Macklins Substitutionsthese und der Begriff der Menschenwürde in der Bioethik

Definition of the problem

Ruth Macklin’s influential essay “Dignity is a useless concept” has revitalized a broad debate on the question whether the concept of dignity is meaningful in medical ethics. In this paper, I would like to examine Macklin’s so-called redundancy claim: according to this claim, the concept of human dignity can be replaced by other concept(s)—the concept of autonomy most prominent among them. What is the meaning of this claim?

Arguments

Starting from an analysis of Macklin’s arguments, I am going to show under which conditions a redundancy claim indeed leads to the eliminating consequences emphasized by its defenders—we should abandon the concept of dignity.

Conclusion

I am going to identify the advantages of her position both in comparison with more radical eliminative standpoints as well as positions that regard it as valid, but unanalyzable.     

„Personalisierte Medizin“ in der Onkologie: Ärztliche Einschätzungen der aktuellen Entwicklung in der Krankenversorgung

Definition of the ProblemPublic discussions about “personalised medicine” indicate that this approach is associated with high expectations regarding its contribution to clinical practice. However, little is known about physicians’ perspectives on “personalised medicine”. This qualitative interview study aims to provide insight into physicians’ perceptions and views regarding clinical practice. Arguments/ResultsPhysicians in this sample view “personalised medicine” as a progress within medicine, but do not see a major departure from long-standing practices. As a major problem, physicians identified handling the amount of molecular and genetic information and integrating this information into the diagnosis and treatment. ConclusionTaking the results into account, one may ask whether “personalised medicine” is not the opposite of what its name connotes—a more patient-centred medicine. The strategies for handling the large amount of information raise novel challenges which are in contrast to the ideas of patient-centred medicine.     

Patientenverfügung und Behandlungsvereinbarung als Instrumente der Vorausplanung in der forensischen Psychiatrie

Definition of the problem

In Germany as well as in many other countries, mentally ill criminals who are not guilty by reasons of insanity can be sentenced to psychiatric treatment in forensic clinics. In 2011, the German Constitutional Court substantially strengthened these patients’ right to self-determination in case of treatment refusal.

Arguments

In this context, we discuss the significance of instruments of advance healthcare planning. First, we describe the context of psychiatric treatment in forensic clinics and the changes the new German legal regulations brought about. A case study helps to illustrate the consequences of treatment refusal for both patient and healthcare personnel.

Conclusion

Eventually, we discuss if and how advance directives and joint crisis plans can be useful in forensic clinics and how additional measures can help to facilitate patient self-determination.

     

Legalisierung der aktiven Sterbehilfe – Förderung oder Beeinträchtigung der individuellen Autonomie?

Definition of the problem Theorists who support the legalisation of active euthanasia usually base their arguments on the principle of autonomy. In their view the wish of a severely ill person not to continue his or her life must be respected. However, some opponents of the legalisation of active euthanasia refer to the principle of autonomy as well. Arguments They are concerned that patients may be held responsible for burdening others with the provision of care. Thus family members, physicians or nurses may exert pressure on patients to opt for active euthanasia. In this article it is argued that these worries are justified; the occurrence of social coercion poses a real danger. Conclusion However, neither the prohibition nor the permission of active euthanasia enables each individual to make an autonomous choice. Comparing the risks involved in both options, legalisation seems to be preferable to maintaining the status quo.     

Ethische Relevanz und faktische Mängel in der Kommunikation von Spezifika der Organspende nach Kreislaufstillstand

Introduction

In many countries, the number of organ donations after circulatory determination of death (DCDD) is increasing, although various aspects of DCDD are critically discussed in medical ethics. In our work, we identify ethically relevant aspects of the DCDD—in particular regarding preparatory measures and the irreversibility of the death criterion—and we investigate to what extent persons interested in becoming organ donors are informed about those issues.

Methods

We performed a comprehensive literature review on ethical issues of DCDD. Subsequently, we conducted a worldwide evaluation of organ donation organisations’ websites and an accompanying survey to investigate the extent to which ethically relevant aspects of DCDD play a role in the information of persons interested in becoming organ donors.

Results

We find that a majority of the organisations’ websites do not deal with the subject of DCDD, whereas the responsibles of the organisations surveyed emphasised the importance of education for potential donors.

Conclusion

We point out central issues about which persons willing to become organ donors should be informed if DCDD is practiced in their respective countries. In addition, we advocate that the criteria and the procedures for determining death in the context of transplantation medicine should be uniform in order to defuse some of the critically discussed aspects in the context of DCDD.

     

Ethische Aspekte der Regularisierung ärztlichen Handelns

Zusammenfassung.   Die Ressourcenknappheit hat zu einer progredienten Regularisierung ?rztlichen Handelns geführt, überwiegend durch staatliche und institutionelle Richt- und Leitlinien. Aber nicht nur der Spardruck, sondern ebenso „offiziell” instrumentierte Wissenschaft kann ?rztliches Denken und damit ethische Reflexion behindern – selbst wenn sie in der optimalen Form evidenzbasierter Leitlinien auftritt. ”Futility” als Begriff ist in den USA l?ngst aus einer andauernden theoretischen Diskussion in die klinische Praxis eingedrungen. Vor allem bei bedrohlichen Erkrankungen am Ende des Lebens gibt es formalisierte Entscheidungswege; etwa im Sinne der prozeduralen Festlegung einer ”Do-Not-Attempt-Resuscitation Order” (DNAR). Unentrinnbar ist die Frage nach dem Sinn und der Vergeblichkeit ?rztlichen Handelns mit derjenigen nach der Entscheidungsmacht im medizinischen Alltag verknüpft. Regularisierungsversuche, die von der Makroebene der Gesundheits?konomie ausgehen, interferieren mit den h?ufig ebenso machtf?rmigen Entscheidungsprozessen in der unmittelbaren Patientenversorgung. Das gilt auch bei der Balance der Interessen von Patienten einschlie?lich ihrer pers?nlichen und juristischen Vertreter mit den fachlichen Ansprüchen der ?rzte. Die schlichte übernahme des Konzeptes der ”Futility” aus den USA ist angesichts der ungel?sten Komplexit?t der Interferenzen von Makro- und Mikroebene in Deutschland wenig sinnvoll, da es zu sehr auf die spezifischen Verh?ltnisse der amerikanischen Medizin zugeschnitten ist. Andererseits helfen die konkret praktikablen Kategorien der ”Futility” gegen das Ausufern von Grundsatzdiskussionen im europ?ischen Stil.      

Rechtliche Verbotsvorschläge der ärztlichen Unterstützung bei der Selbsttötung von schwerkranken Patienten

Definition of the problem In the current ethical debate on physician-assisted suicide in Germany new sanctions in criminal law are debated from different sides. Whereas in the beginning the debate focused only on the ban of organised forms of suicide assistance, the explicit licensing of assisted suicide is also now requested by physicians. Arguments Considering the approach to include prohibition of assisted suicide within the German Criminal Code, the article shows that the impunity of suicide and suicide assistance has a long tradition in Germany. The impunity of assisted suicide cannot only be systematically and factually justified, but also in terms of content. A criminalization can be neither legally nor ethically justified. Conclusion The authors advocate—with reference to different legal drafts in the German Federal Parliament (Deutscher Bundestag)—for an open discourse within the medical profession and for a revision of the professional law.     

Das ‚gute Leben‘ in der Bioethik

Definition of the problem Contemporary bioethics as an academic discipline mainly focuses on moral questions—according to its articulated self-concept and the explicit arguments in most areas of bioethical reflection. Concepts and theories of the good life are hardly considered.Arguments In reality the “good life” plays a much more important role than it is assumed, but mostly only in an implicit way. The article demonstrates this by referencing three selected fields of bioethical discussion. Hence the article argues that bioethics should turn the “good life” into an issue of intense, explicit and systematic consideration. Furthermore, the article provides an initial answer to the questions as to why the “good life” has been marginalized within bioethics up to this point and which function it can assume in future bioethical reflection.Conclusion The “good life” is the blind spot of bioethics. A more intensive and systematic consideration of the “good life” is a challenge for contemporary and future bioethics.     

Individuelle Gesundheitsleistungen in der vertragsärztlichen Versorgung

Definition of the problem

Within Germany’s statutory health insurance system Individual health services are offered (by physicians) or demanded (by patients) with increasing frequency establishing a "second health market". The services come from a wide and heterogeneous spectrum including highly beneficial and evidence-based methods (malaria prophylaxis), so far questionable (sputum cytology) or probably beneficial (osteodensitometry in high-risk populations) screening methods, dubiousand untested methods fromthe field of alternative and complementary medicine and various services to enhance beauty, fitness or wellness. The services are not, as a common characteristic, part of Germany’s official health care offer and have to be paid foron a strictly private basis.

Arguments

This article discusses chances and risks of the development within a normative framework and addresses five questions.How does selling and buying of "individual services" affect the traditional role of physicians, the identification of useful medical methods and services, our understanding of medicine and its goals, the traditional role of patients, the doctor-patient relationship and our understanding of the German statutory health insurance system?

Conclusion

Individual health services are for various and heterogeneous reasons attractive for both patients and doctors. Whereas medicine becomes more and more regulated, they seem to increase the degrees of freedom and range of options of each side. The services may however profoundly change the role and perception of the medical profession within a collectively financed health care system. Whether the second health care market can be effectively controlled and itself regulated is at present an open question.     

践行"学"与"做"促进"生"与"发"

中央在全体党员中开展"学党章党规,学系列讲话,做合格党员"学习教育活动,是将前几次专题教育从党员领导干部的"关键少数"向全体党员覆盖、从集中教育向经常性教育延伸的重要举措。开展好"学与做",对于我们树立正确的人生观、价值观,保持和发扬党的先进性,促进企业的生存与发展有着极其重要的意义。     

"石"与"木"

本文围绕“永恒”这一中心，就欧洲的“石艺术”和中国的“木艺术”进行了比较．作了随想式的阐发，并对“石艺术”，“木艺术”的产生原由和文化蕴涵提出点滴看法。     

"科技情报"不应"正名"为"科技信息"

本文对科技情报“正名”为科技信息的观点提出了商榷的意见,联系实际,较有理有据,辩证地阐述了科技情报为何不应“正名”为科技信息的观点。     

"和昌"·"培罗蒙"·"罗蒙"

我1933年10月出生在上海,五六岁时,父亲不幸病故,家庭陷入困境。母亲带着一家人从上海迁回故乡——今奉化市江口镇前江村生活。 当我到上学年龄时,在村中的锦沙学校就读。锦沙学校是村中老板江良通先生发起建造的,他在上海开和昌西服店,村里人都叫他“和昌老板”。小学各项开支,均由和昌老板支付。这样,学校的校舍设施、教职员工日常经费都有了保障。村里读书的孩子,一律免费,我也是免费入学的。小学毕业后因家庭经济拮据,上中学的希望成了肥皂泡。刚巧那一年,和昌老板要在锦沙学校毕业生中挑     

"汉服"与"国服"

古老的中国,有着深厚的文化底蕴,主体民族汉族创造了无数灿烂文明.衣冠服饰作为文化的一种表现形式,集中体现了汉族的审美观和价值观.以交领右衽、宽衣大袖为特点的“汉服“,在中国曾经延续了几千年,因此今天我们寻找可以作为“国服“的服饰,“汉服“应是首选.在推行“汉服“的过程中,政府、媒体、服装行业应相互配合,尤其是设计方面,对“汉服“应该既有继承又有发展,设计出有时代风貌的“汉服“.这样“汉服“在融入生活的同时,便可自然而然地成为我们的“国服“.     

控制周期激励Van der Pol-Duffing振子的混沌

对周期激励Van der Pol-Duffing振子进行了研究:(x··)-μ(1-x2)(x·)-αx βx3=f cos ωt.首先运用相图分析、直接观察运动时间序列的方法发现,Van der Pol-Duffing振子在一定条件下会出现混沌行为.在实际工程中,混沌行为往往会导致振荡或不规则运动,甚至主系统的彻底崩溃,因此有必要抑制系统的混沌行为.文中采用周期激振力法对系统中的混沌行为进行了控制,并结合lyapunov指数谱进行了分析,结果表明Van der Pol-Duffing振子中的混沌运动得到了有效的控制.     

实践"三个代表"建设"政治文明"

"5·31"讲话是江泽民同志继"7·1"讲话后又一次全面阐述"三个代表"思想的重要理论文献,其中,首次提出了"‘三个代表'思想同马克思列宁主义毛泽东思想和邓小平理论一脉相承"以及关于"建设社会主义政治文明"问题,丰富和发展了建设中国特色社会主义理论,具有重要的理论价值,也为"十六大"的召开奠定了理论基础.