Jørgen Dahlberg

• Jorem, Jacob; Førde, Reidun; Husum, Tonje Lossius; Dahlberg, Jørgen & Pedersen, Reidar (2025). Assessing decision-making capacity in clinical practice in Norway: a qualitative exploration of stakeholder perspectives. BMC Psychiatry. 25. doi: 10.1186/s12888-025-07161-z. Full text in Research Archive Show summary

  Decision-making capacity (DMC) is a widely used criterion in health law, but assessments pose challenges in practice. In Norway, lacking DMC became an additional criterion for involuntary care and treatment following comprehensive amendments to the Mental Health Care Act in 2017. Contrary to the amendments’ objectives, involuntary care rates have continued to increase after an initial reduction in 2017. Assessing DMC typically involves four abilities: understanding, reasoning, appreciating relevant information, and communicating a choice. This four abilities model was introduced to aid in DMC assessments. With limited assessment experience pre-2017, the Norwegian context offers valuable insights into how stakeholders integrate DMC into clinical practice over time. This study aimed to explore how DMC was assessed in clinical practice following the introduction of a capacity-based mental health law governing involuntary care and treatment in Norway. In 2018, semi-structured interviews and focus groups were conducted with 44 key stakeholders, including psychiatrists, specialists in clinical psychology, general practitioners, and lawyers in supervisory bodies (the Control Commission and County Governor). In 2022–23, 21 of these participants took part in individual follow-up interviews. The interviews were transcribed and thematically analysed. Data analysis generated three themes with subthemes: (1) DMC assessments primarily relied on the four abilities model in specialist care, experiencing gradual clinical adaptation with decreased importance, and exhibited variations in quality, particularly in primary care; (2) several challenges in DMC assessments, including lack of training in applying the four abilities model, ownership, continuity of care, information, and patient cooperation, with certain patient groups posing particular challenges, such as those with manic symptoms, substance misuse, and severe eating disorders; and (3) quality assurance measures needed, including systematic training and tools to improve assessment quality. Assessing DMC involves variations and several challenges across the healthcare system. While the four abilities model served as a primary basis of DMC assessments in specialist care, systematic training, validated tools, and further research seem needed to improve assessment quality and better understand factors influencing assessments. Recognising the complex interplay between legal, health service, and societal factors when implementing health law reforms seems crucial for achieving their objectives.

• Jorem, Jacob; Førde, Reidun; Husum, Tonje Lossius; Dahlberg, Jørgen & Pedersen, Reidar (2025). Factors influencing decision-making capacity assessments in involuntary care and treatment in Norway: A qualitative exploration of multi-stakeholder perspectives. International Journal of Law and Psychiatry. ISSN 0160-2527. 104. doi: 10.1016/j.ijlp.2025.102157. Full text in Research Archive Show summary

  Background Decision-making capacity (DMC) is a widely used criterion in health laws to balance respect for patient autonomy with protection from the potential consequences of treatment decisions. In 2017, lacking DMC was introduced as an additional criterion for involuntary care and treatment following comprehensive amendments to the Norwegian Mental Health Care Act. Despite the amendments aiming to reduce involuntary care and treatment rates, national health registry data indicate continued rising rates along the pre-2017 trajectory after an initial reduction in 2017. While previous studies suggesting varying DMC assessment quality, little is known about the potential factors influencing these variations. Aims To identify factors influencing DMC assessments after introducing a capacity-based mental health law governing involuntary care and treatment. Methods 60 purposively sampled stakeholders, including patients, families, health professionals, and lawyers, participated in semi-structured interviews and focus groups in 2018, with 26 of these participating in follow-up interviews in 2022–23. The transcribed interviews were analysed using thematic analysis. Results Data analysis generated four themes: 1) available resources' influence on DMC assessments; 2) health professionals' values and practices regarding involuntary care; 3) legal interpretations by supervisory bodies regarding involuntary care; and 4) political signals from the health authorities regarding involuntary care. Conclusion DMC assessments appear to be influenced by several factors, including resource availability, health professionals' values and practices, legal interpretations by supervisory bodies, and political signals from health authorities. Combined with a lack of systematic training and validated tools, these factors may have raised the threshold for accessing mental healthcare beyond what systematic DMC assessments would suggest, contributing to increased illness severity among patients and rising involuntary care rates post-2017. Further research is needed to better understand the complex dynamics involved in DMC assessments and how to effectively implement capacity-based health laws.

• Jorem, Jacob; Førde, Reidun; Husum, Tonje Lossius; Dahlberg, Jørgen & Pedersen, Reidar (2025). Impact of introducing a capacity-based mental health law in Norway: Qualitative exploration of multi-stakeholder perspectives. BJPsych Open. 11(2). doi: 10.1192/bjo.2024.810. Full text in Research Archive Show summary

  Background Decision-making capacity (DMC) is key to capacity-based mental health laws. In 2017, Norway introduced a lack of DMC as an additional criterion for involuntary care and treatment to strengthen patient autonomy and reduce involuntary care. Health registry data reveal an initial reduction followed by rising involuntary care and treatment rates post-2017. Despite jurisdictions moving towards capacity-based mental health laws, little is known about their impact. Aims To explore the impact of introducing a capacity-based mental health law governing involuntary care and treatment. Method Semi-structured interviews and focus groups were conducted in 2018 with 60 purposively sampled stakeholders, including patients, families, health professionals and lawyers. Of these, 26 participated in individual follow-up interviews in 2022–23. The transcribed interviews were thematically analysed following Braun and Clarke. Results Four themes emerged: (a) increased awareness of patient autonomy and improved patient involvement; (b) altered thresholds for involuntary admission and discharge and more challenging to help certain patient groups; (c) more responsibility for primary health services; and (d) increased family responsibility but unchanged involvement by health services. Conclusions Introducing a capacity-based mental health law appears to raise awareness of patient autonomy, but its impact depends on an interplay of complex health, social and legal systems. Post-2017 changes, including rising involuntary care and treatment rates, higher thresholds for admissions and increased pressure on primary health services and families, may be influenced by several factors. These include implementation of decision-making capacity, legal interpretations, formal measures for care of non-resistant incompetent individuals, reduced in-patient bed availability, inadequate voluntary treatment options and societal developments. Further research is needed to better understand these changes and their causes.

• Aarseth, Svein; Horn, Morten Andreas; Dahlberg, Jørgen & Magelssen, Morten (2023). Befolkningens kunnskaper og holdninger om beslutninger ved livets slutt. Michael. ISSN 1893-9651. 20(1), p. 11–22. Full text in Research Archive Show summary

  Bakgrunn: Medisinske beslutninger når pasientens liv nærmer seg slutten, gir noen ganger opphav til etiske problemer. Formålet med studien var å kartlegge befolkningens kunnskaper og holdninger på feltet. Materiale og metode: Nettbasert undersøkelse til et representativt utvalg av voksne nordmenn. Respondentene tok stilling til fire påstander om norsk helselovgivning, og anga holdning til åtte påstander om behandling og beslutninger ved livets slutt. Svarene ble analysert med deskriptiv statistikk. Resultater: 1167 personer fullførte undersøkelsen (svarprosent 23,7). 78 % trodde feilaktig at når pasienten selv ikke lenger kan ta beslutninger om behandling, er det pasientens nærmeste pårørende som fatter beslutningen. På de øvrige kunnskapsspørsmål svarte et flertall korrekt. Holdninger til helsehjelp ved livets slutt varierte. Samtidig som et flertall (67 %) mener at mange pasienter holdes i live mot sin vilje, har hele 79 % tillit til at de vil få god lindrende behandling hvis de får en dødelig sykdom. Fortolkning: Kunnskapen om helselovgivningen er ufullstendig i befolkningen. Det er viktig for leger å kjenne til utbredte feiloppfatninger.

• Dahlberg, Jørgen (2022). ECT uten samtykke og uten lov - rettsutvikling og kritikk av dagens praksis. In Aasen, Henriette Sinding & Bahus, Marianne (Ed.), Menneskerettigheter i helse- og omsorgstjenesten. Universitetsforlaget. ISSN 9788215045900. p. 153–187. Full text in Research Archive
• Dahlberg, Jørgen; Øverstad, Siri; Dahl, Vegard & Coman, Alina (2021). Autonomy and consent assessment for electroconvulsive therapy (ECT). A retrospective study of medical records. International Journal of Law and Psychiatry. ISSN 0160-2527. 77. doi: 10.1016/j.ijlp.2021.101716. Full text in Research Archive
• Muller, Ashley Elizabeth; Gubrium, Erika; Dahlberg, Jørgen & Fernandes, Ariana Guilherme (2021). Dårlig forskning hindrer effektiv respons på Covid-19. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. Full text in Research Archive
• Dahlberg, Jørgen; Eriksen, Camilla; Robertsen, Annette & Beitland, Sigrid (2020). Barriers and challenges in the process of including critically ill patients in clinical studies. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 28(1), p. 51–51. doi: 10.1186/s13049-020-00732-x. Full text in Research Archive Show summary

  Background Clinical research in severely ill or injured patients is required to improve healthcare but may be challenging to perform in practice. The aim of this study was to analyse barriers and challenges in the process of including critically ill patients in clinical studies. Methods Data from critically ill patients considered for inclusion in an observational study of venous thromboembolism in Norway were analysed. This included quantitative and qualitative information from the screening log, consent forms and research notes. Results Among 279 eligible critically ill patients, 204 (73%) were omitted from the study due to challenges and barriers in the inclusion process. Reasons for omission were categorised as practical in 133 (65%), medical in 31 (15%), and legal or ethical in 40 (20%) of the patients. Among 70 included patients, 29 (41%) consents were from patients and 41 (59%) from their next of kin. Several challenges were described herein; these included whether patients were competent to give consent, and which next of kin that should represent the patient. Furthermore, some included patients were unable to recall what they have consented, and some appeared unable to separate research from treatment. Conclusions Barriers and challenges in the inclusion process led to the omission of near three out of four eligible patients. This analysis provided information about where the problem resides and may be solved. The majority of challenges among included patients were related to issues of autonomy and validity of consent. Trial registration ClinicalTrials.gov (NCT03405766).

• Dahlberg, Jørgen; Dahl, Vegard; Førde, Reidun & Pedersen, Reidar (2019). Lack of informed consent for surgical procedures by elderly patients with inability to consent: a retrospective chart review from an academic medical center in Norway. Patient Safety in Surgery. 13(24). doi: 10.1186/s13037-019-0205-5. Full text in Research Archive Show summary

  Background Respect for patient autonomy and the requirement of informed consent is an essential basic patient right. It is constituted through international conventions and implemented in health law in Norway and most other countries. Healthcare without informed consent is only allowed under specific exceptions, which requires a record in the patient charts. In this study, we investigated how surgeons recorded decisions in situations where the elderly patient’s ability to provide a valid informed consent was questionable or clearly missing. Method We investigated all medical records of patients admitted to surgical departments in a Norwegian large academic emergency hospital over a period of 38 days (approximately 5000 patients). We selected records of patients above the age of 70 (570 patients) and searched through these 570 medical records for any noted clear indications of inability to consent such as “do not understand”, “confused” etc. (102 patients). We read through all the medical records on these 102 patients noting any recordings on lack of informed consent, any recordings on reasoning and process hereto. We also took note whether there were clear indications on the use of coercion. Results None of the 102 included patients´ charts contained legally valid recorded assessments (for example related to the patients´ competence to consent) when patients without the ability to consent were admitted and provided healthcare. Some charts contained records that the patient resisted treatment, thus indicating treatment with coercion. In these situations, we did not find any documentation related to legal requirements that regulate the use of coercion. Discussion and conclusion We found a substantial lack of compliance with the legal requirements that apply when obtaining valid informed consent. There are many possible reasons for this: Lack of knowledge of the legal requirements, disagreement about the rules, or that it is simply not possible to comply with the extensive formal and material legal requirements in clinical practice. The results do not point out whether the appropriate measures are amending the law, educating and requiring more compliance from surgeons, or both.

• Dahlberg, Jørgen (2017). Dette sier loven om beslutninger i livets sluttfase. Tidsskriftet sykepleien. ISSN 0806-7511. p. 74–77. Full text in Research Archive

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• Dahlberg, Jørgen (2023). Syk økonomi. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(6). doi: 10.4045/tidsskr.23.0130. Full text in Research Archive
• Dahlberg, Jørgen (2022). Leger, tvang og juss. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 142(14). doi: 10.4045/tidsskr.22.0589. Full text in Research Archive
• Horn, Morten Andreas & Dahlberg, Jørgen (2022). Når er en person død? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 142(7), p. 576–577. doi: 10.4045/tidsskr.22.0193. Full text in Research Archive
• Horn, Morten Andreas & Dahlberg, Jørgen (2022). Barna må også med! Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 142(10). doi: 10.4045/tidsskr.22.0407. Full text in Research Archive
• Jorem, Jacob; Dahlberg, Jørgen & Pedersen, Reidar (2021). J. Jorem og medarbeidere svarer. 141(9), p. 1–2. doi: 10.4045/tidsskr.21.0400. Full text in Research Archive
• Jorem, Jacob; Dahlberg, Jørgen & Pedersen, Reidar (2021). Vaksinering uten samtykke – til folkets eller pasientens beste? Svar på kommentar til Torstein Vik. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. Full text in Research Archive
• Jorem, Jacob; Dahlberg, Jørgen & Pedersen, Reidar (2021). Vaksinering uten samtykke – til folkets eller pasientens beste? 141(6), p. 539–541. doi: 10.4045/tidsskr.21.0220. Full text in Research Archive
• Dahlberg, Jørgen & Pedersen, Reidar (2018). Samtykkekompetanse – erfaringer fra somatikk og psykisk helsevern. Presentasjon av et nytt e-læringsprogram. Full text in Research Archive
• Førde, Reidun & Dahlberg, Jørgen (2017). Etikk og jus i helsetjenestene, Indremedisin I & II. Forlaget Vett & Viten AS. ISSN 9788241207402. p. 183–188. Full text in Research Archive
• Dahlberg, Jørgen & Dahl, Vegard (2015). Re: Paternalisme på fremmarsj? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 135(4), p. 307–307. doi: 10.4045/tidsskr.15.0133. Full text in Research Archive
• Dahlberg, Jørgen & Dahl, Vegard (2015). Sultestreikende asylsøker – hvor langt går pasientens rett til å nekte behandling? doi: 10.4045/tidsskr.14.0883. Full text in Research Archive
• 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. Full text in Research Archive
• Giske, Liv; Solberg, Berge; Tranvåg, Eirik Joakim; Dahlberg, Jørgen; Halvorsen, Marit & Hafstad, Elisabet Vivianne [Show all 8 contributors for this article] (2019). Organdonasjon med bruk av normoterm regional perfusjon hos pasienter som dør av hjerte- og åndedrettsstans når livsforlengende behandling avsluttes. Folkehelseinstituttet. ISSN 9788284060514. Full text in Research Archive

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