Evaluation of clinical ethical case consultations has been discussed as an important research task in recent decades. A rigid framework of evaluation is essential to improve quality of consultations and, thus, quality of patient care. Different approaches to evaluate those services appropriately and to determine adequate empirical endpoints have been proposed. A key challenge is to provide an answer to the question as to which empirical endpoints—and for what reasons—should be considered when evaluating the quality of a service. In this (...) paper, we argue for an approach that adopts the role of ethics consultants as its point of departure. In a first step, we describe empirical and ethical characteristics of evaluating clinical ethical case. We show that the mode of action and the explicit normative character of the interventions constitute two characteristics which pose challenges to the selection of appropriate quality criteria and require special attention. In a second step, we outline the way in which an analysis of the role of ethics consultants in the context of a clinical ethical case consultation services can account for the existing challenges by linking empirically measurable endpoints with normative theory. Finally, we discuss practical implications of our model for evaluation research. (shrink)

Background: Clinical ethics support services have been advocated in recent decades. In clinical practice, clinical ethics support services are often requested for difficult decisions near the end of life. However, their contribution to improving healthcare has been questioned and demands for evaluation have been put forward. Research indicates that there are considerable challenges associated with defining adequate outcomes for clinical ethics support services. In this systematic review, we report findings of qualitative studies and surveys, which have been conducted to evaluate (...) clinical ethics support services near the end of life. Methods: Electronic databases and other sources were queried from 1970 to May 2018. Two authors screened studies independently. Methodological quality of studies was assessed. For each arm of the review, an individual synthesis was performed. Prospero ID: CRD42016036241. Ethical Considerations: Ethical approval is not needed as it is a systematic review of published literature. Results: In all, 2088 hits on surveys and 2786 on qualitative studies were found. After screening, nine surveys and four qualitative studies were included. Survey studies report overall positive findings using a very wide and heterogeneous range of outcomes. Negative results were reported only occasionally. However, methodological quality and conceptual justification of used outcomes was often weak and limits generalizability of results. Conclusion: Evidence points to positive outcomes of clinical ethics support services. However, methodological quality needs to be improved. Further qualitative or mixed-method research on evaluating clinical ethics support services may contribute to the development of evaluating outcomes of clinical ethics support services by means of broaden the range of appropriate (process-oriented) outcomes of (different types of) clinical ethics support services. (shrink)

Evaluating clinical ethics support services has been hailed as important research task. At the same time, there is considerable debate about how to evaluate CESS appropriately. The criticism, which has been aired, refers to normative as well as empirical aspects of evaluating CESS. In this paper, we argue that a first necessary step for progress is to better understand the intervention in CESS. Tools of complex intervention research methodology may provide relevant means in this respect. In a first step, we (...) introduce principles of “complex intervention research” and show how CESS fulfil the criteria of “complex interventions”. In a second step, we develop a generic “conceptual framework” for “ethics consultation on request” as standard for many forms of ethics consultation in clinical ethics practice. We apply this conceptual framework to the model of “bioethics mediation” to make explicit the specific structural and procedural elements of this form of ethics consultation on request. In a final step we conduct a comparative analysis of two different types of CESS, which have been subject to evaluation research: “proactive ethics consultation” and “moral case deliberation” and discuss implications for evaluating both types of CESS. To make explicit different premises of implemented CESS interventions by means of conceptual frameworks can inform the search for sound empirical evaluation of CESS. In addition, such work provides a starting point for further reflection about what it means to offer “good” CESS. (shrink)

Telepsychiatry has long been discussed as a supplement to or substitute for face-to-face therapeutic consultations. The current pandemic crisis has fueled the development in an unprecedented way. More and more psychiatric consultations are now carried out online as video-based consultations. Treatment results appear to be comparable with those of face-to-face care in terms of clinical outcome, acceptance, adherence and patient satisfaction. However, evidence on videoconferencing in a variety of different fields indicates that there are extensive changes in the communication behaviour (...) in online conversations. We hypothesise that this might impact ethically relevant aspects of the therapeutic relationship, which plays a prominent role in psychiatry. In this paper, we review effects of video-based consultations on communication between therapists and patients in psychiatry. Based on a common understanding of video-based consultations as changing the lived experience of communication, we categorise these effects according to sensory, spatial and technical aspects. Departing from a power-based model of therapeutic relationships, we then discuss the ethical significance of this changed communication situation, based on dimensions of respect for autonomy, lucidity, fidelity, justice and humanity. We conclude that there is evidence for ethically relevant changes of the therapeutic relationship in video-based telepsychiatric consultations. These changes need to be more carefully considered in psychiatric practice and future studies. (shrink)

Academic publications of empirical public health research often entail recommendations for moral action that address practitioners and policy makers. These recommendations are regularly based on implicit moral judgments with the underlying reasons not explicitly stated. In this paper, we elaborate on the moral relevance of such judgments and the need to explain them in order to account for academic argumentation. We argue for an explicit reporting of bridge principles to increase the transparency of the reporting of public health research. The (...) reporting of bridge principles can inform readers, support them in understanding the relationship between empirical and normative claims in a specific paper, and may pave new ways for the rigorous reporting of empirical research that has moral implications. Furthermore, it can be used to classify studies to systematically address the justification for their argumentation. (shrink)

In their careful analysis of conversational artificial intelligence (CAI) in psychotherapy, Sedlakova and Trachsel (2023) propose a framework for the ethical evaluation of such technologies that lo...

Definition of the problem The acquisition of technical and research skills can be promoted in particular in courses that confront students with complex problems. In this article, we present didactic reflections on learning through self-organized inquiry in empirical medical ethics. Arguments Based on the theory of pragmatism, we show how a specific form of research-based learning courses can be realized to promote medical ethical skills. We focus on projects in which students can experience the process of conducting empirical–ethical research. Conclusion (...) Research-based learning through self-organized inquiry courses offer great potential, especially with regard to expanding students’ reflexive and reflective competencies. We discuss the inclusion of such facultative courses in the medical ethics curriculum with regard to its contextual challenges. (shrink)

Digital contact tracing is used in different countries to help contain the COVID-19 pandemic. It raises challenging empirical and ethical questions due to its complexity and widespread effects calling for a broader approach in ethical evaluation. However, existing approaches often fail to include all relevant value perspectives or lack reference to empirical data on the artifact in question. In this paper, we describe the development of an interdisciplinary framework to analyze digital contact tracing from an empirical and ethical perspective. Starting (...) with an analysis of methodological tensions in the attempt to analyze digital contact tracing, we, firstly, set out three methodological premises regarding (a) a specific view of technology, (b) a fruitful normative perspective, and (c) ways to gather empirical knowledge about the object under investigation. Secondly, we inspect consequences of these premises to develop our research methodology. In doing so, we argue for a postphenomenological perspective on technology, solidarity as an important concept to guide the ethical perspective, and an empirical approach based on qualitative social science research and the concept of affordances. We illustrate these considerations by referring to our analysis of the German Corona-Warn-App as an instance of contact tracing based on the Exposure Notification Framework by Google and Apple. We then discuss the implications of using such a framework, including considerations concerning future developments of technologies similar to or inspired by the current concepts of contact tracing. (shrink)

Der Erwerb von Fach- und Forschungskompetenzen kann im besonderen Maße in Lehrveranstaltungen gefördert werden, die Studierende mit der Bewältigung komplexer Probleme konfrontieren. In diesem Artikel stellen wir didaktische Überlegungen zum Forschenden Lernen in der Empirischen Medizinethik dar. Ausgehend von der Theorie des Pragmatismus zeigen wir auf, wie Forschendes Lernen in Lehrangeboten verwirklicht und für die Förderung medizinethischer Kompetenzen genutzt werden kann. Wir fokussieren dabei auf Lehr- und Lernprojekte, in denen die selbstorganisierte Durchführung empirisch-ethischer Forschung für Studierende prozesshaft erfahrbar gemacht werden (...) kann. Solche Lehrangebote bieten große Potenziale, vor allem im Hinblick auf die Erweiterung von Reflexionskompetenzen der Studierenden. Eine Aufnahme solcher Lehrangebote in die fakultative Medizinethik-Lehre wird im Hinblick auf kontextuelle Herausforderungen diskutiert. (shrink)

In their national follow-up study on ethics consultation in the U.S., Fox et al. report the worrying finding of a decline in efforts to evaluate ECs. Compared to the findings of Fox et...

In their recent work, Kok et al propose a theoretical framework for the evaluation of clinical ethical case interventions, in particular moral case deliberation (MCD).1 According to the authors, this framework provides ‘empirically accessible hypothesis that describe the relationship between MCD and care quality at the organisational level’.1 Evaluation of ethical interventions in healthcare is an important topic. As Donabedian has noted, evaluation can be understood as defining reasonable quality expectations and to check by means of empirical research whether and (...) to what extent these expectations have been met.2 If suitable for ethical interventions like MCDs, the carefully compiled framework by Kok et al would surely present a major step towards satisfying the requirements outlined by Donabedian. However, caution is in order whether this holds true. The authors start by observing that most of the recent research regarding the evaluation of MCD tends to follow a paradigm that can be outlined by two premises. First, focusing on quality is justified by the need to provide a rationale for an intervention’s consumption of resources.3 Second, this implies research that is usually centred around the quality …. (shrink)

Socially assistive devices such as care robots or companions have been advocated as a promising tool in elderly care in Western healthcare systems. Ethical debates indicate various challenges. An important part of the ethical evaluation is to understand how users interact with these devices and how interaction influences users’ perceptions and their ability to express themselves. In this review, we report and critically appraise findings of non-comparative empirical studies with regard to these effects from an ethical perspective.Electronic databases and other (...) sources were queried using a comprehensive search strategy generating 9851 records. Studies were screened independently by two authors. Methodological quality of studies was assessed. For 22 reports on 21 datasets using a non-comparative design a narrative synthesis was performed.Data shows positive findings in regard to attitudes and emotional reactions of users. Varying perception of a social relation and social presence are the most commonly observed traits of interaction. Users struggle with understanding technical complexities while functionality of the devices is limited. This leads to a behavioral alignment of users towards the requirements of the devices to be able to make use of them.This evidence adds to three important ethical debates on the use of socially assistive devices in healthcare in regard to (1) reliability of existing empirical evidence to inform normative judgements, (2) ethical significance of the social presence of devices and (3) user autonomy in regard to behavioral alignment. (shrink)

Researchers in applied ethics, and some areas of bioethics particularly, aim to develop concrete and appropriate recommendations for action in morally relevant real-world situations. When proceeding from more abstract levels of ethical reasoning to such concrete recommendations, however, even with regard to the very same normative principle or norm, it seems possible to develop divergent or even contradictory recommendations for action regarding a certain situation. This may give the impression that such recommendations would be arbitrary and, hence, not well justified. (...) Against this background, we, first, aim at showing that ethical recommendations for action, although being contingent in some sense, are not arbitrary if developed appropriately. For this purpose, we examine two types of contingencies arising in applied ethics reasoning based on recent examples of recommendations for action in the context of the COVID-19 pandemic. In doing so, we refer to a three-step model of ethical reasoning towards recommendations for actions. This, however, leaves open the question of how applied ethics may cope with contingent recommendations for action. Therefore, in a second step, we analyze the role of bridge principles for developing ethically appropriate recommendations for action, i.e., principles which connect normative claims with relevant empirical information to justify certain recommendations for action in a given morally relevant situation. Finally, we discuss some implications for reasoning and reporting in empirically informed ethics. (shrink)

BackgroundSocially assistive devices (care robots, companions, smart screen assistants) have been advocated as a promising tool in elderly care in Western healthcare systems. Ethical debates indicate various challenges. One of the most prevalent arguments in the debate is the double-benefit argument claiming that socially assistive devices may not only provide benefits for autonomy and well-being of their users but might also be more efficient than other caring practices and might help to mitigate scarce resources in healthcare. Against this background, we (...) used a subset of comparative empirical studies from a comprehensive systematic review on effects and perceptions of human-machine interaction with socially assistive devices to gather and appraise all available evidence supporting this argument from the empirical side.MethodsElectronic databases and additional sources were queried using a comprehensive search strategy which generated 9851 records. Studies were screened independently by two authors. Methodological quality of studies was assessed. For 39 reports using a comparative study design, a narrative synthesis was performed.ResultsThe data shows positive evidential support to claim that some socially assistive devices (Paro) might be able to contribute to the well-being and autonomy of their users. However, results also indicate that these positive findings may be heavily dependent on the context of use and the population. In addition, we found evidence that socially assistive devices can have negative effects on certain populations. Evidence regarding the claim of efficiency is scarce. Existing results indicate that socially assistive devices can be more effective than standard of care but are far less effective than plush toys or placebo devices.DiscussionWe suggest using the double-benefit argument with great caution as it is not supported by the currently available evidence. The occurrence of potentially negative effects of socially assistive devices requires more research and indicates a more complex ethical calculus than suggested by the double-benefit argument. (shrink)

Question: Where, when and under what circumstances did the two of you get to know each other?Fischer: It was in the early seventies, in Frankfurt, after the dissolution of the gauche proletarienne and while there were still leftist groups in Germany. It must have been 1972. Question: Was that a private visit?Glucksmann: We had private discussions. We also participated in rallies and demonstrations.Question: That was in the late phase of the student movement.Fischer: We kept in contact through my old room-mate, (...) Daniel Cohn-Bendit. He was our link to France, so to speak.Question: And was this the link between the French and the German Left that existed then? (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 27.2 (2003) 341-362 [Access article in PDF] Virgin Father and Prodigal Son Stephen Brockmann I IN BOTH THE UNITED STATES and Germany—as well as in much of the rest of the Western world—the baby-boom generation now holds a controlling position in politics, economics, and culture. The election of Bill Clinton (born in 1946) to the Presidency signaled the generational shift in the United States as early (...) as 1992, and that shift was confirmed by the election campaign of 2000, in which both candidates, Al Gore (born in 1948) and George W. Bush (born in 1946), in spite of their differences, represented the same generation. In Germany the political shift in generations did not occur until 1998, when Gerhard Schröder (born slightly before the beginning of the German baby boom, in 1944) defeated Helmut Kohl (born in 1930).Significantly, Kohl is a member of the generation of Germans born during the 1930s and reared during the years of the Third Reich but too young to have played any significant role, either negative or positive, during the Nazi era. No member of this generation born in the 1930s ever became President in the United States, where the generation of World War Two veterans dominated national politics from Eisenhower to George Herbert Walker Bush. However what in America is a "silent generation" has been, in Germany, the generation most closely identified with the success of the Federal Republic of Germany: these were the so-called Flakhelfer (antiaircraft helpers) who had been children during the war. Kohl therefore famously referred to them as having the "grace of late birth," meaning that they, unlike the war veterans, were presumably untouched by any form of collective guilt for Nazi crimes against humanity. Whereas in the United States the Presidency was transferred directly from the World War Two veterans to [End Page 341] baby boomers—and in the case of the two Bush presidencies, literally, albeit indirectly, from father to son—in Germany the transition from the World War Two veterans (particularly former Chancellor Helmut Schmidt) to the baby boomers was interrupted by a long period of domination by the in-between generation of Flakhelfer.In both countries the baby-boom generation represents a significant shift in sensibilities and encompasses the generation involved in student protest and oppositional social movements in the 1960s and 1970s. In the United States these included the anti-Vietnam War movement, the feminist and gay-rights movements, the sexual revolution, the civil-rights movement, and the ecological movement, as well as, on the extreme fringes, terrorist groupings such as the Weather Underground and a great many religious sects and cults. In Germany the baby boomers formed many parallel groups and movements, including antiwar, feminist, ecological, and gay segments, as well as a proliferation of sectarian Marxist political groupings (so-called K-Gruppen, with the "K" meaning "Kommunist"). In the United States, Bill Clinton was an antiwar protester in the 1960s and 1970s, while both Gerhard Schröder and his Green Foreign Minister Joschka Fischer (born in 1948) had participated in left-wing political movements during the same period.In both West Germany and the United States the heyday of protest movements in the 1960s and 1970s signaled a generational split, with younger people—the very generation that is now in power in the two countries—accusing their elders of Machiavellian cynicism, imperialism, patriarchy, and worse. Such accusations can be recalled by the formerly popular slogans "Hey, hey, LBJ, how many kids did you kill today?" in the United States and "Unter den Talaren der Muff von tausend Jahren" ("under the academic regalia the stench of a thousand years") in Germany. The latter slogan was a reference not just to a generalized stodginess on the part of elderly German academics but to Hitler's invocation of a "Thousand-Year Reich;" German students were none-too-subtly suggesting that many of their professors had once been Nazis.The difference in these two slogans—one referring to past and the other to present sins—corresponds to a major distinction between the two baby... (shrink)

During the past year, the European integration process steadily continued along familiar as well as less familiar paths. This contribution gives an overview of the core decisions made within the three pillars of the European construction in the year 2000. Although the vast majority of these decisions were closely linked to the approaching Eastern enlargement of the European Union, new avenues have been followed during the past year as well. The debate about the finality of the European integration process gained, (...) by way ofspeeches of European leaders like Joschka Fischer, Jacques Chirac, Tony Blair and Guy Verhofstadt, fifty years after the Schuman declaration, a new momentum. (shrink)

Although telepsychiatry consultations have been tried and tested for several years, at least in relatively limited numbers and settings, the current COVID-19 pandemic has caused an exponential increase in their application. Even as lockdown restrictions were lifted and a return to face-to-face consultations was possible, many practitioners and patients decided to uphold teleconsultations for some or a large part of their interactions. This was mostly driven by the exceptional circumstances of the pandemic, as ongoing safety concerns, the need for PPE (...) use and uncertainty around whether face-to-face meetings could go ahead continued to form barriers to usual care practices. Frittgen and Haltaufderheide aptly hypothesise that extensive changes in online communication behaviour will also impact ethical aspects of the therapeutic relationship.1 After considering how the use of technology may affect the therapeutic relationship in video-based consultations, they provide an ethical analysis of this impact along four dimensions: respect for autonomy, lucidity, fidelity and humanity.1 In this commentary I will have a look at the difference between crisis standards of care and usual care, the need to consider specific patient needs in teleconsultation use, the importance of justice understood as equity and access to technology, and a major challenge ahead. Throughout history, crisis situations have often been major catalysts of technological and other progress. Under challenging …. (shrink)

There is robust scientific evidence from meta-analyses in psychotherapy research that common factors such as the alliance between patients and therapists, empathy, goal consensus/collaboration, positive regard/affirmation and genuineness have a much greater effect on the overall psychotherapy outcome than the so-called specific factors like particular treatment methods or ingredients of therapy.1 The current evidence base also suggests that the effects of telepsychiatric treatment are comparable with those of face-to-face treatment, not only regarding clinical outcome parameters but also with respect to (...) patient satisfaction, acceptance and adherence—all common factors of psychotherapy.2 According to a comprehensive review of the main ethical arguments for and against different forms of online psychotherapy, the online setting provides several weighty advantages: for example, increased access, availability, flexibility, convenience, satisfaction, acceptance and increased demand.3 Among the arguments against online psychotherapy, privacy, confidentiality and data security issues, emergency issues, as well as communication issues have been mentioned.3 Frittgen and Haltaufderheide 4 are concerned that telepsychiatry could ‘impact ethically relevant aspects of the therapeutic relationship’. They conclude that ‘there is evidence for ethically relevant changes of the therapeutic relationship in video-based telepsychiatric consultations’,4 particularly pertaining to ‘respect for autonomy, lucidity, fidelity, justice and humanity towards each other’.4 Indeed, video-based consultations as technically mediated communication ‘do not only transmit but transform what can be perceived, …. (shrink)

The COVID-19 pandemic has had, and still has, the risk to have an enormous impact on how people socially interact with each other due to possible lockdowns, quarantine and isolation measures to reduce infection rates. Consequently, these measures hold great implications for those medical disciplines that inherently rely on social interaction, such as psychiatry. In their article, ‘Can you hear me?’— Communication, Relationship and Ethics in Video-based Telepsychiatric Consultations’, Frittgen and Haltaufderheide1 show that videoconferencing holds potential to ensure that this (...) social interaction is guaranteed, be it in a technology mediated manner. In this sense, videoconferencing needs to be conceived as a pharmakon, a medicine, having both curative and toxifying elements, depending on why and how it is used.2 For example, videoconferencing allows continuity of care when physical proximity is impossible. At the same time, it allows the patient to interrupt the therapy by muting the therapist or ending the call at his/her convenience. To guarantee the curative side of videoconferencing, and as such avoid the toxifying elements, an ethical prescription needs to be developed and used. Despite the fact that videoconferencing seems to have a similar clinical effectiveness as face-to-face interaction, Frittgen and Haltaufderheide rightly point out that there are ethical impacts to be addressed to avoid …. (shrink)

The main purpose of the study is to analyze the feasibility and necessity of an EU Constitution. Briefly, the history of the draft constitution is as follows: The draft treaty aims to codify the two main treaties of the European Union - the Treaty of Rome of 1957 and the Treaty of Maastricht of 1992, as amended by the Treaty of Amsterdam (1997) and the Treaty of Nice (2001). The debate on the future of Europe is believed to have begun (...) with a speech by German Foreign Minister Joschka Fischer in Berlin in 2000. The process began after the Laeken Declaration, when the European Convention was set up, chaired by former French President Valerie Giscard d'Estaing, with the aim of drafting a constitution. The draft contract was published in July 2003. After lengthy discussions and debates over the proposal for qualified majority voting, the final text was approved in June 2004 and signed by representatives of the Member States on 29 October 2004. The failure of the treaty in France and the Netherlands is a serious blow to the European Union because these two countries are considered to be loyal supporters of the European project. The text of the treaty was subsequently rewritten by the Amato Group, officially the Active Committee on European Democracy (ACED), a group of high-ranking European politicians. During the German presidency of the Union, a new treaty was proposed - the Treaty of Lisbon - to replace the original draft of the Constitution. On 12 June 2008, the Lisbon Treaty was also rejected in a referendum in Ireland. But if we want to look beyond history, we can ask - Why does the EU need a Constitution and how can the Constitution be the roadmap to an advanced future for the EU? The answers to this question can be found by analyzing several directions (these are the main points of the article): historical reflexivity; socio-cultural analysis of the philosophical concepts of well-known political and social philosophers such as Immanuel Kant, John Locke; the modern constellation through the prism of Jürgen Habermas and the decision to make a text as a Constitution which its aim is to reach the starting point of an entire community like the EU. Keywords: constitution, EU, philosophy, law, John Locke, Immanuel Kant, Jurgen Habermas. (shrink)