Swedish COVID-19 health policy excluding frontline voices

During the COVID-19 pandemic, a Swedish policy document was created to guide who should receive critical care if the healthcare system became overwhelmed. A recent study examines how this policy was developed and implemented, and raises important questions about ethics and how to improve public health policy making in future crises.

The study, published in the journal Politics & Policy, is based on a case study on key policy documents directed towards caregivers during this time, and provides practical support on how to avoid undesirable consequences of policy making. By advocating for collaboration between academics, policy makers, and frontline professionals to create fair and effective policies, the study prepares academics for expert roles in public policy.

First of all, the authors found that the policy document, called National Principles for Prioritization in Intensive Care under Extraordinary Conditions, does not address central aspects affecting Swedish healthcare capacity. Instead, it is based on the assumption that difficult prioritizations will follow from increasing care needs resulting from the pandemic. In other words, the policy treats the problem as a result of the biological effect of the virus, not as the consequences of structural issues in the healthcare system. According to the authors, there is also a risk that the policy was used by regions primarily to make it seem like there were enough resources, by reducing the number of patients needing intensive care.

Another ethical concern presented by the authors, is the fact that the expert group responsible for the policy consisted of 11 male academics, excluding critical voices such as nurses and social scientists. The lack of diversity may have led to an incomplete understanding of the practical and ethical challenges faced by Sweden’s largely female-dominated healthcare workforce during the pandemic.

“Relying only on philosophers to complement physicians in ethically sensitive policy production increases the risk of misunderstanding or discounting the context-specific challenges of implementing new criteria for health care provision during a massive crisis,” says Erica Falkenström, associated researcher at the Centre for Research Ethics & Bioethics, and first author of the study.

To address these issues, the authors propose a more inclusive and interdisciplinary approach.

“These problems could be avoided by using a different approach with a different composition of the expert group, by including, for example, nurses with experience of long-term care and social scientists with an empirically grounded understanding of the organizational challenges in the Swedish healthcare system,” says Erica Falkenström.

Do you want to know more? Read the article: Falkenström, E. & Selberg, R. (2025), Ethical Problems and the Role of Expertise in Health Policy: A Case Study of Public Policy Making in Sweden During COVID-19. Politics & Policy, 53: e12646. DOI: 10.1111/polp.12646

By Fanny Klingvall