comply with our Code of Ethics. Children are vulnerable. They are dependent on their parents and the choices their parents make. Even though children have individual rights, the choices parents make will influence the children’s possibilities of exercising their rights. This is...

07.05.2013: IVDUs are particularly prone to infectious endocarditis, with a lifetime incidence of 1 – 11 % (1, 2). Among the estimated 8 200 to 11 500 IVDUs living in Norway (3), there are indications of an increasing incidence of endocarditis with damage to the valves, as in other Western countries (4). At Haukeland University Hospital, this group of patients account for an estimated 10 – 15 % of the approximately 50 annual cases of infectious endocarditis. Most patients are treated conservatively with antibiotics, but some will need surgery involving removal of the infected valve and implantation of an...

16.10.2012: Genome research, i.e. the use of exome or whole-genome sequencing technologies, is now entering medical research and diagnostics at full speed. This has given rise to an intense ethical debate in international and national expert forums as to how this technology should be handled. For example, the issue of whole-genome sequencing has been discussed in most of the meetings of the Norwegian Biotechnology Advisory Board from 2010 to 2012 (B. Solberg, personal communication). Genome research generates larger and more comprehensive data sets than the genetic analyses that have hitherto been used...

17.04.2012: Values form an implicit basis of the personal encounter between patient and doctor. The equal value of all humans, irrespective of their characteristics and achievements, cannot be taken for granted. Neither can it be proven logically. In the UN Declaration of Human Rights, fundamental values are regarded as intuitive and self-evident. Others see values as learned and communicated through culture and religion (1). In the West, the Christian teachings on creation have had a decisive influence on how human life is viewed. The original justification for this view is found in Genesis (2)...