Advance patient directives are various forms of anticipatory medical directives made by competent individuals for the eventuality of future incompetence. They are therefore appropriate instruments for competent patients in the early stage of Alzheimer's disease to document their self-determined will in the advanced stages of dementia. Theoretical objections have been expressed against the concept of advance patient directives (problems of authenticity and identity) which, however, cannot negate the fundamental moral authority of advance patient directives. Therefore, patients, family members, and physicians (...) should make use of the appropriate form of advance directive as part of common treatment and care planning. Advance directives, when utilized intelligently, represent appropriate instruments for shared decision-making by patient, family members and physician. They should be utilized to a greater extent, particularly for the treatment planning of demented patients. (shrink)

Objectives: To elicit the perceptions and preferences of patients with rheumatoid arthritis regarding information and participation in treatment decision-making. To analyse the patients’ narratives on the background of the ethical discourse on various approaches to treatment decision-making. Design: In-depth interviews with themes identified using principles of grounded theory. Participants: 22 patients with long-standing rheumatoid arthritis. Main outcome measures: Qualitative data on patients’ perceptions and preferences regarding information and participation in decision-making about treatment. Results: Decision-making about treatment has been described by (...) the patients as a process consisting of different stages with shifting loci of control and responsibility. Patients initially received one treatment recommendation and were not aware of alternative treatment options. Those participants in this study who wanted information about negative effects of a treatment cited “interest in one’s own health” and the potential “use of information” as reasons for their preference. The physicians’ expert knowledge and clinical experience regarding the effects of medication were cited as arguments by patients for a treatment recommendation. Conclusions: The patients’ accounts of decision-making about treatment differ from models of physician–patient relationship that have been put forward in ethical discourse. These differences may be relevant with respect to the starting point of an ethical analysis of treatment decision-making. Patients’ accounts with respect to a lack of information on treatment alternatives point to ethically relevant challenges regarding treatment decision-making in clinical practice. (shrink)

Background: Today in vitro fertilisation is a widespread and important technique of reproductive medicine. When the technique was first used, it was considered ethically controversial. This is the first study conducted of adult IVF-offspring in order to learn about their ethical opinions and personal attitudes towards this medical technology.Methods: We recruited the participants from the first cases of in vitro fertilisation in Germany at the Gynaecological Clinic of the University Hospital Erlangen. Our qualitative interview study consisted of in-depth, face-to-face interviews (...) with 16 adults who had been conceived by IVF. Our data was analysed with methods of Grounded Theory.Results: For these adults, the most important factor influencing their personal attitudes towards IVF was the knowledge that they were deeply wanted children. The artificiality of their conception seemed irrelevant for their ethical opinion. All participants mentioned that it was important for them to be informed about the circumstances of their conception by their parents.Conclusions: IVF seems to be a medical technique which, although it affects intimate aspects of human existence, can be integrated into the lives of the affected persons without any great difficulties. The findings suggest that parents should inform their children about their fertilisation at an early age and as part of a process over time, not only on a single occasion. Physicians should advise IVF-parents accordingly. (shrink)

Rauprich O, Marckmann G, Vollmann J: Gleichheit und Gerechtigkeit in der modernen Medizin Content Type Journal Article Pages 71-75 DOI 10.1007/s10202-007-0032-0 Authors Elisabeth Weisser-Lohmann, Institut für Philosophie FernUniversität Hagen 58084 Hagen Germany Journal Poiesis & Praxis: International Journal of Technology Assessment and Ethics of Science Online ISSN 1615-6617 Print ISSN 1615-6609 Journal Volume Volume 5 Journal Issue Volume 5, Number 1.

In lieu of an abstract, here is a brief excerpt of the content:"But I Don’t Feel It":Values and Emotions in the Assessment of Competence in Patients With Anorexia NervosaJochen Vollmann (bio)Keywordscompetence assessment, mental capacity, informed consent, psychiatry, anorexia nervosaThe respect of the self-determination of patients obliges physicians to obtain the patient's consent before providing medical treatment. One important condition for a valid informed consent is the patient's competence to make autonomous health care decisions. Therefore, a proper assessment of competence (...) to make health care decisions is crucial particularly in patients with mental disorders (Vollmann 2000; Helmchen and Vollmann 2001). In recent years, several empirical studies on the assessment of competence in patients suffering from different mental disorders have been performed using the MacArthur Competence Assessment Tool-Treatment (MacCAT-T; Grisso and Appelbaum1998). This assessment tool is based on legal standards of competence such as understanding, reasoning, appreciation, and expressing a choice. Since its first publication, the MacCAT-T has been widely accepted as a "gold standard" of competence assessment in the psychiatric literature. In recent years the MacCAT-T has been applied to patients suffering from depression, schizophrenia, dementia, angina pectoris, and normal controls (for overview, see Welie [2001] and Bauer and Vollmann [2002]).Tan and her colleagues (2006) use the MacCAT-T the first time to assess competence to make treatment decisions in patients with anorexia nervosa. Coming from clinical practice, the authors have noticed that the MacCAT-T might not work in this group of patients. Therefore, they use semi-structured interviews in addition to the MacCAT-T to identify aspects of thinking that might be relevant to the issue of competence to refuse treatment. They use grounded theory techniques for a qualitative analysis of the data as well as five brief, self-administered questionnaires to ascertain levels of psychopathology.The results of the study show that anorexia nervosa can have complex and variable effects on concentration, beliefs, and thought processing without affecting the ability to perform well on the MacCAT-T. At the same time, participants also report a change in their value system as well as in their personal identity. The authors argue that the results of their studies suggest that the competence to refuse treatment might be compromised in [End Page 289] people with anorexia nervosa in ways that are not captured by the MacCAT-T. This is an interesting finding in patients with anorexia nervosa, because in all other studies with patients suffering from mental disorders such as dementia, depression, and schizophrenia, the MacCAT-T identified more patients as limited in their competence to make health care decisions in comparison with other methods of competence assessment such as clinical judgment (Vollmann et al. 2003). The authors argue on the basis on their qualitative, semistructured interviews that anorexia nervosa–specific difficulties with a thought process and the change of values are missed by the MacCAT-T.Furthermore, Tan and her associated could not find a relationship between the participants' scores on the psychopathological scales, the MacCAT-T scores, and their difficulties expressed during the qualitative interviews, although the small size of the study precludes statistical analysis. In an earlier study, clinical dementia scales but not neuropsychological testing correlated with formal (MacCAT-T) and clinical assessment of competence. Therefore, psychopathological factors might play a different role in different subgroups of patients suffering from different mental problems. However, the idea of an objective neuropsychological model of competence assessment, again, finds no support in the presented empirical data.The qualitative data from patients with anorexia nervosa underline the problem of the cognitive bias of the MacCAT-T assessment and the illusion of value-free categories. It has been argued that the cognitive focus for the MacCAT-T is in itself a normative convention and that the MacCAT-T is missing the complexity of the process to make health care decisions in real life. Therefore, values and emotions should be considered in addition to cognitive functions in assessing competence to make health care decisions (Breden and Vollmann 2004; see also "Mental capacity" 2004). Although many authors agree that the cognitive approach of capacity assessment is important but not sufficient for the assessment of competence to make health care decisions, it remains an... (shrink)

Wie lasst sich pagan-antike Naturphilosophie und Naturkunde mit dem christlichen Glauben vereinbaren? Diese Frage stellte fur das Mittelalter kein akademisch-theoretisches Problem dar, sondern ein Anliegen, das die Deutung der Welt, der menschlichen Existenz und der Ethik unmittelbar betraf. Die Antworten, die das Mittelalter auf diese Fragen zu geben versuchte, differieren je nach Zeit, Standort und Intention der Autoren. Das im Rahmen des Sonderforschungsbereichs Wurzburg-Eichstatt durchgefuhrte Symposium stellt in chronologischer Anordnung verschiedene Antwortmodelle vor und gibt einen Uberblick uber das geistliche Naturverstandnis (...) des Mittelalters von der Karolingerzeit bis ins 14. Jahrhundert. Dabei werden die verschiedenen Disziplinen, die an Natur-wissen interessiert waren (Medizin, Theologie, Artes) unter Berucksichtigung der verschiedenen Gattungen (medizinisches Handbuch, Vision, Lehrdialog, enzyklopadisches Nachschlagewerk) einbezogen. Das Spektrum der behandelten Themen erstreckt sich von einem Karolingischen Arzneibuch uber den `Physiologus', Hermann von der Reichenau, Hildegard von Bingen, den altfranzosischen `Lucidaire' und `Sidrac', die Naturenzyklopadisten Thomas von Cantimpre und Bartholomaus Anglicus und reicht bis hin zu den Arzten Ortolf von Baierland und Paracelsus. (shrink)

First published in 1982, this reissue contains a critical exposition of the views of Frege, Dedekind and Peano on the foundations of arithmetic. The last quarter of the 19th century witnessed a remarkable growth of interest in the foundations of arithmetic. This work analyses both the reasons for this growth of interest within both mathematics and philosophy and the ways in which this study of the foundations of arithmetic led to new insights in philosophy and striking advances in logic. This (...) historical-critical study provides an excellent introduction to the problems of the philosophy of mathematics - problems which have wide implications for philosophy as a whole. This reissue will appeal to students of both mathematics and philosophy who wish to improve their knowledge of logic. (shrink)

The work of Jacques Ellul is useful in understanding and evaluating the implications of rapidly changing technologies for human values and democracy. Ellul developed three powerful theses about technology: technological autonomy, technological determinism, and technological bluff. In this essay, the authors explicate these views of technology, and place the work of Ellul in dialogue with the ides of other important theorists of technology. Ellul’s too-often overlooked theses about technology are relevant to our present technological society.

Impostors, confidence artists, and artful deceivers seem to have achieved a strange kind of popularity and even prestige in our contemporary political landscape, for reasons that remain elusive, especially given how harmful and socially unwanted such behaviors ostensibly are. Herman Melville’s 1857 novel, The Confidence-Man: His Masquerade, helps us shift our perspective on this seemingly irrational phenomenon because it points out how being susceptible to dupery is linked to the enjoyment of fiction itself. This insight also highlights the importance of (...) epistemological failure in the recent “return to aesthetics” in literary studies, where the positive dimension of unconsciously “willing one’s dupery” directly links aesthetic form to politics. The logic that connects aesthetics to unconscious enjoyment is then elaborated in the work of psychoanalytic thinkers such as Sigmund Freud, Jacques Lacan, Helene Deutsch and others to raise particular questions about how and why the enjoyment of being duped has been associated with feminine sexuality. Reading Melville’s novel while considering psychoanalytic concepts such as the “as if” personality, imposture, and interpassivity illuminates how confidence games play upon the ruses of sexuality, which have profound implications for why the public remains in thrall to the workings of known deceivers. (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)

This theory accords to volitions the status of basic mental actions, maintaining that these are spontaneous exercises of the will--a "two-way" power which ...

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)

ZusammenfassungIn der aktuellen ethischen Debatte über die ärztliche Unterstützung bei der Selbsttötung von schwerkranken Patienten werden von unterschiedlicher Seite strafrechtliche Verbote gefordert. Ging es zunächst in der politischen Debatte ausschließlich um das Verbot organisierter Formen der Beihilfe zur Selbsttötung, werden nunmehr einerseits auch weitergehende strafrechtliche Verbote bis hin zum Verbot jeder Form von Beihilfehandlungen wie andererseits die ausdrückliche Zulassung der Suizidbeihilfe durch Ärzte gefordert. Ausgehend vom Ansatz, ein Verbot der Suizidassistenz im Strafgesetzbuch aufzunehmen, zeigt der Artikel, dass die Straflosigkeit von (...) Suizid und Suizidassistenz in Deutschland auf eine lange Tradition zurückgeht. Die Straflosigkeit der Beihilfe zum Suizid lässt sich dabei nicht nur systematisch, sondern auch inhaltlich begründen. Eine Strafbarkeit hingegen wäre weder rechtlich noch ethisch überzeugend darzustellen. Die Verfasser sprechen sich unter Bezugnahme auf einzelne Regelungsvorschläge gegen ein Strafverbot und schließlich für einen offenen Diskurs innerhalb der Ärzteschaft sowie für eine Neuregelung im Berufsrecht aus. (shrink)

Forschungs- und Therapieansätze einer „personalisierten Medizin“ erhalten gegenwärtig große Aufmerksamkeit und Förderung in Forschung, Wirtschaft und Politik und erwecken große Hoffnungen. Auf der Grundlage molekulargenetischer Biomarker soll ein zielgerichtetes, stratifiziertes Vorgehen im Bereich der Prävention, Diagnostik und Therapie erreicht werden. Häufig wird der Begriff „personalisierte Medizin“ als Synonym für medizinischen Fortschritt überhaupt benutzt und eine persönlichere, bessere und kostengünstigere Medizin versprochen. 1) Fortschritte in der genetischen Forschung können nicht mit besseren medizinischen Behandlungsmöglichkeiten für eine Vielzahl von Patienten gleichgesetzt werden. In (...) Wirklichkeit beschränken sich die aktuellen Fortschritte einer an genetischen Biomarkern ausgerichteten Diagnostik und Therapie auf Untergruppen von Patienten. Die Mehrheit der Kranken hat bisher keinen Vorteil. 2) Der Begriff „personalisierte Medizin“ ist unangemessen und irreführend. Vielmehr handelt es sich um eine auf genetischen Biomarkern basierte stratifizierende Medizin und nicht um eine patienten- oder personenzentrierte Medizin. 3) Die sog. „personalisierte Medizin“ ist ein stark forschungs- und industriegetriebener Bereich der Medizin. Globale Stakeholder bestimmen die Entwicklung, unabhängig finanzierte Forschung gibt es kaum. Daher besteht die Gefahr, dass wissenschaftlicher Erkenntnisgewinn durch wirtschaftliche Einzelinteressen behindert wird. Empirische Erfahrungen, z. B. der Preisentwicklung neuer Krebsmedikamente, zeigen, dass das Versprechen der Kostenersparnis jeder Evidenz entbehrt. 4) Die hohen Investitionen in die „personalisierte Medizin“ werfen wichtige ethische Fragen nach Opportunitätskosten und Prioritätensetzungen im öffentlichen Gesundheitswesen auf. Derzeit profitieren wenige Patientengruppen von den hohen Forschungs- und Behandlungskosten der „personalisierten Medizin.“ Gleichzeitig bleiben Forschung und Versorgung in anderen wichtigen medizinischen Bereichen unterfinanziert. Eine öffentliche Debatte über die Prioritäten in medizinischer Forschung und Versorgung sowie darüber, wie diese in demokratischen Gesellschaften und in öffentlichen Gesundheitssystemen umgesetzt werden können, ist erforderlich. Eine an genetischen Biomarkern ausgerichtete sog. „personalisierte Medizin“ führt nicht zu einer persönlicheren Behandlung des einzelnen Patienten und ist von einer personen- oder patientenzentrierten Medizin zu unterscheiden. Von den bisherigen Therapiefortschritten profitieren Untergruppen von Patienten, z. B. in der Onkologie. Für die Mehrheit der Patienten konnten keine Verbesserungen erzielt werden. Für eine Kostenersparnis im Gesundheitswesen fehlt jegliche empirische Evidenz, vielmehr muss nach bisherigen Erfahrungen mit Kostensteigerungen gerechnet werden. (shrink)

BackgroundThe methodology of medical ethics during the last few decades has shifted from a predominant use of normative-philosophical analyses to an increasing involvement of empirical methods. The articles which have been published in the course of this so-called 'empirical turn' can be divided into conceptual accounts of empirical-normative collaboration and studies which use socio-empirical methods to investigate ethically relevant issues in concrete social contexts.DiscussionA considered reference to normative research questions can be expected from good quality empirical research in medical ethics. (...) However, a significant proportion of empirical studies currently published in medical ethics lacks such linkage between the empirical research and the normative analysis. In the first part of this paper, we will outline two typical shortcomings of empirical studies in medical ethics with regard to a link between normative questions and empirical data: (1) The complete lack of normative analysis, and (2) cryptonormativity and a missing account with regard to the relationship between 'is' and 'ought' statements. Subsequently, two selected concepts of empirical-normative collaboration will be presented and how these concepts may contribute to improve the linkage between normative and empirical aspects of empirical research in medical ethics will be demonstrated. Based on our analysis, as well as our own practical experience with empirical research in medical ethics, we conclude with a sketch of concrete suggestions for the conduct of empirical research in medical ethics.SummaryHigh quality empirical research in medical ethics is in need of a considered reference to normative analysis. In this paper, we demonstrate how conceptual approaches of empirical-normative collaboration can enhance empirical research in medical ethics with regard to the link between empirical research and normative analysis. (shrink)

Florijn’s analysis of the Dutch Supreme Court ruling on the Albert Heringa case demonstrates that the Dutch approach to justifying physician-assisted death is based primarily on the physician...

ZusammenfassungIn der neueren deutschen Rechtsprechung wurden die Anforderungen an die rechtliche Zulässigkeit von Zwangsbehandlungen verschärft und der Berücksichtigung des natürlichen Willens nicht selbstbestimmungsfähiger Patienten ein höherer Stellenwert eingeräumt. So ist der behandelnde Arzt etwa verpflichtet, einen letzten Versuch zu unternehmen, eine auf Vertrauen gegründete Zustimmung zu erhalten. In Anbetracht dessen, dass ein solches Gespräch im Kontext informellen Zwangs stattfindet, ergibt sich ein medizinethisches Dilemma: Entweder wird eine Zwangsbehandlung durchgeführt und somit direkter körperlicher Zwang angewendet, oder eine Zustimmung wird erzielt, jedoch (...) gegebenenfalls um den Preis, dass informeller Zwang – z. B. in Form einer Drohung, Täuschung oder Manipulation – ausgeübt wird. Es wird dafür argumentiert, dass die Antwort auf dieses Problem im philosophischen Begriff der Anerkennung zu finden ist, der im vorliegenden Kontext als eine spezifische Haltung aufgefasst wird und sich in einem respektvollen Umgang des Klinikpersonals mit den betroffenen Patienten zeigt. Die Ausübung von Zwang ist in solchen Fällen kaum zu vermeiden. Dennoch kann man in dieser Situation besser oder schlechter mit dem Patienten umgehen – und besser heißt hier, dem Patienten Anerkennung entgegenbringen. (shrink)

Talks 1952 -- Ojai, California 3 August -- August -- August -- Talks 1953 -- Bombay 4 March -- London 9 April -- Ojai, California 4 July -- Talks 1955 -- Amsterdam 26 May -- London 25 June -- Talks 1956 -- Madanapalle, India 26 February -- Brussels 24 June -- June -- Hamburg 6 September -- New Delhi 31 October -- Madras 26 December -- Talks 1957 -- Colombo, Sri Lanka 23 January -- January -- Talks 1958 -- Poona, (...) India 21 September -- Madras 26 October -- November -- Bombay 28 December -- Talks 1959 -- Madras 6 December -- December -- Bombay 23 December. (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)

There has been much discussion about the nature and even existence of so-called “pure conscious events” (PCEs). PCEs are often described as mental events which are non-conceptual and lacking all experiential content (Forman 1990). For a variety of reasons, a number of authors have questioned both the accuracy of such a characterization and even the very existence of PCEs (Katz 1978, Bagger 1999). In this chapter, I take a somewhat different, but also critical, approach to the nature and possibility of (...) PCEs. I focus on several overlapping views found in recent analytic philosophy of mind and examine PCEs in light of them. After introducing terminology and some preliminary matters, I examine whether or not the “higher-order thought (HOT) theory of consciousness” rules out the possibility of PCEs, and conversely, whether or not PCEs show that the HOT theory cannot apply to all conscious states. The HOT theory says that what makes a mental state conscious is that it is accompanied by a higher-order thought to the effect that “I am in mental state M now.” A related theme will be to assess PCEs in light of the recent debate between so-called “conceptualists” and those who believe that there are “non-conceptual contents of experience.” Conceptualism, to which I am very sympathetic, is basically the view that all conscious experience is structured by concepts possessed by the subject. I argue that PCEs are indeed conceptual and so no threat to conceptualism. For example, standard criticisms of conceptualism do not apply to PCEs. Finally, I examine the possibility that PCEs are not conscious at all. In the end, my overall conclusion is that we should hold that PCEs are indeed compatible with both HOT theory and conceptualism or seriously question the idea that PCEs are conscious at all. (shrink)

Empirical studies on people's moral attitudes regarding ethically challenging topics contribute greatly to research in medical ethics. However, it is not always clear in which ways this research adds to medical ethics as a normative discipline. In this article, we aim to provide a systematic account of the different ways in which attitudinal research can be used for normative reflection. In the first part, we discuss whether ethical judgements can be based on empirical work alone and we develop a sceptical (...) position regarding this point, taking into account theoretical, methodological and pragmatic considerations. As empirical data should not be taken as a direct source for normative justification, we then delineate different ways in which attitudes research can be combined with theoretical accounts of normative justification in the second part of the article. Firstly, the combination of attitudes research with normative-ethical theories is analysed with respect to three different aspects: The extent of empirical data which is needed, the question of which kind of data is required and the ways in which the empirical data are processed within the framework of an ethical theory. Secondly, two further functions of attitudes research are displayed which lie outside the traditional focus of ethical theories: the exploratory function of detecting and characterising new ethical problems, and the field of ‘moral pragmatics’. The article concludes with a methodological outlook and suggestions for the concrete practice of attitudinal research in medical ethics. (shrink)

The purpose of this text is to draw attention to eight forgotten heroes: William C. Bagley, Charles DeGarmo, David Felmley, William Torrey Harris, Isaac L. Kandel, Charles McMurry, William C. Ruediger, and Edward Austin Sheldon. They have been marginalized from our profession, and drawing upon their legacy is the best hope for restoring the profession of teaching today. This work also includes a chapter at the end of the book entitled "John Dewey's Forgotten Essays." The audience for this book includes: (...) 1) classroom teachers, 2) school administrators, 3) teacher educators, 4) deans and other university administrators, 5) college and university presidents, 6) legislators, 7) historians of education, 8) curriculum specialists, 9) specialists in teacher training, and 10) the general public. (shrink)

The first English translation of Fichte’s second set of 1804 lectures on the Wissenschaftslehre.

This comprehensive and important volume includes contributions by activists, journalists, lawyers and scholars from twenty-one countries. The essays map the directions the movement for women's rights is taking--and will take in the coming decades--and the concomittant transformation of prevailing notions of rights and issues. They address topics such as the rapes in former Yugoslavia and efforts to see that a War Crimes Tribunal responds; domestic violence; trafficking of women into the sex trade; the persecution of lesbians; female genital mutilation; and (...) reproductive rights. (shrink)

Im Zuge einer Änderung des Arzneimittelgesetzes im November 2016 hat der Deutsche Bundestag beschlossen, dass gruppennützige Arzneimittelforschung mit nicht-einwilligungsfähigen Erwachsenen unter bestimmten Bedingungen erlaubt sein soll. Das entsprechende Gesetz wird voraussichtlich im Jahr 2020 in Kraft treten. Das ethische Problem dieser Forschung besteht darin, dass Personen, die nicht in der Lage sind, ihre Einwilligung in die Forschung zu erteilen, nicht vom medizinischen Fortschritt ausgeschlossen werden sollen. Der Gesetzgeber hat versucht, diesen Konflikt zu lösen, indem er die Zulässigkeit der gruppennützigen Forschung (...) mit nicht-einwilligungsfähigen Erwachsenen an die Voraussetzung geknüpft hat, dass Studienteilnehmer ihre Einwilligung zuvor in einer Probandenverfügung erteilen. Der Beitrag hat das Ziel, die neue Regelung zur gruppennützigen Forschung mit nicht-einwilligungsfähigen Erwachsenen aus ethischer Sicht zu bewerten. Die Frage, ob die Gesetzesänderung weitere Forschung ermöglichen wird, hängt wesentlich davon ab, ob man mit Blick auf Studien, die sowohl eigennützige als auch gruppennützige Maßnahmen umfassen, eine Gesamtbetrachtung oder eine Einzelbetrachtung dieser Studien vorzieht. In unserem Beitrag argumentieren wir für eine Einzelbetrachtung. Es wird weiterhin die Auffassung vertreten, dass die im Gesetzgebungsverfahren vorgeschlagene Probandenverfügung die Selbstbestimmung der Patienten fördern kann, wenn sie mit Blick auf die mit der Teilnahme verbundenen Eingriffe ein Mindestmaß an Bestimmtheit erreicht.Zusammenfassend wird die Auffassung vertreten, dass gruppennützige Forschung mit nicht-einwilligungsfähigen Erwachsenen trotz der genannten Bedenken unter bestimmten Bedingungen ethisch zulässig sein kann. In der Gesamtabwägung erscheint dabei die eindeutige Definition und strenge Beachtung der Bedingungen der EU-Verordnung 536/2014 mit Blick auf einen ethisch gerechtfertigten Einbezug von nicht-einwilligungsfähigen Erwachsenen in gruppennützige Forschung als besonders bedeutsam. (shrink)

Forschungs- und Therapieansätze einer „personalisierten Medizin“ erhalten gegenwärtig große Aufmerksamkeit und Förderung in Forschung, Wirtschaft und Politik und erwecken große Hoffnungen. Auf der Grundlage molekulargenetischer Biomarker soll ein zielgerichtetes, stratifiziertes Vorgehen im Bereich der Prävention, Diagnostik und Therapie erreicht werden. Häufig wird der Begriff „personalisierte Medizin“ als Synonym für medizinischen Fortschritt überhaupt benutzt und eine persönlichere, bessere und kostengünstigere Medizin versprochen. 1) Fortschritte in der genetischen Forschung können nicht mit besseren medizinischen Behandlungsmöglichkeiten für eine Vielzahl von Patienten gleichgesetzt werden. In (...) Wirklichkeit beschränken sich die aktuellen Fortschritte einer an genetischen Biomarkern ausgerichteten Diagnostik und Therapie auf Untergruppen von Patienten. Die Mehrheit der Kranken hat bisher keinen Vorteil. 2) Der Begriff „personalisierte Medizin“ ist unangemessen und irreführend. Vielmehr handelt es sich um eine auf genetischen Biomarkern basierte stratifizierende Medizin und nicht um eine patienten- oder personenzentrierte Medizin. 3) Die sog. „personalisierte Medizin“ ist ein stark forschungs- und industriegetriebener Bereich der Medizin. Globale Stakeholder bestimmen die Entwicklung, unabhängig finanzierte Forschung gibt es kaum. Daher besteht die Gefahr, dass wissenschaftlicher Erkenntnisgewinn durch wirtschaftliche Einzelinteressen behindert wird. Empirische Erfahrungen, z. B. der Preisentwicklung neuer Krebsmedikamente, zeigen, dass das Versprechen der Kostenersparnis jeder Evidenz entbehrt. 4) Die hohen Investitionen in die „personalisierte Medizin“ werfen wichtige ethische Fragen nach Opportunitätskosten und Prioritätensetzungen im öffentlichen Gesundheitswesen auf. Derzeit profitieren wenige Patientengruppen von den hohen Forschungs- und Behandlungskosten der „personalisierten Medizin.“ Gleichzeitig bleiben Forschung und Versorgung in anderen wichtigen medizinischen Bereichen unterfinanziert. Eine öffentliche Debatte über die Prioritäten in medizinischer Forschung und Versorgung sowie darüber, wie diese in demokratischen Gesellschaften und in öffentlichen Gesundheitssystemen umgesetzt werden können, ist erforderlich. Eine an genetischen Biomarkern ausgerichtete sog. „personalisierte Medizin“ führt nicht zu einer persönlicheren Behandlung des einzelnen Patienten und ist von einer personen- oder patientenzentrierten Medizin zu unterscheiden. Von den bisherigen Therapiefortschritten profitieren Untergruppen von Patienten, z. B. in der Onkologie. Für die Mehrheit der Patienten konnten keine Verbesserungen erzielt werden. Für eine Kostenersparnis im Gesundheitswesen fehlt jegliche empirische Evidenz, vielmehr muss nach bisherigen Erfahrungen mit Kostensteigerungen gerechnet werden. (shrink)