In this paper, for the benefit of reflection processes in clinical and in local, regional, and national priority-setting, we aim to develop an ethical theoretical framework that includes both ethical principles and medium-range narratives. We present our suggestion in the particular case of having to choose between treatment interventions for attention deficit hyperactivity disorder (ADHD) and treatment interventions for other conditions or diseases, under circumstances of scarcity. In order to arrive at our model, we compare two distinct ethical approaches: a (...) generalist (principles) approach and a particularist (narratives) approach. Our focus is on Sweden, because in Sweden prioritization in healthcare is uniquely governmentally regulated by the “ethics platform.” We will present a (fictional) scenario to analyse the strengths and weaknesses of the generalist principled perspective of the ethics platform and the particularist perspective of narrative ethics. We will suggest an alternative (moderately particularist) approach to prioritization, which we dub a “principles plus medium-range narratives” approach. Notwithstanding the undeniably central role of principles in distributive justice, we claim that medium-range narratives concerning individuals or groups who stand to benefit or lose from ADHD prioritization practices should also be read or listened to and taken into account at all levels of priority-setting. These narratives are expected to ethically optimize clinical priority-setting, as well as that undertaken at local, regional, and national levels. (shrink)

Learning to see the continuity between our everyday decision-making and our decision-making around new biotechnologies is key to acclimatizing to our enhanced future. By excavating this decision-making, Singh helps us see that Ritalin isn’t really that big a deal and helps dispel what Malcolm Gladwell (1999) noted as the “strange inversion of moral responsibility” encouraged by books like ‘Ritalin Nation’ and ‘Running on Ritalin,’ whose authors “seek to make those parents and physicians trying to help children with A.D.H.D. feel guilty (...) for doing so.”. (shrink)