Carl Tollef Solberg

• Jølstad, Borgar & Solberg, Carl Tollef (2022). Reciprocity as an Argument for Prioritizing Healthcare Workers for the COVID-19 Vaccine. De Ethica. ISSN 2001-8819. Show summary

  During the recent debates on whether to prioritize healthcare workers for COVID-19 vaccines, two lines of argument were prevalent, namely arguments centered on maximizing health, either with or without a special emphasis on the worse off, and arguments centered on reciprocity. In this article, we scrutinize the arguments of reciprocity. The notions of fittingness and proportionality are fundamental for the act of reciprocating, and we consider the importance of these notions for various arguments from reciprocity, showing that the arguments are problematic. If there is a plausible argument for reciprocity during the COVID-19 pandemic, this is most likely one that centers on the risk that healthcare workers take on as part of their jobs. Furthermore, we argue that the scope of this argument should not be extended only to healthcare workers, other essential workers at risk are in a position to make the same arguments. We also consider whether reciprocating with vaccines, rather than by other means, is necessary. Allocating vaccines based on reciprocity will arguably conflict with utility-maximizing, concerns for the worse off, and equity concerns. Given the weak state of the reciprocity arguments, we conclude that overriding these concerns seems unreasonable.

• Solberg, Carl Tollef; Tranvåg, Eirik Joakim & Magelssen, Morten (2022). Attitudes towards priority setting in the norwegian health care system: a general population survey. BMC Health Services Research. ISSN 1472-6963. 22(1), p. 1–8. doi: 10.1186/s12913-022-07806-9. Show summary

  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. To increase legitimacy in priority setting, knowledge about laypeople’s attitudes is central. The aim of the study is there- fore to assess the general population’s attitudes towards a broad spectrum of issues pertinent to priority setting in the Norwegian publicly financed health care system. Methods: We developed an electronic questionnaire that was distributed to a representative sample of 2 540 Nor- wegians regarding their attitudes towards priority setting in Norway. A total of 1 035 responded (response rate 40.7%). Data were analyzed with descriptive statistics and binary logistic regression. Results: A majority (73.0%) of respondents preferred increased funding of publicly financed health services at the expense of other sectors in society. Moreover, a larger share of the respondents suggested either increased taxes (37.0%) or drawing from the Government Pension Fund Global (31.0%) as sources of funding. However, the respond- ents were divided on whether it was acceptable to say “no” to new cancer drugs when the effect is low and the price is high: 38.6% somewhat or fully disagreed that this was acceptable, while 46.5% somewhat or fully agreed. Lastly, 84.0% of the respondents did not find it acceptable that the Norwegian municipalities have different standards for providing care services. Conclusion: Although the survey suggests support for priority setting among Norwegian laypeople, it has also revealed that a significant minority are reluctant to accept it. Keywords: Attitude survey, Empirical ethics, General population, Legitimacy, Norway, Priority setting

• Feiring, Eli & Solberg, Carl Tollef (2021). Priority setting of COVID-19 vaccines in Norway: Advice and process (English translation) . Michael. ISSN 1893-9651. 28, p. 49–59. Full text in Research Archive Show summary

  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 vaccine 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 groups in the first phase of the vaccine deployment. The group recommended prioritising the risk group and healthcare personnel and also proposed geographical prioritisation depending on community case incidence. The group’s advisory report was part of a large-scale multidisciplinary project comprising epidemiology, medicine, infection control, computer modelling of COVID-19 vaccine efficacy and economic cost-benefit analyses. Priority setting implies that some citizens are given preference ahead of others who must wait. In Norway, as elsewhere, there is disagreement concerning the values, principles and goals determining vaccine prioritisation. In this article, we present an account of the group’s work process, advice, and rationales in more detail and identify values-based ‘trade-offs’ that pose particular challenges.

• Horn, Sindre August; Barra, Mathias; Norheim, Ole Frithjof & Solberg, Carl Tollef (2021). Public health priority setting: A case for priority to the worse off in well-being during the COVID-19 pandemic. Etikk i praksis. ISSN 1890-3991. 15(2), p. 5–15. doi: 10.5324/eip.v15i2.4097. Full text in Research Archive Show summary

  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 been through intersectoral public health efforts such as lockdowns, quarantines, information campaigns, social distancing, and, in the later phase, vaccine distribution. The aim of this article is to evaluate potential priority setting criteria for public health interventions. We argue in favour of the following three criteria for public health priority setting: benefit, resources and improving the well-being of the worse off. We argue that benefits and priority to the worse off may reasonably be understood in terms of individual well-being, rather than only health, for public health priority setting. We argue that lessons from the COVID-19 pandemic support our conclusions.

• Malkomsen, Anders & Solberg, Carl Tollef (2021). The value of meaning and meaninglessness. Norsk Filosofisk tidsskrift. ISSN 0029-1943. 56(4), p. 178–190. doi: 10.18261/issn.1504-2901-2021-04-04. Full text in Research Archive Show summary

  This article considers the philosophy and psychology of meaning with Einar Duenger Bøhnstarting point. In the popular philosophical book «The Meaning of Life» (Bøhn, 2019), Bøhn has brought the debate of meaning to the center stage of Norwegian philosophy. His positive account is that the meaning of life is improvement. The aim of this article is to continue this conversation about meaning, and in the extension of this, present nuances to meaninglessness. This article proceeds as follows: First, we outline Bøhna critique that gives us momentum for further reflections on the meaningless. We then introduce a novel concept: the meaning neutral. Finally, we discuss how we should relate to meaning. We conclude that meaning and meaninglessness are complementary phenomena and that there may be reasons to claim that meaninglessness is not an unconditional evil and that meaning is not an unconditional good.

• Feiring, Eli & Solberg, Carl Tollef (2021). Prioritering av koronavaksine: Råd og prosess. Michael. ISSN 1893-9651. 18(28), p. 49–59. Full text in Research Archive Show summary

  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 prioriterte grupper i den første fasen av vaksina- sjonen. Gruppen anbefalte å prioritere risikogruppen og helsepersonell og åpnet for geografisk prioritering avhengig av smitteutbredelsen i samfunnet. Gruppens rådgivende rapport var en del av et stort flerfaglig arbeid, som inkluderte epi- demiologi, medisin, smittevern, datamodellering av koronavaksinenes effekter og samfunnsøkonomiske lønnsomhetsanalyser. Prioritering betyr at noen får først, mens andre må vente. I samfunnet er det uenighet om verdier, prinsipper og mål for vaksineprioritering. I denne artikkelen belyser vi gruppens arbeids- prosess, råd, og begrunnelser nærmere, og peker på verdiavveininger som er særlig utfordrende.

• Dahl, Silje Langseth; Vaksdal, Rebekka Hylland; Barra, Mathias; Gamlund, Espen & Solberg, Carl Tollef (2021). Abortion and multifetal pregnancy reduction: An ethical comparison (English translation). Etikk i praksis. ISSN 1890-3991. 15(1), p. 51–73. doi: 10.5324/eip.v15i1.3980. Full text in Research Archive Show summary

  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 (2014) that the Legislation Department consider whether the Abortion Act allows for MFPR of healthy fetuses in multiple pregnancies. The Legislation Department concluded that the current abortion legislation [as of 2016] allows for MFPR subject to the constraints that the law otherwise stipulates. The debate has not subsided, and during autumn 2018 it was further intensified in connection with the Norwegian Christian Democratic "crossroads" policy and signals from the Conservatives to consider removing section 2.3c and to forbid MFPR.Many of the arguments in the MFPR debate are seemingly similar to arguments put forward in the general abortion debate, and an analysis toascertain what distinguishes MFPR from other abortions has yet to be conducted. The aim of this article is, therefore, to examine whether there is a moral distinction between abortion and MFPR of healthy fetuses. We will cover the typical arguments emerging in the debate in Norway and exemplify them with scholarly articles from the literature. We have dubbed the most important arguments against MFPR that we have identified the harm argument, the slippery-slope argument, the intentionargument, the grief argument, the long-term psychological effects for the woman argument, and the sorting argument. We conclude that these arguments do not measure up in terms of demonstrating a morally relevant difference between MFPR of healthy fetuses and other abortions. Our conclusion is, therefore —despite what several discussants seem to think —that there is no morally relevant difference between the two. Therefore, on the same conditions as we allow for abortions, we should also allow MFPR. Keywords: abortion, ethics,medical ethics, MFPR, selective MFPR

• Horn, Sindre August; Jølstad, Odd Borgar; Barra, Georg Mathias Honoré & Solberg, Carl Tollef (2021). Is COVID-19 severe? The Norwegian severity criterion for priority setting meets the pandemic. Tidsskrift for velferdsforskning. ISSN 0809-2052. 24(2), p. 1–14. doi: 10.18261/issn.2464-3076-2021-02-01. Full text in Research Archive Show summary

  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. Alvorlighets- kriteriet innebærer at en mer alvorlig tilstand kan og skal prioriteres høyere enn kostnadseffektiviteten alene tilsier. I denne artikkelen undersøker vi det norske alvorlighetskriteriet for helseprioriteringer i møte med koronaepidemien i Norge. Vi beskriver utviklingen av alvorlighetskriteriet i den norske prioriteringsdiskursen. Videre diskuterer vi hvordan koronaepidemien fremhever uenigheter og tvetydigheter rundt begrepet «alvorlighet» hva gjelder dødsrisiko, komorbiditet og hastegrad. Vi drøfter også hvordan den norske pandemiberedskapen passer inn i dette landskapet og etterlyser en klarere forståelse av alvorlighet i skillet mellom behandling og forebygging av sykdom. Til sist drøfter vi om det norske alvorlighetskriteriet for helseprioriteringer også kan være relevant for prioriteringer utenfor helse- vesenet.

• Solberg, Carl Tollef (2021). Ten moral challenges during a pandemic . Fysioterapeuten. ISSN 0016-3384. 3(21), p. 64–67. Full text in Research Archive Show summary

  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 crisis. The conclusion is that the lessons learned from this pandemic will be formative and make us better equipped for the post- pandemic society that we are slowly heading back to.

• Solberg, Carl Tollef; Barra, Mathias & Robberstad, Bjarne (2020). Should we discount future health benefits? Pro et contra (English translation) . Norsk Filosofisk tidsskrift. ISSN 0029-1943. 02–03(55), p. 1–28. doi: 10.18261/issn.1504-2901-2020-02-03-07. Show summary

  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 consider the most central arguments for and against discounting future health benefits. This includes well-known arguments such as the argument of diminishing marginal returns, the risk argument, the delay argument, and the consistency argument. We also discuss pure time preferences. In addition, we consider less debated arguments, including the instrumental argument and the argument for distributive justice, as well as discontinuous discounting, as an alternative form of discounting. We conclude openly and leave it to you as the reader to reflect further on this important issue. Keywords Cost-effectiveness, discounting, economic evaluation, health, health benefits, priority setting in health care, Quality-Adjusted Life Years, well-being

• Solberg, Amalie; Muller, Karl Erik & Solberg, Carl Tollef (2020). Kunstig intelligens og den fremtidige legekunsten. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 140(2), p. 1–3. doi: 10.4045/tidsskr.19.0779.
• Solberg, Carl Tollef; Sørheim, Preben; Muller, Karl Erik; Gamlund, Espen; Norheim, Ole Frithjof & Barra, Mathias (2020). The devils in the DALY: Prevailing evaluative assumptions. Public Health Ethics. ISSN 1754-9973. 13(3), p. 259–274. doi: 10.1093/phe/phaa030.
• Solberg, Carl Tollef; Barra, Mathias & Robberstad, Bjarne (2020). Should we discount future health benefits? Pro et contra. Norsk Filosofisk tidsskrift. ISSN 0029-1943. 55(2–3), p. 170–184. doi: 10.18261/issn.1504-2901-2020-02-03-07. Show summary

  The aim of this article is to examine the arguments for and against the practice of discounting future health benefits. A more general question is whether we should discount future well-being. We begin with an exposition of what discounting means and how this method is used in the evaluation of health interventions. Next, we consider the most central arguments for and against discounting future health benefits. This includes well-known arguments such as the argument of diminishing marginal returns, the risk argument, the delay argument, the consistency argument, and discussions concerning pure positive time preferences. In addition, we discuss two less debated arguments, that is, the instrumental argument and the argument for distributive justice, as well as discontinuous discounting, as an alternative form of discounting. We conclude openly and leave it to you as a reader to reflect further on this important issue.

• Gamlund, Espen; Muller, Karl Erik; Paquet, Kathrine Knarvik & Solberg, Carl Tollef (2020). Mandatory childhood vaccination: Should Norway follow? Etikk i praksis. ISSN 1890-3991. p. 7–27. doi: 10.5324/eip.v14i1.3316. Show summary

  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 attempt to avoid deaths. In Norway, however, the vaccination programme has remained voluntary. Our childhood immunisation programme covers protection for twelve infectious diseases, and Norwegian children are systematically immunised from six weeks to sixteen years of age. In this article, we address the question of whether our country, Norway, should make the childhood vaccination programme mandatory. This question has received considerable public attention in the media, yet surprisingly little academic discussion has followed. The aim of the article is to systematically discuss whether it is morally justified to introduce a mandatory childhood vaccination programme in Norway. Our discussion proceeds as follows: We begin by presenting relevant background information on the history of vaccines and the current Norwegian childhood vaccination programme. Next, we discuss what we consider to be the most central arguments against mandatory childhood vaccination: the argument from the standpoints of parental rights, bodily integrity, naturalness, mistrust, and immunisation coverage. After that, we examine the central arguments in favour of mandatory childhood vaccination from the standpoints of harm, herd immunity, and as a precautionary strategy. We conclude that there are convincing moral arguments in favour of adopting a policy of mandatory childhood vaccination in Norway.

• Barra, Mathias; Broqvist, Mari; Gustavsson, Erik; Henriksson, Martin; Juth, Niklas & Sandman, Lars [Show all 7 contributors for this article] (2020). Do not despair about severity—yet. Journal of Medical Ethics. ISSN 0306-6800. 0(0), p. 1–2. doi: 10.1136/medethics-2019-105870. Show summary

  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 context, the conclusion that severity does not contain plausible ethical content is too hasty. Rather than abandonment, our proposal is to take severity seriously by carefully mapping the possibly multiple underlying accounts to well-established ethical theories, in a way that is both morally defensible and aligned with the term’s colloquial uses.

• Millum, Joseph; Gamlund, Espen; Ngamasana, Emery & Solberg, Carl Tollef (2019). Age and the Disvalue of Death. In Norheim, Ole Frithjof; Emanuel, Ezekiel J. & Millum, Joseph (Ed.), Global Health Priority-Setting: Beyond Cost-Effectiveness . Oxford University Press. ISSN 9780190912765. p. 239–261. doi: 10.1093/oso/9780190912765.001.0001. Show summary

  Presents ethical reflections and a new framework for how to think about priority setting in health for countries that want to achieve Universal Health Coverage and the Sustainable Development Goals for health and reduced poverty. Will be of use for any course in global health at a school of public health or public policy or foreign service. Considers the pressing issues such as the above and provides a usable framework for use in the allocation of health care in an ethically and economically justifiable way.

• Solberg, Carl Tollef (2019). The Badness of Death: A Review . Norsk Filosofisk tidsskrift. ISSN 0029-1943. 54(3), p. 167–186. doi: 10.18261/issn.1504-2901-2019-03-05. Full text in Research Archive Show summary

  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 death debate can be summarized into two questions. First, can death be negative for the person who dies? Second, what makes death negative for the one who dies? The aim of this article is first and foremost to explain and systematize the development of this philosophical debate in Norwegian, as well as to present and discuss the most central arguments that have been put forward in the debate.

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• Gamlund, Espen & Solberg, Carl Tollef (2020). Hva er DØDEN. Universitetsforlaget. ISBN 9788215042718. 153 p. Show summary

  Hva er DØDEN innbyr til filosofisk refleksjon og benytter dessuten historie, sosiologi og medisin til å gi ulike perspektiver på døden. 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 benytter dessuten historie, sosiologi og medisin til å gi ulike perspektiver på døden. Hva er DØDEN vil få deg til å tenke nye tanker om både livet og livets slutt.

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• Søndbø, Mildrid Hagrønning; Magelssen, Morten; Solberg, Carl Tollef; Luther, Iren Mari & Sørlie, Christine Haga (2022). Vi må sette etikken i høysetet. Sykepleien. ISSN 0802-9768. 110(88475), p. e1–e7. doi: 10.4220/Sykepleiens.2022.88475. Show summary

  Alle avdelinger bør ha et tilbud om etikkrefleksjon. Det er langt fra realiteten i dag, viser en undersøkelse. I november 2021 sendte Rådet for sykepleieetikk, kommune- og spesialisthelsetjenesten (KS) og Senter for medisinsk etikk (SME) en spørreundersøkelse til 5853 sykepleieledere i kommune- og spesialisthelsetjenesten. Vi stilte spørsmål om den systematiske etiske refleksjonen: I hvor stor grad eksisterer den? Resultatene var både oppløftende og nedslående. Bare 39 prosent av sykepleielederne svarte at deres ansatte hadde et tilbud om etisk refleksjon. Kun 10 prosent av de spurte besvarte undersøkelsen. Det kan bety at de som faktisk driver etikkarbeid, var mer tilbøyelig til å svare. I så fall er 39 prosent høyere enn det reelle tallet.

• Torjusen, Marius Lamberg; Solberg, Carl Tollef; Barra, Mathias & Feiring, Eli (2022). Priority setting in Norwegian municipal health and care services: A content analysis of policy documents. BMJ Global Health. ISSN 2059-7908. 7. doi: 10.1136/bmjgh-2022-ISPH.73. Show summary

  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, resources, and severity – in the municipal health and care services. The aim of this article was to examine the arguments for and against implementing the current criteria in municipal health and care services, using documentary data from the ensuing political process. Methods Data consisted of Norwegian policy documents discussing prioritisation principles for municipal health and care services: The Official Norwegian Report 2018:6 (green paper), the written consultation responses from the hearings, and the Report to the Parliament 38 (2020-2021) (white paper). The documents were analysed using a predefined conceptual framework where arguments were categorised by their level of abstraction and the degree of (dis)agreement with the recommendations in the green paper. Results Data suggested general agreement to use the same criteria in all levels of Norwegian health service. However, disagreement was identified when considering the lack of feasible implementation processes. Recurrent themes in the data were the municipalities’ legal and financial lack of scope to set priorities under constraints, challenges regarding operationalising a supplementary physical, psychological and social mastery criterion, and prioritising in situations where the benefits are difficult to measure. Discussion The many duties and responsibilities of municipal health and care make priority setting decisions more complex than in specialist health care. In summary, the Norwegian green paper on priority setting in municipal health and care services has presented a well-received recommendation. However, how to inevitably tackle the many complex, and sometimes wicked, prioritisation problems in practice remain unanswered.

• Horn, Sindre August & Solberg, Carl Tollef (2022). Priority setting across different levels of decision-making: the way forward. BMJ Global Health. ISSN 2059-7908. 7. doi: 10.1136/bmjgh-2022-ISPH.101. Show summary

  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 health trusts) and micro level (bedside rationing). Objective The aim of this article is to present a systematic discussion of priority setting across different levels of decision-making. Should different criteria for priority setting apply at the different levels? How can we decide which criteria fall into which category? And what should count as a sufficient argument for having different principles at different levels? Methods We present the current literature on the topic through a scoping review. We expand on the literature to suggest useful definitions of levels of priority setting and candidate reasons for significant differences between the levels. Results We found that definitions and the suggested number of levels differ, but the most favoured approach was two or three levels of priority setting. We present descriptive differences between the levels and suggest what we believe are useful definitions of levels of priority setting. We further present and discuss candidate reasons for ethically significant differences between the levels with applications for priority setting. Discussion We consider this article to be a first step towards a more rigorous approach to priority setting across levels of decision-making in health care. We recommend that the levels of priority setting are more consistently and comprehensively defined. We argue in favour of further systematic discussion of this topic in future and conclude that this topic should be unavoidable in further discussions.

• Malkomsen, Anders & Solberg, Carl Tollef (2022). Det er altfor mange urealistiske forventninger til psykiatrien (republisering i nettavis). Nettavisen. Show summary

  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?

• Malkomsen, Anders & Solberg, Carl Tollef (2022). A. Malkomsen og C.T. Solberg svarer . Tidsskrift for Den norske legeforening. ISSN 0029-2001. Show summary

  Lien og Malts kommentar gir oss anledning til å takke Norsk psykiatrisk forening (Npf) for at de ønsker å bidra til å realitetsjustere forventningene til psykiatrien ved å engasjere seg i kampanjen «Gjør kloke valg». Npfs innspill var ikke offentliggjort da vi sendte inn vår kronikk (1), og vi tar selvkritikk på at vi ikke gjorde nøyere undersøkelser rundt hvorvidt noe var i anmarsj. Dermed er vi også enige i at vår påstand om manglende intern forventningsavklaring i psykiatrien kan modifiseres noe. Det er også tillitsvekkende at Npf tar selvkritikk på sendrektigheten i sine forslag. Vi har lest de offentliggjorte forslagene med interesse og håper de vil skape en fruktbar debatt om fagets fremtid (2). Vi leser også at foreningen mener det er en «rekrutteringskrise i psykiatrien» (3). Vi tror at en løsning på forventningskrisen også kan bidra til å løse rekrutteringsutfordringene. En realitetsorientering av forventingene vil gjøre det enklere å få øye på alt det gode psykiatrien tross alt gjør og lykkes med. Derfor håper vi at foreningen også i fremtiden vil fortsette å kommunisere realistiske forventninger utad. Hasting trekker frem utvidelsen av sykdomsbegrepet og gir dermed et viktig bidrag til vår kronikk. Uklare grenser for hva som bør kalles sykdom gjør psykiatrien særlig utsatt for medikalisering. Det finnes interessant akademisk litteratur som omhandler medikalisering i psykiatrien (4), men ofte har denne litteraturen få konkrete råd til den alminnelige kliniker. Det har også blitt hevdet at det pågår en medikalisering av de menneskelige grunnvilkår, en utvikling som ytterligere vil kunne øke de urealistiske forventningene til psykiatrien (5). Furuholmen tilfører også flere viktige perspektiver. Det blir ofte sagt at enhver kirurg kan si «ja» til å operere en pasient, men bare de virkelig gode kirurgene vet når de skal si «nei». Etter vår mening stiller det seg på samme måte i psykiatrien. Bare den virkelig gode psykiater vet når det er riktig å si «jeg kan ikke hjelpe deg» – og deri ligger legekunsten.

• Magelssen, Morten & Solberg, Carl Tollef (2022). Bør dødshjelp legaliseres i Norge? Fem spor i dødshjelpsdebatten.
• Solberg, Carl Tollef (2022). Prioriteringer under pandemien .
• Solberg, Carl Tollef (2022). Konsekvensetikk og rettferdighetsteori .
• Malkomsen, Anders & Solberg, Carl Tollef (2022). Psychiatry's crisis of expectations (English translation). Tidsskrift for Den norske legeforening. ISSN 0029-2001. doi: 10.4045/tidsskr.21.0895. Show summary

  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?

• Malkomsen, Anders & Solberg, Carl Tollef (2022). Psykiatriens forventningskrise. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 3(142), p. 202–204. doi: 10.4045/tidsskr.21.0895. Show summary

  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?

• Solberg, Carl Tollef (2022). Etikkarbeid .
• Solberg, Carl Tollef (2021). Prioritering i helsetjenesten.
• Solberg, Carl Tollef (2021). Hvor går grensen for helsepersonells forpliktelser – under en pandemi og ellers?
• Solberg, Carl Tollef (2021). Etiske Teorier: Metaetikk og Normativ Etikk .
• Solberg, Carl Tollef (2021). Etiske dilemmaer i møte med covid-19.
• Barra, Mathias; Stenmarck, Mille Sofie; Jølstad, Odd Borgar; Torjusen, Marius Lamberg; Horn, Sindre August & Solberg, Carl Tollef [Show all 8 contributors for this article] (2021). SEVPRI Rådgiverpanelseminar.
• Solberg, Carl Tollef (2021). Filosofiens rolle i helseprioriteringer .
• Hartvedt, Eilif Guldvog; Winther, Hannah; Sterri, Aksel Braanen; Betzonich-Wilken, Per; Bauhn, Per & Watzl, Sebastian [Show all 9 contributors for this article] (2021). Koronavaksine: Bør folkehelse trumfe selvbestemmelse? [Journal]. Salongen – nettidsskrift for filosofi og idéhistorie. Show summary

  Er det etisk forsvarlig for en stat å innføre obligatorisk koronavaksinasjon? Salongen har spurt syv filosofer i Norge, Sverige og Danmark.

• Gamlund, Espen & Solberg, Carl Tollef (2021). Døden i kulturen. [Newspaper]. Klassekampen.
• Horn, Sindre August & Solberg, Carl Tollef (2021). Prioriteringer under en pandemi.
• Solberg, Carl Tollef (2021). Koronavaksinasjon av barn: Etiske betrakninger .
• Solberg, Carl Tollef (2021). Introduksjon: Prioriteringer og rettferdighet – HELSAM301.
• Solberg, Carl Tollef (2021). Commentary on "Geographical variation in compulsory hospitalisation" .
• Solberg, Carl Tollef (2021). Severity as a moral qualifier of disease .
• Gamlund, Espen & Solberg, Carl Tollef (2021). Newborns or young adults? What we have and what we could have . Show summary

  Suppose a decision-maker must prioritize between life-saving interventions that will save either newborns or young adults. It is assumed that individuals in either group will go on to live a life worth living, or die in a few weeks if denied help. Should the decision-maker give the life-saving treatment to the newborns or the young adults? The key issue at stake here is the relative importance of preventing the deaths of groups of individuals at these two ages.

• Mårdalen, Irene & Solberg, Carl Tollef (2021). 10 etiske dilemmaer under lupen: Bør fysioterapeuter behandle covid-19-pasienter selv om smitteutstyret er dårlig? [Journal]. Fysioterapeuten. Show summary

  Bør fysioterapeuter og andre i helsevesenet gi behandling til covid-19-pasienter selv om smittevernutstyret er for dårlig? Og bør fysioterapeuter prioriteres i vaksinekøen? Her er 10 etiske dilemmaer som følge av koronapandemien.

• Solberg, Carl Tollef; Gamlund, Espen & Stormyren Larsen, Selma (2021). Livet er en knapp ressurs . [Newspaper]. Klassekampen. Show summary

  I boka «Hva er døden?» spør to filosofer hva den sekulære døden innebærer. Nå får vi bruk for denne lærdommen.

• Solberg, Carl Tollef (2021). Vaksineprioriteringer.
• Solberg, Carl Tollef (2021). Konsekvensetikk og rettferdighetsteori.
• Gamlund, Espen; Solberg, Carl Tollef & Schei, Edvin (2020). På tide å vurdere aktiv dødshjelp i Norge. Bergens Tidende. ISSN 0804-8983.
• Gamlund, Espen & Solberg, Carl Tollef (2020). Den aktualiserte døden. Digitalt bokbad. .
• Gamlund, Espen; Solberg, Carl Tollef & Jeanette Andrea, Søderstrøm (2020). En samtale med filosofene/forfatterne bak boka "Hva er døden." . [Internet]. I lys av døden - podcast. Show summary

  Hvilken verdi kan en økt bevissthet om døden ha for oss alle mens vi lever? I denne episoden kan du høre filosofene bak boka Hva er døden, snakke om nettopp det, og om hvordan døden har påvirket deres liv på ulike vis. Espen mistet pappaen sin da han var 7, og Carl Tollef – som også er lege – har møtt på døden gjennom sin legepraksis. Begge deler tas opp i denne episoden, i tillegg til ideen om et etterliv når denne ikke er forankret i en religiøs overbevisning. Vi er dessuten innom temaene dødsangst, vårt forhold til dyrs død versus menneskers død og Corona-pandemien. Samt om hvorfor mennesket generelt sett anser døden som noe negativt, og om når og hvordan vi kan se på døden som noe positivt. I sistnevnte forbindelse slår de to filosofene opp noen spennende dører angående aktiv dødshjelp, som muligens blåser nytt liv inn i en debatt som mange av oss opplever vanskelig og ikke minst polarisert. Hva er døden ble utgitt sommeren 2020 av Universitetsforlaget og er et ambisiøst prosjekt gitt bokas størrelse. Like fullt et prosjekt jeg tror mange kan enes om at forfatterne har bestått med glans. For mer info om boka, se her: https://www.universitetsforlaget.no/hva-er-doden

• Gamlund, Espen; Muller, Karl Erik; Solberg, Amalie C. & Solberg, Carl Tollef (2020). Heroes in white? (English translation) . Tidsskrift for Den norske legeforening. ISSN 0029-2001. p. 1–5. doi: 10.4045/tidsskr.20.0702. Show summary

  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 sufficient protection against infection are going beyond the call of duty, and this can be viewed as heroic

• Gamlund, Espen; Muller, Karl Erik; Solberg, Amalie C. & Solberg, Carl Tollef (2020). Helter i hvitt? . Tidsskrift for Den norske legeforening. ISSN 0029-2001. 15(27), p. 1–5. doi: 10.4045/tidsskr.20.0702. Show summary

  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 de har plikt til, og det kan ses på som heltemodig.

• Solberg, Carl Tollef (2020). Hva er døden.
• Solberg, Carl Tollef; Sørheim, Preben; Norheim, Ole Frithjof & Barra, Georg Mathias Honore (2020). Helseprioriteringer under en pandemi. Agenda Magasin.
• Solberg, Carl Tollef (2020). Naturalism.
• Solberg, Carl Tollef (2020). Reductionism .
• Solberg, Carl Tollef (2020). Scientific Explanations .
• Solberg, Carl Tollef (2020). Falsification.
• Solberg, Carl Tollef (2020). Conjecture and Refutation.
• Solberg, Carl Tollef (2020). Hva er døden .
• Barra, Mathias & Solberg, Carl Tollef (2020). SEVPRI.
• Bøhn, Einar Duenger; Solberg, Carl Tollef; Melsom, Kaja & Østby, Hilde (2020). Meningen med livet, døden, husarbeidet og ettermælet. [Journal]. Fri Tanke . Show summary

  Hva skjer når tre filosofer møter en idehistorier for å snakke om meningen med livet, døden og Sisyfos?

• Barra, Mathias & Solberg, Carl Tollef (2020). Presentation of SEVPRI .
• Solberg, Carl Tollef (2020). Concepts, Classifications and Definitions .
• Solberg, Carl Tollef (2020). Language and Reality II.
• Solberg, Carl Tollef (2020). Language and Reality I.
• Solberg, Carl Tollef (2020). Research Ethics: Laws, Regulations and Guidelines.
• Solberg, Carl Tollef (2020). Research Ethics: Ethical Theories.
• Solberg, Carl Tollef (2020). Scientific Misconduct.
• Solberg, Carl Tollef (2020). Etiske teorier .
• Solberg, Carl Tollef (2020). Hva skal vi med helseprioriteringer? .
• Solberg, Carl Tollef (2020). Historical Examples of Bad Ethics .
• Solberg, Carl Tollef (2020). What is science? .
• Solberg, Carl Tollef (2020). Presentation of HELVIT300 .
• Gamlund, Espen & Solberg, Carl Tollef (2020). Espen Gamlund og Carl Tollef Solberg om døden . [Internet]. Universitetsforlagets Podcast .
• Solberg, Carl Tollef; Sørheim, Preben; Norheim, Ole Frithjof & Barra, Georg Mathias Honore (2020). Helseprioriteringer under en pandemi. Agenda Magasin.
• Gamlund, Espen & Solberg, Carl Tollef (2020). Should we fear death? (Oxford University Press-blog) . Show summary

  We are currently faced with a global crisis. A virus has spread to all parts of our planet, and thousands of people have died from the coronavirus. Many people now fear that they are going to be sick and die. Fear of sickness can certainly be rational. It is more questionable whether fear of death is so. Death is something we mourn or fear as the worst thing that could happen. And yet being dead is something that no one can experience and live to describe.

• Gamlund, Espen & Solberg, Carl Tollef (2020). Døden rykker nærmere. Morgenbladet. ISSN 0805-3847. p. 1–2.
• Barra, Mathias; Norheim, Ole Frithjof & Solberg, Carl Tollef (2020). Severity and priority setting in health care (populærvitenskapelig fremstilling, Forskningsrådet) . Show summary

  Prioriteringer innen helsevesenet er uunngåelige og har vidtrekkende, endog fatale, konsekvenser for pasienter og pårørende. I Norge hersker det en utstrakt, men skjør, enighet om at det er de mest alvorlig syke som skal prioriteres høyest. Alvorlighetsgrad som prioriteringskriterium har vært en hjørnesten i hele den norske prioriteringstradisjonen siden det første Lønningutvalget i 1987. Alvorlighetsgrad består som ett av de sentrale begrepene i etterfølgende prioriteringsutvalg (Norheim 2014, Blankholm 2018). Den tilsynelatende konsensusen omkring viktigheten av alvorlighetsgrad som prioriteringskriterium er mer broket ved nærmere ettersyn: tenker vi alle sammen på det samme når vi beskriver en tilstand som «alvorlig»? Er begrepet robust nok som grunnlag for gode prioriteringer som befolkningen vil slutte opp om? Hva mener egentlig helsearbeidere, helseøkonomer, eller politikere om saken? Hva synes pasientene selv, og betyr alvorlighet noe annet i Alta enn i Oslo? SEVPRI skal kartlegge hvilket meningsinnhold som tillegges begrepet «alvorlighet» generelt, og i forbindelse med helseprioriteringer spesielt. Handler alvorlighet om smerte, funksjonstap og død? Om pasientens sosiale situasjon? Om fordelingshensyn? Er alvorlighet noe her-og-nå, eller handler det om livsløp? Gjennom samtaler med et bredt utvalg mennesker skal SEVPRI fremskaffe et kvalitativt råmateriale for videre analyse. Ulike kvantitative og kvalitative metoder anvendes for å beskrive meningsmangfoldet fra ulike teoretiske rammeverk. Forskergruppen er bredt sammensatt med filosofer, økonomer, og helsepersonell. SEVPRI skal analysere alvorlighet som prioriteringskriterium så uttømmende som mulig, slik at vi kan skille områder der vi er enige fra områder med reell uenighet. Målet er å forbedre språket i den offentlige prioriteringssamtalen, slik at prioriteringer oppfattes som rettferdige av flest mulig, og med akseptable kompromisser der uenigheten er uløselig.

• Gamlund, Espen; Muller, Karl Erik; Solberg, Amalie C. & Solberg, Carl Tollef (2020). Dette handler om deg! (Blogg for politisk filosofi) . Show summary

  På kort tid har verden forandret seg. Det samme har hverdagen til folk flest. Et virus har snudd opp ned på alt. Hva skal vi gjøre nå?

• Solberg, Carl Tollef (2020). Forskningsetikk .
• Solberg, Carl Tollef (2020). Vitenskapelig uredelighet: Forfalskning, fabrikkering og plagiering .
• Barra, Mathias; Broqvist, Mari; Gustavsson, Erik; Henriksson, Martin; Juth, Niklas & Sandman, Lars [Show all 7 contributors for this article] (2020). Why care about severity? (Journal of medical ethics blog). . Show summary

  In an ideal world, everyone one of us would receive medical treatments in a timely manner, in the best possible way. There would be an unlimited number of organs available for transplantation. There would be enough health workers everywhere, and they would have sufficient time and knowledge to take care of each and every one of us. We would all live long and meaningful lives, and inequity in the distribution of health would be non-existent. This is not the world we find ourselves in. No resource is unlimited, and no effect is granted. Even in the world’s wealthiest countries, we need to prioritize.

• Barra, Mathias; Norheim, Ole Frithjof & Solberg, Carl Tollef (2020). Norske helseprioriteringer på ramme alvor: Hva nå? (Blogg for politisk filosofi) . Show summary

  Å si nei til å behandle syke pasienter, selv om behandlingen finnes, byr oss imot. Det er problematisk dersom begrunnelsen er at behandlingen er for kostbar—det skal ikke stå på pengene når det gjelder liv og helse. Likevel sier vi nei til en rekke tiltak i dag, fordi de ikke er kostnadseffektive. Når pasienten er alvorlig syk strekker vi oss likevel lenger enn ellers. Men, hvordan bør et slikt alvorlighetskriterium for helseprioriteringer egentlig se ut?

• Solberg, Carl Tollef (2020). Forebyggingens etikk: Fremtidens tankesett? Fysioterapeuten. ISSN 0016-3384. p. 1–5. Show summary

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

• Amalie C., Solberg; Muller, Karl Erik & Solberg, Carl Tollef (2020). Artificial intelligence and the future art of medicine (English translation) . Tidsskrift for Den norske legeforening. ISSN 0029-2001. doi: 10.4045/tidsskr.19.0779.
• Amalie C., Solberg; Muller, Karl Erik & Solberg, Carl Tollef (2020). Kunstig intelligens og den fremtidige legekunsten. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 2(140), p. 123–124. doi: 10.4045/tidsskr.19.0779. Show summary

  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. Enkelte hevder at vi med kunstig intelligens kan vente oss sikrere diagnoser, mer skreddersydde behandlinger og økt behandlingskvalitet (1). Vi deler dette synet. Samtidig vil vi oppfordre legestanden til en større årvåkenhet omkring alle verdiantagelsene som ligger gjemt i medisinfaget.

• Gamlund, Espen & Solberg, Carl Tollef (2019). Hva er døden. Kapittel 3: Livshjelp eller dødshjelp?
• Solberg, Carl Tollef (2019). Når er det verst å miste livet? .
• Solberg, Carl Tollef (2019). When is the worst time to die? (english translation) . Tidsskrift for Den norske legeforening. ISSN 0029-2001.
• Solberg, Carl Tollef (2019). Når er det verst å miste livet? Tidsskrift for Den norske legeforening. ISSN 0029-2001. 139(13). doi: 10.4045/tidsskr.18.0471.
• Solberg, Carl Tollef (2019). En tapt fremtid (bokkapittel) .
• Solberg, Carl Tollef (2022). Refleksjoner omkring verdighet, samfunnsøkonomi og presedensvirkninger ved kremering av hjerteimplantater (oppdatert rapport) . gravplasskultur.no. Show summary

  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) sammenlignet med å operere ut implantat før kremering - (II). hva litteraturen sier om samfunnsøkonomi/kostnadseffektivitet ved bruk av helsepersonell til slike oppgaver - (III). presedensvirkninger av å oppheve påbudet om fjerning av implantat før kremering i lys av en aldrende befolkning, økende kremasjonsprosent og flere implantattyper Oppdragsgiver åpner også for at rapporten kan inneholde betraktninger utover de tre nevnte punktene. Undertegnede ønsker i den sammenheng å inkludere et fjerde punkt i denne rapporten, nemlig: - (IV) handlingsalternativer

• Solberg, Carl Tollef (2021). (U)verdighet, samfunnsøkonomi og presedensvirkninger ved kremering av hjerteimplantater: Svar på oppdrag: 9210ILL. Barne- og familiedepartementet .
• Husum, Tonje Lossius; Dahlberg, Jørgen; Jorem, Jacob; Solberg, Carl Tollef & Pedersen, Reidar (2021). Høringssvar fra Senter for medisinsk etikk, Universitetet i Oslo, til «Høringsnotat om oppfølging av forslagene fra Tvangslovutvalget». Regjeringen.no.
• Solberg, Carl Tollef (2021). Etiske betrakninger rundt kremering av hjerteimplantater . Senter for medisinsk etikk .
• Runa, Askeland Hougen; Solberg, Carl Tollef & Horn, Sindre August (2021). Priority setting in health care: The moral basis for prioritising the severely ill. Universitetet i Bergen. Show summary

  It is assumed by many, among these the Norwegian health care system, that prioritising the more severely ill is just. In this thesis, I examine exactly this relationship between a priority setting criterion of severity and distributive justice. The overarching aim is to explore the moral bases for prioritising the more severely ill. The goal is that by doing so, both the ethical background for the debate about priority setting in general, and the meaning of the term ‘severely ill’ specifically, will become clearer. In order to investigate the relationship between prioritisation of the more severely ill and how this relates to justice, I have sought to establish a general overview of the literature concerning justice and health care priority setting, as well as more closely examining the specific literature exploring the relationship between these topics. The methods utilised are philosophical in nature, the most important being the method of reflective equilibrium. With regards to the overarching aim, I will present and discuss four different alternative moral bases for justifying the prioritisation of the more severely ill. These are four major theories of distributive justice, namely utilitarianism, egalitarianism, prioritarianism and sufficientarianism. Furthermore, I argue that pluralistic egalitarianism ought to be the background theory guiding just priority setting in health care, in addition to proposing that the definition and operationalisation of the severity criterion should be broader, in order to also include indirect and non-health-related social factors.

• Feiring, Eli; Førde, Reidun; Holm, Søren; Norheim, Ole Frithjof; Solberg, Berge & Solberg, Carl Tollef [Show all 7 contributors for this article] (2020). The Coronavirus Immunisation Programme Advice on priority groups for coronavirus vaccination in Norway Expert group in ethics and priority setting 15 November 2020. Norwegian Institute of Public Health. Full text in Research Archive
• Feiring, Eli; Førde, Reidun; Holm, Søren; Norheim, Ole Frithjof; Solberg, Berge & Solberg, Carl Tollef [Show all 9 contributors for this article] (2020). Råd om prioriterte grupper for koronavaksinasjon i Norge. Ekspertgruppe i etikk og prioritering 15. november 2020. Folkehelseinstituttet, Koronavaksinasjonsprogrammet. Full text in Research Archive
• Urnes, Nina Julia; Sørheim, Preben; Muller, Karl Erik & Solberg, Carl Tollef (2019). Mitigating antimicrobial resistance: Evaluating high-income countries’ responsibilities through the liability model and the social connection model. Universitetet i Bergen.

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