Freiwilliger Verzicht auf Essen und Trinken – zur ethischen Lagebestimmung eines ambivalenten Begriffs

Ethik in der Medizin - Wie ist der Freiwillige Verzicht auf Essen und Trinken und eine medizinische Begleitung dabei ethisch zu bewerten? Die ethische Bewertung des Freiwilligen Verzichts auf Essen...     

Passive, indirekt und direkt aktive Sterbehilfe – deskriptiv und ethisch tragfähige Unterscheidungen?

Zusammenfassung.   In der Auseinandersetzung um die Frage, ob aktive Sterbehilfe mit dem ?rztlichen Ethos vereinbar ist, werden h?ufig deskriptive Unterscheidungen wie Tun vs. Unterlassen, aktiv vs. passiv oder auch intendieren vs. in Kauf nehmen benutzt, um eine kategorische moralische Differenz zwischen T?ten und Sterbenlassen auszuweisen. Als zus?tzliche Schwierigkeit erweist sich dabei zum einen, da? zentrale Begriffe zwischen einer deskriptiven und einer ethischen Bedeutung changieren, und zum anderen, da? die Kennzeichnung des Problems (z.B. Sterbehilfe) selbst ethisch nicht neutral ist. Nach der Entwicklung einer ethisch neutralen Problemstellung werden kategorische Argumente gegen die ethische Zul?ssigkeit aktiver Sterbehilfe diskutiert und verworfen. Anschlie?end werden Begründungen diskutiert, die mittels intrinsischer oder extrinsischer Situationsmerkmale eine ethische Unzul?ssigkeit aktiver Sterbehilfe aufzuweisen versuchen. Dabei zeigt sich, da? graduelle ethische Unterschiede zwischen passiver, indirekt und direkt aktiver Sterbehilfe begründbar sind, die ein jeweils h?heres Ma? an Rechtfertigungsgründen erfordern.      

Reproduktionsmedizin und embryonale Stammzellforschung – aktueller Problemstand und gesetzlicher Regelungsbedarf

Ohne Zusammenfassung

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Medizinische Prädiktion, Prävention und Gerechtigkeit: Anmerkungen zu ethischen Dimensionen eines biomedizinischen Ideals

Definition of the problem The ideal of a truly predictive medicine vested with effective causal strategies of prevention down to the molecular level is far from being reality. However, we have to appreciate the fact that the concepts of health negotiated at the intersection of medicine and society are becoming increasingly directed towards a prediction of future health and the notion of prevention. This paper investigates whether novel concepts of a predictive–preventive medicine—especially public health genetics or public health genomics—are likely to promote the social achievability of health. Arguments The analysis presented is based on an assessment of the role of fundamental social values for the function of medicine in society, on the one hand, and on the role of the key concepts of medicine—health and disease—at the interface of medicine and society, on the other. Conclusion We observe a transition of medicine toward increasingly more predictive concepts of disease. With this shift, the normative characteristics of the key concepts of health and disease shared between medicine, individuals, and society are also subject to profound changes. This is a challenge to social values in their function as pillars of health care systems, particularly the social value of justice and its societal perceptions in the realm of health.     

Prinzipien und Diskurs – Ein Ansatz theoretischer Rechtfertigung der ethischen Fallbesprechung und Ethikkonsultation

Definition of the Problem Models of decision making in medical ethics have to establish themselves as being able to lead to ethically right or at least “credible” decisions. For this purpose, approaches of theoretical justification stemming from ethics are vital. However, clinical ethics is sometimes criticized for theoretical deficits. In order to address this criticism, we will try to justify ethical case discussion and ethics consultation by principlism and discourse ethics by referring to a clinical ethics project (METAP). Arguments Principlism and discourse ethics can fruitfully complement each other when used in ethical case discussion or consultation. Thereby, some theoretical as well as practical weaknesses of both approaches can be mitigated. Discourse ethics, for example, safeguards the ethical validity of moral decisions and norms for action, respectively, thus mitigating shortcomings of justification when using principlism. Conversely, principlism answers questions concerning ethical adequacy and functions particularly as a safeguard for appropriate decisions in the individual case. Conclusion By using a combination of these two approaches, a broader justification seems possible rather than by relying on principlism or discourse ethics alone. Even if some challenges persist, and even if the combined model cannot always prevent dissent, it may strengthen practical confidence in the ethical decision by its ?double“ safeguards (principles and discourse). This could render clinical ethics more ?robust“ that have been missing so far.     

Governance und Gesundheit – Beobachtungen zur strukturellen und kulturellen Ver?nderung in Krankenh?usern

Definition of the problem

Corporate Governance is being established throughout German hospitals. This might prove to be a further step in the economization of public health services, with alienating effects on core characteristics of therapeutic interaction.

Arguments

This article outlines (1) the origin, design and function of Corporate Governance, (2) how processes of managerialization, economization, and commercialization presently transform hospitals, and (3) the impact of Corporate Governance on hospitals in Germany.

Conclusion

The moral implications of Corporate Governance need further research and critical ethical scrutiny.     

Monika Bobbert (2002) Patientenautonomie und Pflege. Begründung und Anwendung eines moralischen Rechts. Campus,Frankfurt am Main,New York, 380 S., 29,90 Euro,ISBN 3-593-37128-6

Rezensionen

Monika Bobbert (2002) Patientenautonomie und Pflege. Begründung und Anwendung eines moralischen Rechts. Campus, Frankfurt am Main, New York, 380 S., 29,90 Euro, ISBN 3-593-37128-6     

Ethische und rechtliche Aspekte im Umgang mit genetischen Zufallsbefunden – Herausforderungen und Lösungsansätze

Definition of the problem With an increasing number of genetic results obtained in whole genome analyses, the problem of incidental findings arises, i.e., findings that are discovered beyond the aims of the original investigation but have potential health or reproductive importance for patients or research participants. Since national or international guidelines have not been established, the authors discuss for Germany the current opinions about the management of incidental findings in clinical care and research. Arguments Following the German genetic diagnosis act (?Gendiagnostikgesetz“, GenDG), it is mandatory to inform about the possibility of incidental findings. It is part of the informed consent which findings are communicated to the patient, taking the right not to know and the protection of minors into account. In the research context, the GenDG is not valid; however, the disclosure of possible incidental findings should be also included in the consent documents. There is agreement that results of high clinical utility should be returned to participants, even if there is no obligation to do so. The following aspects have to be considered when dealing with incidental findings: (1) information given in the consent documents, (2) interpretation of genetic results according to high, moderate, possible, questionable or unknown clinical meaning, (3) processing of returning results at the present and in the future, and (4) decision about resources to evaluate the clinical utility, to communicate results and to transfer them into clinical practice. Conclusion There is urgent need for empirical research and policy development in the context of incidental genetic results. In addition, it is important to study how patients and participants understand and utilize incidental findings and to develop educative and communicative strategies.