This is the first book to provide a coherent overview over the ethical implications of AI-related technologies in medicine. It explores how these technologies transform practices, relationships, and environments in the clinical field. It provides an introduction into ethical issues such as data security and privacy protection, bias and algorithmic fairness, trust and transparency, challenges to the doctor-patient relationship, and new perspectives for informed consent. The book focuses on the transformative impact that technology is having on medicine, and discusses several (...) strategies for dealing with the resulting challenges. It also introduces innovative methods of ethics research for addressing existing desiderata and future challenges. This book is written to inform health care professionals, policy-makers, and researchers in medicine, health sciences, nursing science, social sciences, and ethics, but may also function as a primary textbook for graduate as well as undergraduate university courses. (shrink)

Definition of the problem Biomedical research based on big data offers immense benefits. Large multisite research that integrates large amounts of personal health data, especially genomic and genetic data, might contribute to a more personalized medicine. This type of research requires the transfer and storage of highly sensitive data, which raises the question of how to protect data subjects against data harm, such as privacy breach, disempowerment, disenfranchisement, and exploitation. As a result, there is a trade-off between reaping the benefits (...) of big-data-based biomedical research and protecting data subjects’ right to informational privacy. Arguments Blockchain technologies are often discussed as a technical fix for the abovementioned trade-off due to their specific features, namely data provenance, decentralization, immutability, and access and governance system. However, implementing blockchain technologies in biomedical research also raises questions regarding consent, legal frameworks, and workflow integration. Hence, accompanying measures, which I call enablers, are necessary to unleash the potential of blockchain technologies. These enablers are innovative models of consent, data ownership models, and regulatory models. Conclusion Blockchain technologies as a technical fix alone is insufficient to resolve the aforementioned trade-off. Combining this technical fix with the enablers outlined above might be the best way to perform biomedical research based on big data and at the same time protect the informational privacy of data subjects. (shrink)

The notion of being a burden to others is mostly discussed in the context of care‐intensive diseases or end‐of‐life decisions. But the notion is also crucial in decision‐making at the beginning of life, namely regarding prenatal testing. Ever more sophisticated testing methods, especially non‐invasive prenatal testing (NIPT), allow the detection of genetic traits in the unborn child that may cause disabilities. A positive result often influences the decision of the pregnant women towards a termination of the pregnancy. Thus, critics claim (...) that these testing methods send a negative message to people with disabilities. At the core of this is what we call the burden assumption. This assumption claims that children with disabilities are necessarily a burden to others, especially to their parents and other family members. In this paper, we discuss what being a burden to others means in this context and how such an attitude can be avoided without restraining reproductive autonomy. A closer examination shows that the burden assumption is mostly based on misinformation and a false model of disability. Empirical studies as well as narrative evidence from parents who raise a child with disabilities show that the burden assumption is wrong. Raising a child with disabilities does not necessarily mean a decrease in the quality of life. We show how the burden assumption can be challenged through an advanced genetic counselling that combines empirical evidence with narratives from a first‐person perspective. (shrink)

Digital technologies have become a crucial factor in nursing. Given the fact that many tasks could also be done by robots or AI systems, the place for the nurse in this scenario is unclear. In what way and to what extent will the implementation of ever more sophisticated technology affect nursing practice? It is the aim of this paper to analyse the potential challenges of nursing practice in the digital age. The analysis is conducted through the lens of new materialism, (...) a set of theoretical models that understand the relationship between humans and technology as dynamic and performative. According to this view, there is no prefixed essence of technology. Rather, the meaning of technology is enacted in concrete practice. The analysis shows that in past debates on technology use in nursing, the nurses’ role has been defined as guardians of humanity, defending the patient against the dehumanizing effects of technology. This role has been transferred to the digital age, where it is the duty of nurses to cushion the negative effects of digital technology. As an alternative to this outdated role, nurses should be included in processes of technology design and policymaking. Enabling nursing professionals to shape the circumstances of a digitally enhanced holistic practice may empower their status within the healthcare system and also benefit the patient by contributing to a more person‐centred care. (shrink)

In March 2019, the German Gemeinsamer Bundesausschuss (G‑BA; Federal Joint Committee) presented the result of the method assessment process on non-invasive prenatal testing (NIPT). The aim of this method assessment process was to decide whether NIPT should become a publicly funded procedure of routine prenatal care. The G‑BA decided in favor of NIPT, making the implementation of NIPT very likely, provided that other healthcare and political institutions also agree. This development could be interpreted as empowering from the perspective of reproductive (...) autonomy, since NIPT allows pregnant women to obtain valuable information on the health of the fetus in a fast and easy manner and without the risks of invasive methods. However, the routinization of NIPT also implies ethical challenges. Will the routinization lead to a normalization of prenatal quality control? Will it lead to an expansion to women outside the high-risk group? What would be the ethical implications of such a development? How should physicians, geneticists, and patients deal with the increased amount of obtainable information? What are the implications for choice and decision-making in the prenatal care context? In this paper, we analyze the ethical aspects of the routinization of NIPT, focusing on information and the counseling process, the burden of choice, and the threats to reproductive autonomy by societal interests linked to NIPT. (shrink)

In March 2019, the German Gemeinsamer Bundesausschuss (G‑BA; Federal Joint Committee) presented the result of the method assessment process on non-invasive prenatal testing (NIPT). The aim of this method assessment process was to decide whether NIPT should become a publicly funded procedure of routine prenatal care. The G‑BA decided in favor of NIPT, making the implementation of NIPT very likely, provided that other healthcare and political institutions also agree. This development could be interpreted as empowering from the perspective of reproductive (...) autonomy, since NIPT allows pregnant women to obtain valuable information on the health of the fetus in a fast and easy manner and without the risks of invasive methods. However, the routinization of NIPT also implies ethical challenges. Will the routinization lead to a normalization of prenatal quality control? Will it lead to an expansion to women outside the high-risk group? What would be the ethical implications of such a development? How should physicians, geneticists, and patients deal with the increased amount of obtainable information? What are the implications for choice and decision-making in the prenatal care context? In this paper, we analyze the ethical aspects of the routinization of NIPT, focusing on information and the counseling process, the burden of choice, and the threats to reproductive autonomy by societal interests linked to NIPT. (shrink)

In March 2019, the German Gemeinsamer Bundesausschuss (G‑BA; Federal Joint Committee) presented the result of the method assessment process on non-invasive prenatal testing (NIPT). The aim of this method assessment process was to decide whether NIPT should become a publicly funded procedure of routine prenatal care. The G‑BA decided in favor of NIPT, making the implementation of NIPT very likely, provided that other healthcare and political institutions also agree. This development could be interpreted as empowering from the perspective of reproductive (...) autonomy, since NIPT allows pregnant women to obtain valuable information on the health of the fetus in a fast and easy manner and without the risks of invasive methods. However, the routinization of NIPT also implies ethical challenges. Will the routinization lead to a normalization of prenatal quality control? Will it lead to an expansion to women outside the high-risk group? What would be the ethical implications of such a development? How should physicians, geneticists, and patients deal with the increased amount of obtainable information? What are the implications for choice and decision-making in the prenatal care context? In this paper, we analyze the ethical aspects of the routinization of NIPT, focusing on information and the counseling process, the burden of choice, and the threats to reproductive autonomy by societal interests linked to NIPT. (shrink)

In March 2019, the German Gemeinsamer Bundesausschuss (G‑BA; Federal Joint Committee) presented the result of the method assessment process on non-invasive prenatal testing (NIPT). The aim of this method assessment process was to decide whether NIPT should become a publicly funded procedure of routine prenatal care. The G‑BA decided in favor of NIPT, making the implementation of NIPT very likely, provided that other healthcare and political institutions also agree. This development could be interpreted as empowering from the perspective of reproductive (...) autonomy, since NIPT allows pregnant women to obtain valuable information on the health of the fetus in a fast and easy manner and without the risks of invasive methods. However, the routinization of NIPT also implies ethical challenges. Will the routinization lead to a normalization of prenatal quality control? Will it lead to an expansion to women outside the high-risk group? What would be the ethical implications of such a development? How should physicians, geneticists, and patients deal with the increased amount of obtainable information? What are the implications for choice and decision-making in the prenatal care context? In this paper, we analyze the ethical aspects of the routinization of NIPT, focusing on information and the counseling process, the burden of choice, and the threats to reproductive autonomy by societal interests linked to NIPT. (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)

Definition of the problem Medical ethics is increasingly faced with issues that result from power asymmetries and epistemic injustice. However, medical ethics lacks the epistemic lenses for analyzing these social context factors of clinical practice. A theoretical and conceptual reconfiguration is necessary in order to be able to address these issues. Arguments This paper discusses the foundations of critical medical ethics, which takes perspectives and epistemic categories from critical theories. This includes the Critical Theory of the Frankfurt School as well (...) as those approaches from social sciences and cultural studies that reflect on power asymmetries. By drawing on these theories, the epistemic spectrum of medical ethics could be broadened in order to better include real power relations into normative analyses. The paper starts by outlining the contribution of social sciences to empirical medical ethics. This shows that an empirical approach as such cannot bridge the epistemic gap. In a further step, epistemic lenses and concepts from critical theories are discussed, such as Critical Theory of the Frankfurt School, feminist approaches, postcolonial approaches, queer theory, gender studies, and science and technology studies (STS). The conclusion sums up the foundations of critical medical ethics and discusses its limitations. Conclusion Critical medical ethics possesses the epistemic categories and broader social perspective needed to address issues in medicine that result from power asymmetries and epistemic injustice in society. (shrink)

Die Möglichkeiten der Reproduktionsmedizin erweitern sich ständig. Bei einigen Maßnahmen assistierter Reproduktion ist es oft unklar, ob eine Indikation vorliegt oder ob diese Maßnahmen als wunscherfüllend anzusehen sind. Die Unterscheidung zwischen medizinisch indizierter Maßnahme und wunscherfüllender Behandlung hängt von dem hier verwendeten Konzept der Indikation ab. Daher kommt dem Konzept der Indikation auf dem Gebiet der Reproduktionsmedizin ein besonderer Stellenwert zu. Dabei fällt auf, dass die Abgrenzung zwischen medizinisch indizierter Behandlung und Wunschbehandlung nicht allein klinisch begründet ist, sondern implizit oder (...) explizit normative Urteile enthält. Der sprachlich-kommunikative Aspekt spielt hierbei eine zentrale Rolle. Der übliche Sprachgebrauch von „indiziert“ suggeriert ein Urteil, das allein auf empirisch-klinischen Fakten basiert, und verdeckt die normativen Urteile, die in das Konzept der Indikation einfließen. Ziel des vorliegenden Beitrags ist es, den normativen Gehalt der Indikation in der Reproduktionsmedizin zu analysieren. Grundlage ist die eingehende Betrachtung des Konzepts der Indikation und der besonderen Stellung der Indikation in der Reproduktionsmedizin. Aus dieser Betrachtung ergibt sich, dass der normative Gehalt der Indikation von einem soziokulturellen Skript bezüglich Elternschaft geprägt ist, das sich v. a. im Leistungsrecht niederschlägt. Dieses Skript enthält gesellschaftliche Anschauungen, Normen und Rollenbilder und kann als „gute Elternschaft“ bezeichnet werden. Das Skript der guten Elternschaft wirkt als Regulativ, das durch leistungsrechtliche Vorgaben über den Zugang zu reproduktionsmedizinischen Maßnahmen bestimmt. Es basiert auf traditionellen heteronormativen Ehe- und Familienkonzepten und sieht Elternschaft für heterosexuelle, verheiratete Paare vor. Somit ergibt sich der Widerspruch, dass Verfahren der Reproduktionsmedizin, die den Raum für die Fortpflanzung jenseits traditionell-heteronormativer Konzepte öffnen, von ebenjenen Konzepten legitimiert und limitiert werden. (shrink)

Definition of the problemThe options of reproductive medicine are expanding. In some cases, it is unclear whether there is a medical indication for applying procedures of assisted reproduction or whether this application is wish-fulfilling. The distinction between medical indication and wish fulfilment depends on the concept of indication. Thus, the concept of indication has a special status in reproductive medicine. The distinction between medical indication and wish-fulfilling treatment is mostly based on implicit or explicit normative judgements, rather than on mere (...) clinical facts. The use of “indicated” suggests a purely empirical-clinical judgment, whereas the normative judgements behind the concept are concealed. The aim of this paper is to analyze the normative implications of indication in reproductive medicine. Therefore, the concept of indication and its special status within reproductive medicine is scrutinized.ArgumentsThe analysis shows that the normative implications of indication are tied to a sociocultural script of parenthood, which manifests in the regulations of reimbursement. This script encompasses societal views, norms, and role models, and can be described as “good parenting”. The script of good parenting acts as a regulatory instance that determines the access to procedures of assisted reproduction. It is based on traditional heteronormative concepts of marriage and family, and reserves reproduction exclusively for heterosexual, married couples.ConclusionThe sociocultural script of good parenting in reproductive medicine implies a contradiction: Assisted reproduction technologies provide the opportunity of reproduction for individuals outside the heteronormative frame, yet they are legitimized and limited by this exact frame. (shrink)

With the arrival of new methods of genome editing, especially CRISPR/cas 9, new perspectives on germline interventions have arisen. Supporters of germ line genome editing claim that the procedure could be used as a means of disease prevention. As a possible life-saving therapy, it provides benefits that outweigh its risks. Opponents of GGE claim that the medical and societal risks, especially the use of GGE for genetic enhancement, are too high. In our paper, we analyze the risks and benefits of (...) GGE. We show that the medical risk on an individual level might be reduced by further research in the near future so that they may be outweighed by the benefits. We also show that the societal risks of the procedure, i.e. genetic enhancement, are manageable by establishing a regulative framework before the GGE is implemented. Since the effects of modifying genes for the genepool of a given population are extremely difficult to model, the medical risks on the population level might be too high. (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)

Ambient Assisted Living (AAL) refers to technologies that track daily activities of persons in need of care to enhance their autonomy and minimise their need for assistance. New technological developments show an increasing effort to integrate automated emotion recognition and regulation (ERR) into AAL systems. These technologies aim to recognise emotions via different sensors and, eventually, to regulate emotions defined as “negative” via different forms of intervention. Although these technologies are already implemented in other areas, AAL stands out by its (...) tendency to enable an inconspicuous 24-hour surveillance in the private living space of users who rely on the technology to maintain a certain degree of independence in their daily activities. The combination of both technologies represents a new dimension of emotion recognition in a potentially vulnerable group of users. Our paper aims to provide an ethical contextualisation of the novel combination of both technologies. We discuss different concepts of emotions, namely Basic Emotion Theory (BET) and the Circumplex Model of Affect (CMA), that form the basis of ERR and provide an overview over the current technological developments in AAL. We highlight four ethical issues that specifically arise in the context of ERR in AAL systems, namely concerns regarding (1) the reductionist view of emotions, (2) solutionism as an underlying assumption of these technologies, (3) the privacy and autonomy of users and their emotions, (4) the tendency of machine learning techniques to normalise and generalise human behaviour and emotional reactions. (shrink)

The nursing gaze, that is the specific ways of observing the patient in nursing practice, has been the object of ethical debates for decades. It has been argued that the specific feature of observing patients in nursing is the stereoscopic vision that allows nurses to see the patient at the same time as a subject and a body. However, with the increased use of technology in nursing and the focus on quantifiable biomedical data, some commentators see a shift from the (...) view of the patient as subject to the patient as body, which results in a de‐humanisation and objectification of patients. The new digital technologies in patient monitoring and surveillance add a further dimension to this topic. It is yet unclear how digital technologies affect the nursing gaze, and with it, nursing practice. Furthermore, the ethical implications of the digitally enhanced nursing gaze have yet to be analysed. It is the purpose of this study to make a first step in this direction. By focusing on digitally enhanced monitoring technologies in long‐term care, these technologies are interpreted as liquid surveillance, an approach introduced by Zygmunt Bauman. The Baumanian concept of adiaphorisation, that is the detachment of social action from moral evaluation, is used as normative framework of the analysis. The analysis shows that the tendency to remove surveillance practices from moral evaluation by framing them as enablers of an active, healthy life and as tools for caring for the vulnerable, the stereoscopic vision of the nursing gaze is undermined. (shrink)

Geflüchtete weisen eine hohe Prävalenz an psychischen Störungen auf. Dem hohen Behandlungsbedarf stehen jedoch Barrieren gegenüber, die den Zugang zu psychischen Versorgungsleistungen behindern. Zu den Zugangsbarrieren gehören strukturelle Hürden ebenso wie kulturell differente Haltungen gegenüber psychischer Gesundheit und Krankheit sowie therapeutischen Maßnahmen. Eine Möglichkeit, diese Zugangsbarrieren zu überwinden und Geflüchteten Versorgungsleistungen nach ihrem Bedarf zukommen zu lassen, wird in digitalen Interventionen gesehen. In Form von interaktiven Websites oder Smartphone-Apps haben sich diese internet- und mobilgestützten Interventionen bereits in der Versorgung bewährt. (...) Auch gibt es erste Beispiele für einen gelungenen Einsatz bei Geflüchteten. Die ethischen Aspekte digitaler Interventionen für Geflüchtete sind bislang aber kaum erforscht. Ziel des Beitrags ist es, dieses Desiderat zu bearbeiten. Als Instrument der ethischen Analyse wird dazu das agency-Konzept verwendet. Nach dem agency-Konzept sind Personen als handlungsfähige Akteure zu verstehen, die aus eigenen Ressourcen und Kompetenzen schöpfen und selbstwirksam handeln können. Agency ist in vorliegender Arbeit das Leitprinzip, um die Chancen und Risiken digitaler Interventionen bei Geflüchteten zu analysieren. Darüber hinaus werden die Perspektiven eines agency-basierten Einsatzes digitaler Interventionen für Geflüchtete aufgezeigt. Auf dieser Grundlage können therapeutische Konzepte entwickelt werden, die aus ethischer Sicht zu einer Verbesserung der Versorgungssituation von Geflüchteten beitragen können. (shrink)

Definition of the problem Refugees show a high prevalence of mental health burden. Catering to the need for mental health services is made difficult by access barriers. These barriers consist of structural factors as well as culturally different attitudes towards mental health, mental illness, and therapeutic interventions. One option to overcome these access barriers and to provide mental healthcare services in an appropriate manner is seen in digital interventions. In the form of interactive websites or smartphone apps, these interventions have (...) proven to be effective in mental healthcare. There are also promising examples of successful use of these technologies with refugees. However, the ethical aspects of digital interventions for refugees have scarcely been studied yet. Arguments Aim of this paper is to tackle this research desiderate. The instrument of the ethical analysis to be conducted is the concept of agency. According to the concept of agency, persons have to be seen as actors capable of acting based on their own resources and competencies. Agency is the guiding principle here for analyzing the opportunities and risks of digital interventions for refugees. In addition, I will attempt to point out prospects for an agency-based application of digital interventions. Conclusion The ethical analysis could be used as the blueprint for developing therapeutic concepts that contribute to the improvement of mental healthcare services for refugees from an ethical perspective. (shrink)

AgeTech involves the use of emerging technologies to support the health, well-being and independent living of older adults. In this paper we focus on how AgeTech based on artificial intelligence (AI) may better support older adults to remain in their own living environment for longer, provide social connectedness, support wellbeing and mental health, and enable social participation. In order to assess and better understand the positive as well as negative outcomes of AI-based AgeTech, a critical analysis of ethical design, digital (...) equity, and policy pathways is required. A crucial question is how AI-based AgeTech may drive practical, equitable, and inclusive multilevel solutions to support healthy, active ageing. In our paper, we aim to show that a focus on equity is key for AI-based AgeTech if it is to realize its full potential. We propose that equity should not just be an extra benefit or minimum requirement, but the explicit aim of designing AI-based health tech. This means that social determinants that affect the use of or access to these technologies have to be addressed. We will explore how complexity management as a crucial element of AI-based AgeTech may potentially create and exacerbate social inequities by marginalising or ignoring social determinants. We identify bias, standardization, and access as main ethical issues in this context and subsequently, make recommendations as to how inequities that stem form AI-based AgeTech can be addressed. (shrink)

Der weltweit erste Mitochondrien-Transfer, auch als Erzeugung eines „Drei-Eltern-Kindes“ bezeichnet, hat 2016 eine intensive Debatte ausgelöst. Hinsichtlich des Verfahrens, das bisher nur in Großbritannien zugelassen ist, werden auch verschiedene ethische Aspekte angesprochen. Dazu gehören die Risikoabwägung, die reproduktive Selbstbestimmung und die psychosoziale Entwicklung eines Kindes, das von drei Individuen abstammt. Dabei fällt auf, dass zentrale konzeptuelle Fragen hinsichtlich des Mitochondrien-Transfers nicht geklärt sind. Ist der Mitochondrien-Transfer eine genetische Intervention in die Keimbahn? Handelt es sich bei dem Verfahren um eine medizinisch (...) indizierte Therapie oder um eine elektive Behandlung assistierter Reproduktion? Welche Konzepte von Identität und Elternschaft liegen der Auffassung eines „Drei-Eltern-Kindes“ zugrunde? Im Kontext dieser konzeptuellen Fragen muss eine ethische Analyse des Mitochondrien-Transfers durchgeführt werden. In den meisten Fällen zeigt sich allerdings, dass die ethische Analyse zu stark auf Einzelaspekte fokussiert ist, wodurch diese konzeptuellen Fragen aus dem Blick geraten. Daher verbinden wir in unserem Beitrag die ethische Analyse mit konzeptuellen Überlegungen. Dabei ist es von zentraler Bedeutung, auch die biomedizinischen Grundlagen des Verfahrens eingehend zu erörtern, um die konzeptuellen Aspekte angemessen einordnen zu können. In einem ersten Schritt erläutern wir die unterschiedlichen Verfahren des Mitochondrien-Transfers. In einem zweiten Schritt schlagen wir eine konzeptuelle Klärung der drei genannten Fragen vor. Diese konzeptuelle Klärung dient als Grundlage, um die ethischen Aspekte der reproduktiven Selbstbestimmung, Risikoabwägung sowie Elternschaft und Identitätskonzeption zu analysieren. In einem dritten Schritt fassen wir die Ergebnisse zusammen. (shrink)

Interventions in the human germline have been regarded as a red line in genetic engineering up to now. However, with the recent progress in genome editing techniques, first and foremost CRISPR-based methods, the tide seems to be turning. The therapeutic benefits in particular are brought forward as an argument in favor of germline genome editing. According to this view, the main benefit of GGE is disease prevention. The procedure could be used to prevent monogenetic conditions for which no treatment is (...) available so far. This leads many commentators to the view that the benefits of GGE outweigh the risks. In this article, I examine the status and ethical implications of GGE as a means of disease prevention. I intend to show that the notion of GGE as disease prevention is only true for one specific application. Instead of being preventive treatments, most applications of GGE are advanced techniques of assisted reproduction. As such, they can be thought of as wish-fulfilling medicine, that is the use of medical techniques for non-medically indicated purposes. Thus, it is necessary to reconsider the risk-benefit analysis of GGE for most of its applications. (shrink)

It is the aim of this paper to establish the concept of politicized medicine. The starting point is the work by Steger and Schochow on the Closed Venerological Wards in the GDR. Steger and Schochow operate with the concept of politicized medicine, although they do not elaborate it due to their primarily empirical approach. In this paper, the theoretical foundations for this concept shall be laid. Therefore, the results of the research by Steger and Schochow as well as the different (...) approaches to politicized medicine have to be examined. In a further step, the house rules of the Closed Venerological ward in Halle is analyzed as an example of politicized medicine. Finally, politicized medicine is differentiated from Foucault’s approach of Bio-Power/Bio-Politics on order to demonstrate its status as an autonomous and fruitful concept. (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)

Background In nursing homes, residents’ relatives represent important sources of support for nurses. However, in the heightened stress of emergency situations, interaction between nurses and relatives can raise ethical challenges. Research objectives The present analysis aimed at elaborating a typology of nurses’ experience of ethical support and challenges in their interaction with relatives in emergency situations. Research design Thirty-three semi-structured interviews and six focus groups were conducted with nurses from different nursing homes in Germany. Data were analysed according to Mayring’s (...) method of qualitative content analysis. Participants and research context Participants were licensed nurses working in nursing homes. Ethical considerations Ethical approval was granted by Ostfalia University of Applied Sciences (02.07.2020) and the Ethics Committee of Hannover Medical School (Nr. 8866_BO_K_2020; 27.01.2020). Interviewees were anonymised and focus group were pseudonymised during transcription. All participants provided written consent. Findings/results In emergency situations, relatives can represent important sources of support for nurses. However, they may also give rise to different challenges, relating to four ethical conflicts: (1) the challenge of meeting the information needs of relatives while providing appropriate care to all residents; (2) the challenge of managing relatives’ demands for hospitalisation when hospitalisation is not deemed necessary by nurses; (3) the challenge of managing relatives’ demands for lifesaving treatment when such treatment contradicts the will of the resident; and (4) the challenge of attempting to initiate hospitalisation when relatives oppose this course of action. Several external factors make these conflicts especially challenging for nurses: fear of legal consequences, a low staffing ratio, and a lack of qualified nursing staff. Conclusions Conflict between nurses and relatives typically revolves around hospitalisation and the initiation of lifesaving treatment. Whether nurses perceive interaction with relatives as supportive or conflictual essentially depends on the quality of the relationship, which may be negatively influenced by a number of external factors. (shrink)

AAL encompasses smart home technologies that are installed in the personal living environment in order to support older, disabled, as well as chronically ill people with the goal of delaying or reducing their need for nursing care in a care facility. Artificial intelligence (AI) is seen as an important tool for assisting the target group in their daily lives. A literature search and qualitative content analysis of 255 articles from computer science and engineering was conducted to explore the usage of (...) ethical concepts. From an ethical point of view, the concept of independence and self-determination on the one hand and the possible loss of privacy on the other hand are widely discussed in the context of AAL. These concepts are adopted by the technical discourse in the sense that independence, self-determination and privacy are recognized as important values. Nevertheless, our research shows that these concepts have different usages and meanings in the ethical and the technical discourses. In the paper, we aim to map the different meanings of independence, self-determination and privacy as they can be found in the context of technological research on AI-based AAL systems. It investigates the interpretation of these ethical and social concepts which technicians try to build into AAL systems. In a second step, these interpretations are contextualized with concepts from the ethical discourse on AI-based assistive technologies. (shrink)

Risk and crisis communication (RCC) is a current ethical issue subject to controversy, mainly due to the tension between individual liberty (a core component of fairness) and effectiveness. In this paper we propose a consistent definition of the RCC process in public health emergencies (PHERCC), which comprises six key elements: evidence, initiator, channel, publics, message, and feedback. Based on these elements and on a detailed analysis of their role in PHERCC, we present an ethical framework to help design, govern and (...) evaluate PHERCC strategies. The framework aims to facilitate RCC, incorporating effectiveness, autonomy, and fairness. It comprises five operational ethical principles: openness, transparency, inclusivity, understandability, and privacy. The resulting matrix helps understanding the interplay between the PHERCC process and the principles of the framework. The paper includes suggestions and recommendations for the implementation of the PHERCC matrix. (shrink)

This handbook is currently in development, with individual articles publishing online in advance of print publication. At this time, we cannot add information about unpublished articles in this handbook, however the table of contents will continue to grow as additional articles pass through the review process and are added to the site. Please note that the online publication date for this handbook is the date that the first article in the title was published online.

Giovanni Mion defends the idea that knowledge is context relative, but, in contrast to current versions of epistemic contextualism, on his view, knowledge is relative to contexts that are objective. Following Christopher Gauker’s conception of what a context is, Mion argues that knowledge is relative to the speakers’ conversational goals; and since the best way to achieve the goals of a conversation depends upon the way the world really is, it follows that participants in a conversation might be unaware (...) of the content of the context that truly governs their conversation. Finally, Mion uses objective contexts to explain why practical interests have epistemic significance. According to him, if we assume that the primary function of language is not to share thoughts, but to achieve practical goals, and, accordingly, that knowledge attributions play primarily an action-guiding role (as opposed to a mind-revealing role), then we are in a better position to understand why knowledge is not just a matter of theoretical factors, but it is also a matter of how much is at stake. (shrink)

La 4e de couverture indique : "Questo lavoro di Giovanni Scirocco è una delle prime ricerche storiche sull'opera di Norberto Bobbio che si avvale in modo siste- matico delle carte del suo archivio personale conservate presso il Centro Studi Piero Gobetti di Torino. Argomento dello studio è il giudizio sulla guerra giusta nelle varie fasi dell'itinerario politico e culturale del filosofo a partire dal 1961, quando Bobbio in colloquio con Günther Anders matura la convinzione che di fronte alla guerra (...) nucleare siamo tutti potenzialmente obiettori di coscienza, fino alle posizioni da lui assunte di fronte alla Guerra del Golfo nel 1991 e alla guerra "umanitaria" con la Serbia nel 1999. In poche agili ma dense pagine il lettore può seguire lo svolgersi nel tempo delle argomentazioni di Bobbio, illustrate con documenti d'archivio e corroborate da una scelta intelligente e felice di brani tratti dai principali saggi bobbiani sulla pace e la guerra: la prefazione al libro "Essere e non essere. Diario di Hiroshima e Nagasaki" di Anders, "Il conflitto termonucleare e le tradizionali giustificazioni della guerra", "Filosofia della guerra nell'era atomica", "Diritto e guerra", "Il problema della guerra e le vie della pace".". (shrink)

Emotions and personhood are important notions within the field of mental health care. How they are related is less evident. This book provides a framework for understanding the important and complex relationship between our emotional wellbeing and our sense of self, drawing on psychopathology, philosophy, and phenomenology.

How can we better understand and treat those suffering from schizophrenia and manic-depressive illnesses? This important new book takes us into the world of those suffering from such disorders. Using self descriptions, its emphasis is not on how mental health professionals view sufferers, but on how the patients themselves experience their disorder. A new volume in the International Perspectives in Philosophy and Psychiatry series, this book will be of great interest to all those working with sufferers from such disorders - (...) helping them to better understand their mental lives, and providing important insights into how best to treat them. (shrink)