Behinderung und medizinischer Fortschritt

Ohne Zusammenfassung     

Das Problem der Behindertenselektion bei der pränatalen Diagnostik und der Präimplantationsdiagnostik

Definition of the problem: Are selective abortion and preimplantation diagnosis to be criticized for discriminating against the disabled? Arguments and Conclusions: The answer is often said to depend on the position a person takes concerning the status of the embryo: If the embryo is a subject of human rights, the mother's decision not to accept the embryo (insofar as it may be justified at all) should be made irrespective of the child's disability status if the decision is to be non-discriminating. The following article (i) does not presuppose that the embryo is not a subject of human rights, (ii) argues that the mother is still not to be criticized for letting her decision depend on the disability status because many people consider, and everybody must be allowed to consider, such a status in matters concerning her or his sphere of privacy, (iii) argues that the intuitive reserve against preimplantation diagnosis in the German public debate is rooted in something else than a concern for the rights of the rejected embryo-individuals, and that the problem should be discussed accordingly.     

Historische Betrachtungen zur Qualitätssicherung und Ethik medizinischer Behandlung

Ethik in der Medizin - Mit Inkrafttreten des Sozialgesetzbuches V, das in seinem §137 auch Krankenhäuser zu Qualitätssicherung verpflichtet, kann sich seit Ende der 80er Jahre kein...     

Forschung an Kindern und die Novellierung des Arzneimittelgesetzes

Ohne Zusammenfassung     

Schwangerschaftsabbruch,pränatale Diagnostik und intrauterine Therapie

Ethik in der Medizin - Wegen der engen Symbiose zwischen Mutter und Kind, die charakteristisch für die Schwangerschaft ist, können sich Interessenskonflikte zwischen den beiden Individuen...     

Ethische und rechtliche Aspekte der epidemiologischen Forschung mit Kindern und Jugendlichen in Deutschland am Beispiel des Kinder- und Jugendgesundheitssurveys

Definition of the problem: The Health Survey of Children and Adolescents shall produce representative, valid data on this target population in Germany, as an essential prerequisite for the evaluation and improvement of their health. The examinations and blood samplings involve persons not able to give their informed consent. The ethical and legal assessment necessary has to respect national and international recommendations as well as the German relevant laws. According to the German legal situation it appears that parents cannot give their informed consent to blood sampling in their children except if it benefits the individual child. This goes beyond international recommendations that accept a group specific benefit of studies in children if the risk of the measure is minimal. Arguments and conclusion: The blood sampling in the Health Survey certainly has a group specific benefit, but it also benefits the individual participant in that it detects e.g. hidden nutritional deficiencies, allergic sensitization, immunization deficits, or indicators of health risks in adulthood that could not be discovered by other means. In the pretest of the survey, many children were found to have such problems that could be brought to intervention. In more than 90% of the participating children of the pretest, blood sampling was possible after parental informed consent and after respecting informal disagreement of individual children or adolescents in every single case. In a sub-sample the general acceptance was tested anonymously, and was found to be quite good.     

Personalisierte Medizin als Orphanisierung: rechtliche und ethische Fragen

Definition of the problem The development of personalized medicine is currently a popular topic. Particularly the personalized pharmacotherapy is a matter of relative importance due to pharmacological and molecular–genetic developments. For this reason it is required to examine the implications of personalized pharmacotherapy to statutory health insurance and health care of patients. Arguments In this context the question of orphanization arises: If medical drugs of personalized medicine could be regularly indicated as orphan drugs, i.e., as drugs to medicate orphan diseases, it would not be necessary according to the “Arzneimittelneuordnungsgesetz” (AMNOG) to prove an auxiliary value within the assessment of the “Gemeinsamer Bundesausschuss” (GBA). Crucial to the drug’s indication as an orphan drug is among other things the rate of prevalence of the patient group, whose disease should be medicated with the drug. In this connection, there is importance attached to the stratification of patient groups within personalized medicine. Conclusion An orphanization causes consequences in terms of prices to the statutory health insurance due to the lack of knowledge about an auxiliary value. For patients, the implications must be considered in a more differentiated manner.     

Ethik und Geschichte: Die Hirntoddebatte als Streit um die Vergangenheit

Zusammenfassung.   Die aktuelle Diskussion um den Hirntod ist von historischen Argumenten gepr?gt. Die erste zentrale Frage lautet, ob die Einführung des Hirntodkriteriums einen Bruch mit der Vergangenheit bedeutet oder nicht. Zweitens geht es darum, ob der Hirntod zum Zweck der Organgewinnung eingeführt wurde oder nicht. Diese historischen Fragestellungen werden jedoch in der Hirntoddiskussion nicht mit angemessenen historischen Mitteln bearbeitet. Das Beispiel der Hirntoddiskussion zeigt die Allgegenwart geschichtlicher Argumente in der Diskussion ethischer Probleme und die Bedeutung eines Qualit?tsstandards für solche Aussagen über die Vergangenheit.      

Empirische Forschung in der Medizinethik: Methodenreflexion und forschungspraktische Herausforderungen am Beispiel eines mixed-method Projekts zur ärztlichen Handlungspraxis am Lebensende

Definition of the problem The contribution of empirical research to medical ethics is part of the current interdisciplinary debate on methods in medical ethics. In contrast to the numerous empirical studies which have been published in medical ethics journals there is scarcity of literature which reflects on methodical challenges of empirical research projects in medical ethics. Arguments The analysis of the relationship between ethics and empirical facts in the context of defined research projects is interesting for several reasons. On one hand such work provides an opportunity to analyse the potential contribution of the research to the medical ethical discourse. On the other hand methodical as well as practical challenges with respect to the planning and conducting of interdisciplinary research can be demonstrated by using a specific piece of interdisciplinary research in medical ethics. In this paper the methodical challenges of applying empirical methods in an interdiscplinary research project on physicians’ practice at the end of life will be presented and discussed. Conclusion The paper gives examples for the potential contribution of empirical research to the medical ethics discourse and provides illustrations for the challenges of such research.