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The purpose of this report is to contribute knowledge about organizational ethical aspects of the Swedish pandemic preparedness. More specifically, 12 key policy documents aimed at guiding health care practice – before a pandemic and during the Covid-19 pandemic – has been analyzed regarding the purpose of the policy documents, their ethical content, and the attention given to value conflicts and the recipient organizations' ability to comply with fundamental ethical requirements. Based on the results, concrete proposals are given to strengthen the health care system’s preparedness and capacity for ethical responsibility in relation to the goal of the Swedish pandemic preparedness – and thus reduced vulnerability – for future pandemics.

The analysis shows that purposes and essential ethical values prescribed by law, such as the principle of human dignity, tended to be reduced and even drained of their ethical content in the policy documents. Fundamental aspects of organizational ethics in health care (including an ethics of care) were also missing. For instance, overall, the purpose of health care has not been properly indicated in the policy documents, and no attention was given to the receivers’ prerequisites to take ethical responsibility for conflicts of interest that occur and to apply the policy documents during the pandemic. Moreover, by presenting new national principles for priorities during the ongoing pandemic, which in addition deviated from the Health Care Act, The National Board of Health and Welfare may have misled priority decisions and increased the moral stress among healthcare staff rather than reduced it. Thus, during the Covid-19 pandemic health care providers may have had insufficient organizational conditions, political guidance, and administrative support to act ethically in relation to the goal of the Swedish preparedness for crisis and pandemics.

In order to maintain the ethical value system that the Swedish constitution and the Health Care Act are ultimately based on – and to promote social trust and a long-term sustainable and robust welfare system – ethics needs to be taken more seriously and given legitimacy by being organized into the every-day practices in the healthcare system.

Hur förhåller det sig med den svenska pandemiberedskapen? Enligt svensk lag ska all offentligt finansierad vård ges efter behov, på lika villkor och med respekt för varje människas värdighet. Men under en pandemi kan beslutsfattare tvingas att göra svårare prioriteringar än vanligt och vårdens medarbetare utsättas förbetydande stress och infektionsrisk. Att i en sådan situation kunna skydda befolkningens liv och hälsa och samhällets grundläggande demokratiska värderingar fordrar en robust beredskap och organisatoriska förhållanden som tål extraordinära påfrestningar.

Den här rapporten belyser organisationsetiska aspekter av Sveriges pandemiberedskap. Därmed uppmärksammas nödvändiga förutsättningar för att beslutsfattare och vårdens medarbetare under en pandemi ska kunna ta ansvar för lagstadgade etiska mål, värden och principer. Rapporten visar på flera uppenbara brister vad gäller organisationsetiska aspekter av den svenska pandemiberedskapen och argumenterar för att förbättringar är både möjliga och önskvärda. Rapporten vänder sig till beslutsfattare på samtliga nivåer i hälso- och sjukvårdssystemet, till policy- och verksamhetsutvecklare, till vårdens chefer och medarbetare och till en intresserad allmänhet.