Recent scientific developments, in particular advances in pharmacogenetics and molecular genetics, have given rise to numerous predictive procedures for detecting predispositions to diseases in patients. This knowledge, however, does not necessarily promise benign results for either patients or health care professionals. The aim of this volume is to analyse issues related to prediction and prognosis as a burgeoning field of medicine, which is revolutionizing the way we understand and approach diagnosis and treatment. Combining epistemic and ethical reflection with medical expertise (...) on contemporary practice and research, an interdisciplinary group of international experts critically examine anticipatory medicine from various perspectives, including history of medicine, bioethics, theories of science, and health economics. The highly complex issues involved in medical prediction call for a far-reaching debate on the value and scope of foreknowledge. For example, which responsibilities and burdens arise when still healthy people learn of their predisposition to diseases? How should health care insurance reflect risky life styles? Is the increasing medicalization of life connected with prevention ethically sustainable and financially possible in the developing world? These and other related issues are the subject of this timely and important book, which not only serves as an introduction to the area, but also proposes many feasible solutions to the problems outlined. (shrink)

Moralvorstellungen generieren Erwartungen, die den Umgang mit den Mitmenschen prägen. Doch welches Verhalten ist kennzeichnend für einen integren, tugendhaften Menschen? In einer säkularisiert-pluralistischen Gesellschaft gelten Frauen und Männer als sozial kompetent, wenn sie sich durch Eigenschaften wie Ehrlichkeit, Zuverlässigkeit, Kollegialität und Vertrauenswürdigkeit auszeichnen. Diese Attribute haben die klassischen und christlich-theologischen Tugenden, etwa Tapferkeit, Keuschheit oder Mäßigung verdrängt. Die hier versammelten Beiträge fragen nach dem Einfluss expliziter und impliziter Tugendmodelle auf den Menschen, nach ihrer geschlechtlichen Prägung sowie nach den Geltungskonkurrenzen von (...) alten und neuen Idealvorstellungen. Aus der Perspektive des Subjekts betrachtet stellt sich die Frage, ob Tugendhaftigkeit wie ein Korsett je nachdem, von wem und für wen es geschnürt wurde stützend, formend, schützend, einengend oder sogar erstickend wirkt. *** Conceptions of morality generate expectations which inform our interactions with others. But what behaviour is typical of an integrated, virtuous person? In a secular and pluralist society men and women are deemed to be socially competent if they are distinguished by characteristics such as honesty, reliability, collegiality and trustworthiness. These attributes have replaced classical and Christian virtues such as courage, chastity and temperance. The essays collected here examine the influence of explicit and implicit models of virtue on people according to their gender imprinting and to the competing values of old and new moral conceptions. Viewed from the perspective of the subject, the question is raised as to whether virtuousness is like a corset and depending on the person for or by whom it is fastened can have a supporting, shaping, protective, constricting or suffocating effect. (shrink)

Ethical issues are inherent in medicine. Morally appropriate forms of medical behaviour, the thorough communication of diagnosis and prognosis, and carefully evaluated treatment promising recovery have been among the standards of medical ethics down to the present day. The testimonies of a lively tradition, which since antiquity has contributed to the permanent critical reflection of medicine, constitute the cultural background of contemporary bioethics. They demonstrate how fertile the dialogue between medicine and philosophy on ethical questions can be. This also includes (...) the critical examination of the objects, aims, methods and boundaries of the physicians profession and of medical research. These boundaries have had throughout history to be constantly renegotiated and defined, and not only in the 21st century. --- Eine Reflexion uber die moralischen Fragen und Probleme, die die arztliche Praxis begleiten, ist der Medizin immanent. Die sittlich angemessene arztliche Haltung, die "gute" und hilfreiche Behandlung und das arztliche Ethos stehen im Zentrum zahlreicher Schriften, die zwischen Humanismus und fruher Neuzeit verfasst wurden. Es sind Zeugnisse einer lebhaften Tradition, die ununterbrochen seit der Antike zur Selbstvergewisserung der Medizin beigetragen hat. Zwischen Mittelalter und Humanismus sahen sich Mediziner den Herausforderungen des mannigfaltigen und lebhaften Heilkunde-Marktes ausgesetzt und dementsprechend verpflichtet, sich umso starker zu behaupten. Die hier prasentierten Beitrage befassen sich mit der uber sich selbst reflektierenden Medizin. Dazu gehoren die kritische Auseinandersetzung mit Gegenstand, Ziel, Methoden und Grenzen des arztlichen Berufes und der medizinischen Forschung. Diese mussten - nicht anders als heute - immer wieder neu definiert und verhandelt werden. (shrink)

ZusammenfassungDieser Beitrag ist Teil des Forums COVID-19: Perspektiven in den Geistes- und Sozialwissenschaften. Das neuartige Coronavirus (Sars-CoV-2) stellt die Weltgemeinschaft vor eine große Herausforderung. Das Wissen über das Virus und seine Eigenschaften ist lückenhaft, aber der Bedarf, politische und medizinische Entscheidungen an wissenschaftlicher Erkenntnis auszurichten ist groß. Diese Lage führt zu einer Dynamisierung der Forschung. Ein prominentes Beispiel ist die WHO-Studie SOLIDARITY. Die epistemologischen Besonderheiten und die daraus resultierenden ethischen Implikationen werden in diesem Beitrag näher beleuchtet.

Hospital acquired infections (HAIs) are a major threat to patient safety. This paper addresses the following question: given what is known about the causes of and possible interventions on HAIs, to whom or what should the moral responsibility for preventing these infections be attributed? First, we show how generating robust evidence on the effectiveness of preventive hygiene measures is a complex endeavour and review the existing evidence on the causes of HAIs. Second, we demonstrate that the existing literature on the (...) ethical aspects of infection control has focused on responsibility at the individual-level. Thirdly, we argue that these accounts do not accommodate systemic factors relevant for HAI prevention. We show that the notion of collective responsibility is useful for making understandable how systemic factors, such as employment conditions in hospitals, are both causally and ethically relevant in infection control. (shrink)

ZusammenfassungDieser Beitrag ist Teil des Forums COVID-19: Perspektiven in den Geistes- und Sozialwissenschaften. Das neuartige Coronavirus stellt die Weltgemeinschaft vor eine große Herausforderung. Das Wissen über das Virus und seine Eigenschaften ist lückenhaft, aber der Bedarf, politische und medizinische Entscheidungen an wissenschaftlicher Erkenntnis auszurichten ist groß. Diese Lage führt zu einer Dynamisierung der Forschung. Ein prominentes Beispiel ist die WHO-Studie SOLIDARITY. Die epistemologischen Besonderheiten und die daraus resultierenden ethischen Implikationen werden in diesem Beitrag näher beleuchtet.This paper is part of Forum (...) COVID-19: Perspectives in the Humanities and Social Sciences. The novel coronavirus poses a huge challenge to the world community. Knowledge about the virus and its properties is limited, but there is a great need to base political and medical decisions on scientific knowledge. This situation is leading to a dynamization of research. A prominent example of such a development is SOLIDARITY. The epistemological dimensions of this trial, which is coordinated by the WHO, and the resulting ethical implications are discussed in this article. (shrink)

Seeing the entwinement of social and epistemic challenges through COVID, we discuss the perils of simplistic appeals to ‘follow the science’. A hardened scientism risks excarbating social conflict and fueling conspiracy beliefs. Instead, we see an opportunity to devise more inclusive medical knowledge practices through endorsing experiential knowledge alongside traditional evidence types.

In times of ongoing resource shortages, appropriate evaluation criteria are crucial for the ethical prioritization of medical care. While the use of scoring models as tools for prioritization is widespread, they are barely discussed in the medical-ethical discourse in the context of the COVID-19 pandemic. During this time, the challenge of providing care for patients in need has promoted consequentialist reasoning. In this light, we advocate for the integration of time- and context-sensitive scoring (TCsS) models in prioritization policies that foster (...) treatment opportunities for patients with subacute and chronic conditions. We argue, first, that TCsSs enable a more efficient use of resources, reducing avoidable harm to patients by preventing arbitrary postponement of necessary but nonurgent interventions. Second, we contend that on an interrelational level, TCsSs render decision-making pathways more transparent, which promotes the information requirement of patient autonomy and raises confidence in the resulting prioritization decision. Third, we claim that TCsS contributes to distributive justice by reallocating available resources to the benefit of elective patients. We conclude that TCsSs promote anticipatory measures that extend the timeframe for responsible action into the future. This strengthens patients' ability to exercise their right to healthcare—primarily during times of crisis, but ultimately in the longer term too. (shrink)