Hard Choices in Nordic Health Care 2.0

Stockholm, 20 November 2017


All countries are facing ethical and economic problems in today's and, even more, in tomorrow's health care systems. One main reason is demographic changes in the population which gives rise to increasing demands of health care. In the western hemisphere, this is mostly due to a longer life expectancy which leads to an increase of disorders that are costly for the society at large, such as for example Alzheimers disease. Another main reason is the rapid progress in biomedical technologies which often leads to new possibilities of treatment but often to increasing costs in the health sector. The development of new drugs as well as other technologies is often costly. Many countries have experienced a need for new decisions concerning what the costs for a prolonged life, often limited to a fairly short time, can be justified. The gap between what can be done and what can be afforded in the health care sector is thus growing.

There has always been a need for priority settings within modern health care, but those have hitherto often been on a horizontal level, i.e. choices between different groups of disorders. These decisions have often been made on a political and administrative level, but often not explicit and with limited transparency towards the citizens.

Today we are facing new situations where vertical priority settings have come to the fore in a more explicit manner. New ethical questions are being raised like "how much is a life worth?" or "can a patient be denied treatment due to high costs?". These questions have hitherto been implicit in professional decisions but have now also been institutionalized in different manners in systems and processes that are set up in order to defend ethical principles of priority settings in relation to business proposals from the pharmaceutical industry and other similar stakeholders.

It is quite clear that these questions are worrying for politicians and chief administrative persons in all Nordic countries. The work in this area, however, seems to mostly be focused on economical and administrative processes, whereas the fundamental ethical principles that should guide all priority settings often are not discussed satisfactory. There may therefore be a good timing to bring the primary bioethical principles that are used in the Nordic countries to discussion. The principles used in the Nordic countries are similar but not identical and it could be of great interest to compare these principles and to examine what difference this could make in health care praxis. It could also be important to examine the "old and classical" principles with the challenges in the health care sector described above.

With this conference, the Nordic Committee for Bioethics aims to highlight fundamental ethical principles that should guide the priority settings in the modern health care. The conference is aimed at medical professionals, policy makers, academics and the general public, and is a follow-up of the NCBio workshop "Hard Choices in Nordic Health Care – Expensive treatments and priority settings", held in Stockholm in November 2015.

Please note that the seminar is free of charge,  but participants pay their own travel and accommodation costs. The conference is organised in cooperation with the Swedish Society of Medicine.

Preliminary programme:

08:30 Opening and welcome, NCBio Chair Professor Kirsten Kyvik

08:40 Introductory remarks and presentation of the programme, Local host Professor Ingemar Engström

Session 1: What are the goals of medicine?

08:45 Mapping the goals of medicine, Professor Maartje Schermer, ErasmusMC Rotterdam

09:15 The nature of suffering and the goals of medicine, Professor Fredrik Svenaeus,

Södertörn University

09:45 Discussion

10:00 Coffee

Session 2: Needs or demands as driving forces in health care

10:30 Justice and priority settings in health care, Professor/Director Angus Dawson, University of Sydney

11:00 The cake and its bits: can universal health care systems survive (without) ethical priority setting?, Professor Christian Munthe, University of Gothenburg

11:20 Health care as a commodity or a sign of solidarity?, Professor Bettine Lemann Kristiansen, University of Aarhus

11:40 Discussion

12:00 Lunch

Session 3: Does age matter?

13:00 Intergenerational Cooperation and Priority Setting Between Age Groups, Professor Greg Bognar, Stockholm University

13:30 The question of age in priority settings, Professor Jan Abel Olsen, University of Tromsø

14:00 Discussion

14:30 Coffee

Session 4: How much is a life worth?

15:00 The place of economics in priority settings, Professor Samuli Saarni, University of Helsinki

15:30 Is there a limit to health costs, Professor Gudmundur Heidar Frimannsson, University of Akureyri

16:00 Discussion

Final lecture:

16:30 Who should make the hard choices in health care, Director Birgir Jakobsson, Directorate of Health, Iceland

17:00 End of conference

Venue: The Swedish Society of Medicine, Klara Östra Kyrkogata 10, 101 35 Stockholm