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 Practical Ethics in
Occupational Health

Edited by

Peter Westerholm
Professor Emeritus in Occupational Epidemiology
National Institute for Working Life, Sweden

Tore Nilstun
Professor of Medical Ethics
University of Lund, Sweden

John 0vretveit
Director of Research
The Karolinska Institute Medical Management Centre, Stockholm
Professor of Health Policy and Management
The Nordic School of Public Health, Gothenberg
Bergen University Faculty of Medicine, Norway

Boca Raton London New York

CRC Press is an imprint of the

Taylor & Francis Group, an informa business
First published 2004 by Radcliffe Publishing

Published 2018 by CRC Press

Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742

© 2004 Peter Westerholm, Tore Nilstun and John 0vretveit

CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
ISBN-13: 978-1-85775-617-3 (pbk)

This book contains information obtained from authentic and highly regarded sources. While
all reasonable efforts have been made to publish reliable data and information, neither the
author[s] nor the publisher can accept any legal responsibility or liability for any errors or
omissions that may be made. The publishers wish to make clear that any views or opinions
expressed in this book by individual editors, authors or contributors are personal to them and
do not necessarily reflect the views/ opinions of the publishers. The information or guidance
contained in this book is intended for use by medical, scientific or health-care professionals
and is provided strictly as a supplement to the medical or other professional's own judgement,
their knowledge of the patient's medical history, relevant manufacturer's instructions and the
appropriate best practice guidelines. Because of the rapid advances in medical science, any in-
formation or advice on dosages, procedures or diagnoses should be independently verified.
The reader is strongly urged to consult the relevant national drug formulary and the drug
companies' and device or material manufacturers' printed instructions, and their websites,
before administering or utilizing any of the drugs, devices or materials mentioned in this
book. This book does not indicate whether a particular treatment is appropriate or suitable for
a particular individual. Ultimately it is the sole responsibility of the medical professional to
make his or her own professional judgements, so as to advise and treat patients appropriately.
The authors and publishers have also attempted to trace the copyright holders of all material
reproduced in this publication and apologize to copyright holders if permission to publish in
this form has not been obtained. If any copyright material has not been acknowledged please
write and let us know so we may rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, repro-
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British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library.
Typeset by Anne Joshua & Associates, Oxford
 Contents

Foreword v
Preface vii
About the editors xii
About the contributors xiv
Acknowledgements xxiii

1 A changing life at work: ethical ramifications 1

Peter Westerholm
2 Ethics, research-informed practice and quality 23
improvement
John 0vretveit
3 Ethical analysis 37
Tore Nilstun and John 0vretveit
4 The ethics of risk assessm ent 49
Kit Harling
5 The ethics of workplace interventions 61
Peter H asle and Hans Jorgen Limborg
6 Workplace health surveillance 77
Kari-Pekka Martimo
7 Health examinations on new employment: ethical issues 91
Stuart Whitaker
8 Work disability assessm ent in the Netherlands 105
Jos Verbeek and Carel Hulshof
9 Sickness absence management 115
Andre NH Weel and M arja J Kelder
10 Reducing sick leave: swimming upstream - positioning 133
and multiple loyalties
Stein E Grytten
iv Contents

11 A case of workplace drug and alcohol testing in a UK 151

transport company
Olivia Carlton
12 Alcohol abuse in the workplace: some ethical 167
considerations
Tommy Alklint
13 Blood-borne viruses as workplace hazards 177
Ian S Symington
14 Workplace rehabilitation 189
Knut Erik Andersen
15 Insurance medicine and work-related diseases: some 199
ethical and legal aspects
Juhani funtunen
16 Recognition of work-related diseases 217
Bengt Jarvholm
17 Workplace genetic screening 223
Lisbeth Ehlert Knudsen
18 Occupational health research 241
D avid Coggon
19 The ethics of health and safety services: a trade union 253
perspective
Laurent Vogel
20 Employer attitudes to ethics in occupational health 263
Niki Ellis
21 Whistleblowing 283
Tore Nilstun and Peter Westerholm
22 Education in ethics 291
Noks N auta
23 Ethical occupational health management and 307
organisation
John Ovretveit
24 Professional codes of ethics 321
Kit Harling, Peter Westerholm and Tore Nilstun
25 Concluding remarks 331
Index 339
 Foreword

This book addresses an area of fundamental importance for occupational

health professionals. It is a core component of our professionalism.
Competent professionals are expected to make decisions which are
perceived as fair and equitable by both employees and employers.
Other stakeholders influenced by our judgements include the work
team and those affected by the impact of the enterprise on the wider
biopsychosocial environment. Although the patients of general health­
care professionals increasingly have autonomy and real choice about their
health treatments, healthcare workers have much less control over their
work and socio-economic conditions, and may have no ability to choose
their occupational health advisers, who have been appointed by their
employers.
Into this picture in the past 20 or 30 years has come the growth of
information technology and access to information for all, and much new
legislation on equal opportunities, disability discrimination and employ­
ment conditions. Although evidence-based guidelines have been developed
in occupational health, these have lagged behind some other areas of
medical, nursing and safety practice. Scientific uncertainty creates ethical
challenges and occupational health professionals regularly have to make
judgements on extremely complex situations.
Thus it is no surprise that national and international ethical standards for
occupational health practice have been produced, perhaps proportionately
more than for any other area of healthcare. These are necessary reading for
both occupational health professionals and their customers.
In the training of occupational health professionals competence in law
and ethics is one of the more important aims. For occupational health
physicians in Europe this was confirmed within the World Health Organ­
ization (WHO) publication on occupational medicine in Europe, Scope and
Competencies/ and endorsed by the Occupational Medicine Section of the
Union of European Medical Specialists in their Annex describing the
common core competencies required in training occupational physicians.
Similar emphases have developed in the training of occupational health
nursing, safety, hygiene, ergonomic and other professions.
Across the European Union there is increasing universality of moral
norms and shared values. The principles of free exchange of labour and
capital have been established.
vi Foreword

Implicit in good occupational health practice is the principle of respect

for individuals, taking into account the needs of both society and enterprise.
This multi-author European text explores practical scenarios by use of a
structured and analytical approach, and in so doing shows the reader how to
apply and implement existing codes and guidelines in this increasingly
complex professional area.

Dr Ewan B Macdonald
University of Glasgow
President, Section of Occupational Medicine
Union of European Medical Specialists
February 2004

Reference
1 WHO European Centre for Environment and Health (2000) Occupational Medicine
in Europe: Scope and Competencies. Series: Health, Environment and Safety in
Enterprises No. 3. WHO Regional Office for Europe, Copenhagen.
 Preface

All censorships exist to prevent anyone from challenging current conceptions and
existing institutions. All progress is initiated by challenging current conceptions
and executed by supplanting institutions. Consequently, the first condition of
progress is the removal of censorships. There is the whole case against censorship
in a nutshell.
George Bernard Shaw (1856-1950)

This book deals with the ethical challenges confronting occupational

health professionals in today's changing world of work. It is written, as
the title of the book implies, with a view to the issues and problems
occupational health professionals deal with in everyday practice. Com­
monly, occupational health professionals are commissioned for advisory
and consulting tasks in the realm of occupational safety and health
management by enterprises and organisations. They may be in the employ­
ment of companies using their services, or act as experts external to client
firms or organisations.
Accordingly, the primary target group (the 'bull's eye', so to speak) of this
book consists of occupational health professionals. This broad category
includes occupational health physicians and nurses, physiotherapists and
ergonomists, occupational hygienists and safety engineers, occupational
psychologists, and social workers (to mention the most common groups),
and also the managers of occupational health service units or organisations.
As well as this primary target group, the book is designed to meet the
needs of all those who purchase and use occupational health services - the
services' customers and clients. They have legitimate interests in seeking
services of good quality whilst seeking certainty that the ethical standards
of the services on offer are reliable and trustworthy.
It is a daunting task to write a book on practical ethics, and possibly
particularly with regard to occupational health services. The point of
departure with regard to problems and observations has to be in the settings
and organisations where occupational health professional care is practised.
So, the context is thereby defined. This implies that readers seeking
philosophical innovation are likely to be disappointed. The book emphasises
the ethical issues inherent in the practical problems encountered by
occupational health professionals. These may, however, illustrate and
bring up more profound issues - questions and arguments that are, by
v ii i Preface

analogy, similar to but not dependent on the context of the case material
presented here.
Our starting point lay simply in a feeling that a book with a focus on the
ethics of occupational health specialists was needed. The issues of profes­
sional ethics have been examined, and rules for the behaviour of occupa­
tional health professionals presented earlier, in the International Code of
Ethics for Occupational Health Professionals 1992.1This was published as
a set of norms in 1992 (revised in 2002) by the International Commission of
Occupational Health (ICOH). Earlier, in 1980, the Faculty of Occupational
Medicine (FOM) of the Royal College of Physicians in the UK published the
document Guidance on Ethics for Occupational Physicians.2 Now avail­
able in its fifth edition, this document takes the reader one step closer to the
issues emerging in real life in different fields of occupational health
practice. It also provides principled recommendations on ethical conduct.
This book seeks to supplement both the ICOH Code of Ethics and FOM
Guidance on Ethics by adding a dimension of reflection. There are prob­
lems in identifying pertinent facts and the ethical values involved, and
using these as bases for arriving at considered decisions.
The book is structured according to the following logic. We start with
three chapters of an introductory nature, providing an initial conceptual
framework for the subject, which are then followed by a series of case-based
chapters describing a problem or an issue in occupational health profes­
sional ethics from real life. Though the approach is somewhat different in
these case chapters, they are similarly structured to include analysis of the
specific problem or ethical dilemma at hand. The book concludes with a
chapter designed to synthesise the editors' views in light of the preceding
chapters.
We have no ambition to be exhaustive in dealing with the substance of
professional ethics in occupational health and safety. The problems in
the case chapters should be seen as examples that serve to demonstrate the
use of three value criteria - namely autonomy (or the right to self-
determination), beneficence (including non-maleficence) and justice (in­
cluding equity). There are, of course, many other types of situations besides
the ones described in the case chapters. They all give rise to ethical
dilemmas for health professionals not covered by the book. It is our
sincere belief, however, that its case material will be pertinent and give
food for thought and reflection with regard to the challenges often met by
occupational health professionals in their life at work.
It is important to remind readers that most of the chapter authors are, or
have been, professional occupational health practitioners - from Belgium,
Denmark, Finland, the Netherlands, Norway, Sweden and the UK. These
are all countries from a relatively affluent region of the world, namely
northern Europe. They have many common factors in their general
 Preface ix

functioning, structure and culture, and they are also characterised by

relatively efficient public infrastructures and collaboration between private
capital, the organs of the state and trade unions. These commonalities are
likely to have enabled the various authors to converge in their views on the
ethical values of beneficence, autonomy and justice. Indeed, they can be
expected to have found much common ground in interpreting and using
these value concepts. But it also implies that we do not claim universality
in our descriptions of ethical problems, or in the mental processes we
undergo in arriving at reflected opinions. We are convinced that a book
written by people recruited on a more global basis would accept these
values, but they would probably specify them differently, and also advocate
a different balance between them.
Any introductory book on occupational health does not spring from any
one single scientific discipline. In fact, the area is the common subject
matter of a range of disciplines, in both the theoretical and applied sciences.
It is concerned with the health, technical, psychological, organisational,
social and political aspects of working life, and draws on scientific know­
ledge from many fields. This is a truly multidisciplinary arena, which
carries the issues of ethics - with all their ramifications - into the realms of
business, environment and politics.
Biomedical ethics has, at least until recently, focused primarily on
individuals - in health services commonly referred to as the 'patient'.
Patients' autonomy and integrity, and also their rights, are largely depend­
ent on the judgements of health professionals and the complex workings of
healthcare organisations, dominated as they are by hospital-based medi­
cine. In issues of environmental ethics, however, issues of benefit or harm
to the general public and society make up a significantly larger portion of
our concerns. In the latter domain, individual autonomy is to be seen from a
different perspective. It is often a source of harm to others - leading to a
need not to expand, but rather to set limits to individual freedom. For
example, biotechnological considerations commonly lead to state regula­
tions on the emissions of pollutants or discharges of toxic waste and
requirements for high safety standards. They may also lead to demands
for international standards or regulations on environmental matters, which
then become subject to enforcement by state authorities acting in concert
across national borders.
Occupational health ethics occupy an intermediate position. They are
clearly oriented towards individuals and their health concerns, but simul­
taneously focus on context and living conditions in the workplace. In this
domain, the workplace - embedded as it is in the social organisation of an
enterprise - constitutes a dominant component of the environmental
setting of people at work. The workplace is not only the place where we
earn our livelihood. It forms, in reality, the centre stage of key social
x Preface

processes and interactions between people. Many different interests and

stakeholders meet in the workplace, and the outcomes of interactions
between them affect people's lives in many ways. There are also health
implications of such processes. The workplace is a setting where we acquire
knowledge, leam skills, and develop. People emerge on this stage in the
roles of manager or staff, as expert or consultant, as owner or trades
unionists, or as representative of the state in one of its many guises.
Thus, the physical and cultural settings of the real-life issues of profes­
sional ethics in the workplace are of considerable complexity. Our idea is
that an awareness of this complexity and the multitude of interests
involved in occupational health service will equip professionals better for
the difficult tasks with which they are confronted.
This book has no normative intent. We do not approve or recommend any
one or other of the solutions offered in the conclusions of our case chapter
authors. But, if they provide incentives for fact-finding and for identifying
and using relevant value criteria in structured ethical analyses, we will be
content with what we have achieved. All along, our aim has been to provide
occupational health professionals with tools for the ethical analysis of
challenging and complex cases and situations, all of which impose the
demand of arriving at a well-reflected professional decision.
Please note that in some of the reference lists throughout the book
English translations have been given for titles of documents published in
languages other than English. This is for the reader's benefit only and does
not necessarily indicate that the publication is available in the English
language.

Peter Westerholm, Tore Nilstun and John 0vretveit

February 2004

References
1 International Commission on Occupational Health (2002) International Code of
Ethics for Health Professionals 1992. Updated version of the Code (2002) available
(English and French languages) on ICOH website (www.icoh.org.sg).
2 Faculty of Occupational Medicine of the Royal Society of Medicine (1999) Guidance
on Ethics for Occupational Physicians (5e). Royal Society of Medicine, London.
T h e editors and con tribu tors
 About the editors

Peter Westerholm MD, FFOM

Following his retirement in 2000, Peter Westerholm is now Professor
Emeritus in Occupational Epidemiology at the National Institute for
Working Life (NIWL), Sweden. He was born in Finland in 1935. After
clinical postgraduate training in general surgery he served as a surgeon in
the Royal Swedish Navy, as Deputy Medical Director of Sweden's National
Board of Occupational Safety and Health, a consultant epidemiologist at the
National Board of Health and Welfare, and a medical adviser to the Swedish
Confederation of Trade Unions. He was appointed Professor of Occupa­
tional Epidemiology to the NIWL in 1990. During the years 1993-2000 he
was Chairman of the ICOH Scientific Committee for Health Services
Research and Evaluation in Occupational Health.
Contact information
Office address: National Institute for Working Life, SE-113 91 Stockholm,
Sweden
Tel: +46 861 96972
E-mail: [email protected]

Tore Nilstun
Tore Nilstun has been Professor in Medical Ethics at Lund University in
Sweden since 2002. He was born in Norway in 1944.
Contact information
Office address: Department of Medical Ethics, St Grabrodersgatan 16,
SE-222 22 Lund, Sweden
Tel: +46 46 22 21282
E-mail: [email protected]

John Ovretveit PhD

Professor John Ovretveit, bom in England in 1954, is currently Director of
Research at the Karolinska Institute Medical Management Centre (MMC),
Stockholm, Sweden. He is also Professor of Health Policy and Management
at the Nordic School of Public Health, Gothenburg, Sweden, and at Bergen
University Medical School, Norway. A theme underlying his work is
how practical research can contribute to healthy work organisation and
better patient care. He has undertaken health evaluation and development
 About the editors x iii

projects in African countries, Yemen, Indonesia, Thailand, New Zealand,

Australia, Japan, Sweden, Norway, Estonia and the USA. He was awarded
the 2002 European Health Management Association Award and the Baxter
Health Publication of the Year prize for 'Action Evaluation', and the 1992
award for 'Health Service Quality'. He also received the 1999 British
Association of Medical Managers' publication award for 'Evaluating
Health Interventions'.
Contact information
Office address: The Nordic School of Public Health, Box 12133, S-40242
Gothenburg, Sweden
Tel: +46 31 693900
E-mail: [email protected]
 About the contributors

Tommy Alklint MD
Tommy Alklint is an occupational health physician, currently working at
Sweden's National Insurance Board, providing information and training for
physicians concerning sickness certification and rehabilitation. He is also
an occupational health adviser to Previa South, Sweden - an organisation
providing occupational health services to the labour market. He is a former
board member of the Association of Swedish Occupational Physicians. He
was born in 1945 and has been a member of the board of the Union for
Occupational Health Physicians of Sweden.
Contact information
Office address: FK Lund, Box 104, S-22100 Lund, Sweden
Tel: +46 703 003470
E-mail: [email protected]

Knut Erik Andersen MD

Dr Knut Erik Andersen is a specialist mentor and tutor in occupational
medicine, currently working for the Jotun A/S company as Chief Medical
Adviser to HSE Group Staff. He was Norway's governmental representative
to the International Labour Organisation (ILO) in the spring of 1980.
Following clinical postgraduate training, he has held posts as an occupa­
tional physician in Svalbard, Norway, in Greenland, and within the
Directorate of Labour Inspection, Oslo.
Contact information
Office address: Jotun A/S, HSE Group Staff, Post Box 2221, N-3248
Sandefjord, Norway
Tel: +47 33 457410
E-mail: [email protected] or [email protected]

Olivia Carlton MB, BS, DRCOG, FFOM

Dr Olivia Carlton is an occupational physician who has worked for London
Transport, later London Underground, for 14 years, and now acts as adviser
to the London Underground Board on occupational health policy and
strategy. She heads a multidisciplinary occupational health team that
includes medical and nursing advisers, a counselling and trauma service,
a drug and alcohol advisory service, and a physiotherapy service. Since 1997
 About the contributors XV

she has been seconded to the Department of Health to provide policy advice
on occupational health to the Minister of Public Health. She was closely
involved in the development of the British government's 'Healthy Work­
place' initiative and the occupational health strategy for 'Securing Health
Together' and in developing the conceptual framework for 'NHS Plus'
standards - the vehicle through which the National Health Service (NHS)
provides occupational health services to non-NHS employers. She was
elected as Registrar of the Faculty of Occupational Medicine in May 2003.
Contact information
Office address: London Underground Limited, 280 Old Marylebone Road,
Griffith House, London NW1 5RJ, UK
Tel: +44 207 918 1973
E-mail: [email protected]

David Coggon OBE, MA, PhD, DM, FRCP, FFOM, FMed Sci, MRC
David Coggon has been Professor of Occupational and Environmental
Medicine at the University of Southampton in the UK since 1997. He
studied mathematics and medicine at Cambridge and Oxford universities
and has also received clinical training in internal medicine. He has been an
epidemiologist at the MRC Environmental Epidemiology Unit since 1980
and Honorary Consultant Occupational Physician, Southampton Univer­
sity Hospitals Trust since 1987.
Contact information
Office address: MRC Environmental Epidemiology Unit, Southampton
General Hospital, Southampton, SO 16 6YD, UK
Tel: +44 23 807 77624

Niki Ellis PhD, MBBS, FAFOM, FAFPHM

Dr Niki Ellis is an occupational and public health consultant, currently
working as research associate at the Wellcome Trust Centre for the History
of Medicine, University College London, UK. She was Director of Health
Risk Management, PricewaterhouseCoopers, Sydney, Australia (2000-01),
Principal of NE&A, Sydney and Melbourne (1990-2000) and Head of
Preventive Strategies, National Occupational Health and Safety Commis­
sion (1985-90). She was Inaugural President of the Australasian Faculty of
Occupational Medicine (1992-94).
Contact information
Office address: Flat 14, 1 Batemans Row, London EC2A 3HH, UK
Tel: +44 207 729 8640
E-mail: [email protected]
xvi About the contributors

Stein E Grytten MD, Cand Med

Dr Stein E Grytten is a specialist in occupational and family medicine,
currently working at the Spiggeren Health Centre in Mandal in Norway,
which he established in 2002. He also works as a general practitioner and
further specialises in orthopaedic surgery. He received his post-graduate
training in Tromso, Norway. He has great experience of major industrial
and commercial operations in Norway and was a member of the Norwegian
Medical Association's Board of Occupational Physicians (1996-2002).
Contact information
Office address: Spiggeren legesenter, Sandskargata 6, 4515 Mandal, Norway
Tel: +47 382 71933
E-mail: [email protected]

Kit Harling MD
Professor Kit Harling was appointed as consultant in the UK National
Health Service in 1984, where he continues to work as a clinical occupa­
tional physician. He is currently seconded to the UK Department of Health
to direct a national occupational health service. He has been an examiner
with the Faculty of Occupational Medicine at the Royal College of
Physicians of London for 10 years and was Dean of the Faculty (1996-99).
He has been a member of the Faculty's Ethics Committee for eight years,
the last three as chair, and is currently editing the sixth edition of the
Faculty's Guidance on Ethics for Occupational Physicians. Following
undergraduate training in Oxford and London, he undertook specialist
training in occupational medicine in the diving, aviation, chemical and
coal-mining industries.
Contact information
Office address: Department of Health, Room 330b, Skipton House, 80
London Road, London SE1 6LH, UK.
Tel: +44 207 972 3830
E-mail: [email protected] or [email protected]

Peter Hasle PhD

Dr Peter Hasle is an associate professor, in organisation, management and
working life, at the Department of Engineering Manufacturing and Manage­
ment, Technical University of Denmark. He has held assignments as a
consultant in the occupational health service of the Municipality of
Copenhagen. He acted as adviser on work environment during the
UNDP/ILO project for the establishment of a national institute for work
conditions and environment in Bangkok, Thailand (1985-87). Previously,
he was research manager at the Centre for Alternative Social Analysis
(1990-2002), and a trainer at the Danish TUC School.
 About the contributors x v ii

Contact information
Office address: Department of Engineering Manufacturing and Manage­
ment, Technical University of Denmark, Building 303, DK-2800 Lyngby,
Denmark
Tel: +45 45 256056
E-mail: [email protected]

Card Hulshof MD, PhD

Carel Hulshof is a certified occupational physician and epidemiologist. He
has held posts as an occupational physician in Nijmegen and Amsterdam,
Netherlands. From 1984 onwards he has combined work as an occupational
health physician with scientific research in positions at the Coronel
Institute of the Academic Medical Centre in Amsterdam. Since 1998 he
has also been affiliated to the Foundation for Quality in Occupational
Health Care (SKB). He is a member of the International Advisory Board of
the Scandinavian Journal for Work, Environment and Health, a member of
the Executive Board of the ICOH Scientific Committee on Health Services
Research and Evaluation in Occupational Health and Vice-Chair of the
Dutch National Complaints Committee for Pre-employment Medical
Examinations.
Contact information
Office address: Academic Medical Center, University of Amsterdam
Coronel Institute, PO Box 22700, 1100 DE Amsterdam, Netherlands
Tel: +31 20 5 665333/5325
E-mail: [email protected]

Bengt Jarvholm PhD

Bengt Jarvholm is Professor of Occupational and Environmental Medicine
at the Department of Public Health and Clinical Medicine, Umea Uni­
versity, Sweden. He is a consultant in the Department of Occupational and
Clinical Medicine at the Northern University Hospital in Umea. He
worked previously at the Sahlgren University Hospital in Gothenburg,
Sweden. He acts as an expert in legal cases involving compensation for
occupational diseases, and is editor of a recently published Swedish text­
book on insurance medicine.
Contact information
Office addresss: Occupational Medicine, Department of Public Health and
Clinical Medicine, SE-901 85 Umea, Sweden
Tel: +46 90 785 2241
E-mail: [email protected]
x v ii i About the contributors

Juhani Juntunen MD, PhD

Professor Juhani Juntunen is Medical Director of Etera Mutual Pension
Insurance Company, Finland. He is a specialist in neurology, with special
competence in insurance, addiction and traffic medicine. He was Chief
Medical Officer for clinical neurosciences at the Institute of Occupational
Health, Helsinki (1979-89) and has been Acting Professor of Neurology,
University of Tampere, Professor of Alcohol Diseases, University of
Helsinki, and Professor of Occupational Health, University of Bergen,
Norway. Since 1986 he has specialised in insurance medicine at the
University of Helsinki and in neurotoxicology at the University of Tampere.

Contact information
Office address: Etera Mutual Pension Insurance Company, Palkkatilan-
portti 1, FIN-00240 Helsinki, Finland
Tel: +358 10 553 3324, +358 (0) 400 441 330
E-mail: [email protected]

Marja J Kelder
Marja J Kelder is a certified occupational physician and jurist currently
working for Arbo Unie, an occupational health service in the Netherlands.
She was course manager for occupational health training at the Nether­
lands School of Public Health for seven years. She is secretary of the Ethics
Committee of the Dutch Society of Physicians in Occupational Health
and member of the Pre-employment Medical Examinations Complaints
Committee.
Contact information
Office address: Arbo Unie BV, Houtlaan 21, 3016 DA Rotterdam, Nether­
lands
Tel: +31 10 417 7500
Alternative address: Jeroen Boschlaan 60,3055 NR Rotterdam, Netherlands
Tel: +31 10 418 2011
E-mail: [email protected]

Lisbeth Ehlert Knudsen PhD

Dr Lisbeth Ehlert Knudsen is associate professor at the Institute of Public
Health, University of Copenhagen, Denmark. She has trained in toxicology
and occupational health, specialising in genetic toxicology and biomonitor­
ing and their ethical aspects. She has held assignments in the Danish
Environmental Protection Agency, the Danish Working Environment
Inspection Service, the National Institute of Occupational Health and the
Danish Medicines Agency. She is involved in a number of EU projects and
European networks, such as Children's Susceptibility to Environmental
 About the contributors x ix

Genotoxicants, Evaluation of Medicinal Products, Validation of Alternative

Methods (ECVAM) and the Implementation of the EU Data Protection
Directive in Relation to Medical Research and the Role of Ethics
Committees.
Contact information
Office address: Environmental Medicine Institute of Public Health, Uni­
versity of Copenhagen, c/o Dept of Pharmacology, Panum Blegdamsvej 3,
DK-2200 Copenhagen, Denmark
Tel: +45 353 27653
E-mail: [email protected]

Hans Jergen Limborg PhD

Dr Hans Jorgcn Limborg has been research co-ordinator and senior work-
environment consultant at the Centre for Alternative Social Analysis
(CASA), Copenhagen, Denmark since 1994. He has been an occupational
health hygienist at Midtsjaellands Bedriftssundhedscenter and an occupa­
tional health work-environment planner at Bedriftssundhedscenter
Kobenhavn Vest. He was educational adviser at Denmark's Work Environ­
ment Fund in charge of programmes aimed at occupational health staff
(1990-93). In his present position, as senior research consultant at CASA,
he is responsible for the development and implementation of occupational
health and safety projects and for programmes aimed at third world
countries.
Contact information
Office address: CASA, Linnesgade 25, III, DK-1361 Copenhagen, Denmark
Tel: +45 33 320555
E-mail: [email protected]

Kari-Pekka Martimo Lie Med

Kari-Pekka Martimo is a specialist in occupational healthcare and occupa­
tional medicine, and has been Chief Physician at M-real Corporation in
Finland since 1998. He has previously held assignments as an occupational
physician in the Kruunuhaka Medical Centre, Oy Lohja Ab, and the Neste
Oil Refinery. He was trained as a specialist physician at the Finnish
Institute of Occupational Health. He has been appointed as EU Pre­
accession Adviser in Estonia during 2003-04.
Contact information
Office address: Corporate Human Resources, M-real Corp, PO Box 582,
FIN-33101 Tampere, Finland
Tel: +358 50 566 5797
E-mail: [email protected]
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