In order to build on the information that was obtained in the course of the first study, a follow-up survey was conducted first by phone and subsequently in a written form between August and October 2014. We contacted 1.858 hospitals in all of Germany for the follow-up survey by phone. In cases where a hospital had not participated in the first study, the willingness to participate in the follow-up survey was established in advance. The survey’s dispatch was ensured in the (...) case of acceptance. The same structured survey was used as a research tool. The data of the first study and the follow-up survey were merged and evaluated. 654 surveys could be evaluated altogether. Our survey by phone revealed that 912 hospitals in all of Germany have at least one form of clinical ethics consultation available. The health care ethics committee is the most frequently implemented structure of clinical ethics consultation. The implementation of clinical ethics consultation is dependent on sponsorship and hospital size. Recommendations to deliver structures of clinical ethics consultations have a smaller influence on the implementation compared to the certification by KTQ respectively proCum Cert. The rate of implementation in regard to the structures of clinical ethics consultation has steadily increased for years. The establishment of clinical ethics consultation in German hospitals should be further promoted. It would be desirable further to develop suitable juridical regulations in order to implement clinical ethics consultation as well as structural parameters. (shrink)

Since 1989, clinical ethics consultation in form of hospital ethics committees was established in most of the transition countries of Central and Eastern Europe. Up to now, the similarities and differences between HECs in Central and Eastern Europe and their counterparts in the U.S. and Western Europe have not been determined. Through search in literature databases, we have identified studies that document the implementation of clinical ethics consultation in Central and Eastern Europe. These studies have been analyzed under the following (...) aspects: mode of establishment of HECs, character of consultation they provide, and their composition. The results show that HECs in the transition countries of Central and Eastern Europe differ from their western-European or U.S. counterparts with regard to these three aspects. HECs were established because of centrally imposed legal regulations. Little initiatives in this area were taken by medical professionals interested in resolving emerging ethical issues. HECs in the transition countries concentrate mostly on review of research protocols or resolution of administrative conflicts in healthcare institutions. Moreover, integration of non-professional third parties in the workings of HECs is often neglected. We argue that these differences can be attributed to the historical background and the role of medicine in these countries under the communist regime. Political and organizational structures of healthcare as well as education of healthcare staff during this period influenced current functioning of clinical ethics consultation in the transition countries. (shrink)

German medical schools have not yet sufficiently introduced students to the field of good scientific practice. In order to prevent scientific misconduct and to foster scientific integrity, courses on GSP must be an integral part of the curriculum of medical students. Based on a review of the literature, teaching units and materials for two courses on GSP were developed and tested in a pilot course. The pilot course was accompanied by a pre-post evaluation that assessed students’ knowledge and attitudes towards (...) scientific integrity and scientific misconduct. A syllabus was designed that comprised the following six topics: theoretical foundations of GSP; scientific publishing; empirical data; scientific supervision and teamwork; clinical research; personal interests. The comparison pre versus post-intervention yielded statistically significant changes in regard to the participants’ knowledge and attitude toward all forms of scientific misconduct treated in the course. As the majority of participants was not familiar with the fundamental regulations or guidelines of GSP, it seems crucial to train students in actively applying such norms to real-world conflicts. Students’ unfamiliarity with the fundamentals of GSP can be linked to the fact that many students have already experienced forms of scientific misconduct. Thus, GSP syllabi should be closely adjusted to a student’s realm of experience. All in all, courses on GSP can be seen as a potential means to increase the number of young scholars. (shrink)

The executive board of the Academy for Ethics in Medicine and two AEM working groups formulated standards and recommendations for clinical ethics consultation in 2010, 2011, and 2013. These guidelines comply with the international standards like those set by the American Society for Bioethics and Humanities. There is no empirical data available yet that could indicate whether these standards and recommendations have been implemented in German hospitals. This desideratum is addressed in the present study. We contacted 1.858 German hospitals between (...) September 2013 and January 2014. A follow-up survey was conducted between October 2014 and January 2015. The data of the initial survey and the follow-up survey were merged and evaluated. The statements of the participants were compared with the standards and recommendations. The standards of the AEM concerning the tasks of clinical ethics consultation are employed by a majority of participants of the study. Almost all of these participants document their consultation activities by means of protocols or entries in the patient file. There are deviations from the recommendations of the AEM working groups regarding the drafting of statutes, activity reports, and financial support. The activities of clinical ethics consultation predominantly comply with the standards of the AEM and recommendations for the documentation. The recommendations for evaluation should be improved in practice. This applies particularly for activity reports in order to evaluate the activities. Internal evaluation could take place accordingly. (shrink)

Telemedicine is a complex field including various applications and target groups. Especially telehealthcare is seen by many as a means to revolutionize medicine. It gives patients the opportunity to take charge of their own health by using self-tracking devices and allows health professionals to treat patients from a distance. To some, this means an empowerment of patient autonomy as well as an improvement in the quality of care. Others state the dangers of depersonalization of medicine and the pathologization of daily (...) life. This paper examines the ethical implications of telehealthcare, focusing on patient autonomy and quality of care by analyzing metareviews, randomized controlled trials and narrative ethical analyses on the topic. As a result, we conclude that the technically enhanced encounter between patients and health professionals may mean an empowerment of patient autonomy when it goes along with a personal relationship based on trust, assistance and support. When it comes to the quality of care, telehealthcare may lead to an improvement as long it is adopted to the patient’s individual needs. (shrink)

Surveys of the German public have revealed a high acceptance of social freezing, i.e. oocyte conservation without medical indication. Up to now, there are no investigations available on the experiences and attitudes of health professionals towards social freezing. Between August 2015 and January 2016, we surveyed gynecologists Germany-wide on the topic social freezing. Five gynecologists specialized in reproductive medicine and five office-based gynecologists in standard care were chosen for the survey. The survey was conducted with an explorative, qualitative research design. (...) The demand for social freezing in Germany is low. With regard to their fertility age, most women attend consultations too late, they have only little previous knowledge and false expectations. The gynecologists consider it the duty of society and politics to provide for the compatibility of family and work. They relate late parenthood to disadvantages primarily for the children. A majority of the gynecologists interviewed tend to advise natural reproduction. Social freezing is often mistaken as a kind of fertility insurance. Thus, it is necessary that physicians inform women early about the possibilities and limitations of social freezing. In the first place, social freezing is not a medical or medical-ethical topic. Women consider the method as a possibility to ensure the compatibility of family and work. This compatibility should be mostly perceived as a political topic. It cannot be a medical task to solve this issue. In fact, a debate in society as a whole is necessary that includes all relevant actors. (shrink)

German medical students are not sufficiently introduced to the ethical principles and pitfalls of scientific work. Therefore, a compulsory course on good scientific practice has been developed and implemented into the curriculum of medical students, with the goal to foster scientific integrity and prevent scientific misconduct. Students’ knowledge and attitudes towards GSP were evaluated by a pre-post-teaching questionnaire survey. Most participants initially had startling knowledge gaps in the field. Moreover, they were not acquainted with core institutions on GSP, the office (...) of ombudsperson and the nationally binding guidelines on GSP. The pre-post-teaching comparison showed statistically significant improvement in all areas tested; moreover, after the course participants confided more trust in GSP institutions. Applying ethical rules into practice can be challenging; therefore, students need to learn to work independently with guidelines on GSP and should be introduced to institutions providing further guidance. As our study has shown, students are very willing to pursue a scientific career based on integrity and honesty, however, they lack the knowledge how to do so. In light of our results, we therefore recommend to integrate courses on GSP already at an early time into the mandatory curriculum of medical students. (shrink)

Anhand historischer Quellen, die sich dem hermaphroditischen Körper zuwandten, darunter zahlreichen Abbildungen, diskutiert diese Studie die Entstehung von Geschlechtlichkeit, die Praktiken der Geschlechtseinschreibung in die Körper und die hiermit korrespondierenden Effekte. Dabei werden naturgeschichtliche, medizinische und juridische Diskurse des 15. bis 19. Jh.s analysiert. Die Hermaphroditen-Beschreibungen des 15. Jh.s, beispielsweise von Paracelsus, erschüttern durch das Fehlen der Definition von Intersexualität über die doppelte Anzahl der Geschlechtsteile, das Fehlen der modernen, wohlbekannten Verbindung von Hermaphrodit und Geschlecht die Vertrautheit unseres Wissens über (...) Hermaphroditen. Solch eine Verbindung taucht erstmals in den Hermaphroditen-Diskursen des beginnenden 17. Jh.s auf. Sie wird in jenen medizinischen Traktaten produziert, die nach der "Wahrheit des Geschlechts" hermaphroditischer Körper fragen. Und genau diese Frage ist es, die den Moment markiert, da im abendländischen Denken das Geschlecht erfunden wurde. (shrink)

In the GDR, women from the age of 12 onwards have been committed to closed venerology wards. The involuntarily committed had not been informed about the medical treatment on the wards; it was performed without their consent – impinging on their physical integrity. The closed venerology wards have been controlled by the Ministry of State Security. Unofficial employee reported to the Ministry on the medical personnel and on the patients on the wards. Due to this information the Ministry of State (...) Security knew at all times, what was taking place within the closed venerology ward in Halle and who was being compulsory admitted to this ward. The Ministry of State Security diversely used this information. Physicians were simultaneously involved as unofficial employees in operational processes against individual patients. (shrink)

Die Konzepte „Informationsmetabolismus“ von Antoni Kępiński und „Autopoiesis“ von Niklas Luhmann rekurrieren auf die Struktur biologischer Zellen. Beide Autoren übertragen diese biologischen Strukturen auf ihre jeweiligen Anwendungsfelder. Während Kępiński die Funktionsweise der Psyche zu bestimmen sucht, integriert Luhmann den biologischen Ansatz in seine Systemtheorie der lebenden und psychischen Systeme. Bei der Lektüre von Kępińskis und Luhmanns Arbeiten wird deutlich, dass beide Autoren das Verhältnis zwischen einerseits Psyche und andererseits psychischem System mit ihrer jeweiligen Umwelt näher bestimmen. In Luhmanns Werk ist (...) das Verhältnis zwischen System und Umwelt umfangreich beschrieben und ausgearbeitet. Vor diesem Hintergrund werden seine Ausführungen im Folgenden verwendet, um Kępińskis Überlegungen zum „Informationsmetabolismus“, dem Verhältnis von Psyche und Umwelt, zu reflektieren. (shrink)

Schon 1926 prägte der protestantische Theologe Fritz Jahr (1895-1953) aus Halle (Saale) den Begriff Bioethik. Der von Jahr vorgeschlagene bioethische Imperativ lautet dabei: «Achte jedes Lebewesen grundsätzlich als einen Selbstzweck und behandle es nach Möglichkeit als solchen!» Dieser Band untersucht die Perspektiven von Jahrs Thesen.