Ethics consultation is a novel paradigm in European health-care institutions. In this paper, patient involvement in all clinical ethics activities is scrutinized. It is argued that patients should have access to case consultation services via clearly defined access paths. However, the right of both health-care professionals and patients indicates that patients should not always be notified of a consultation. Ethics education, another well-established function of an ethics committee, should equally be available for patients, lay people and hospital staff. Beyond access (...) and utilization, lay membership on a clinical ethics service is a matter of transparency, equal participation, empowerment and democratization. Lay and patient perspectives will contribute to the quality of ethics services on all levels from case consultations to ethics education and policy development. (shrink)

Gegenwärtig gibt es eine intensive internationale Diskussion zum Stellenwert der Sedierungsbehandlung am Lebensende. Auch in Deutschland sind der grundsätzliche Status und die medizinethische Bewertung palliativer bzw. terminaler Sedierung noch nicht ausreichend geklärt. Der vorliegende Beitrag stellt anhand der Analyse sechs möglicher klinischer Szenarien differenzierte Beispiele für die Situation von Patienten vor einer Sedierungsbehandlung dar. Dazu wird ein Vergleich mit Standardsituationen der Sterbehilfe vorgenommen. Für die moralische Bewertung werden Aktionen und Intentionen der Sedierungsformen unter besonderer Berücksichtigung von Aufklärung und Autonomie diskutiert. (...) Aus Perspektive einer klinisch orientierten Ethik sind eine differenzierte Entscheidungsanalyse, die Form informierter Zustimmung sowie der Ablauf der Sedierungs- und Ernährungsbehandlung von Bedeutung. Eine kritische Debatte zur moralischen Legitimität der Sedierung am Lebensende ist notwendig für die medizinethische Kultur ärztlicher Praxis. (shrink)

ZusammenfassungGegenwärtig gibt es eine intensive internationale Diskussion zum Stellenwert der Sedierungsbehandlung am Lebensende. Auch in Deutschland sind der grundsätzliche Status und die medizinethische Bewertung palliativer bzw. terminaler Sedierung noch nicht ausreichend geklärt. Der vorliegende Beitrag stellt anhand der Analyse sechs möglicher klinischer Szenarien differenzierte Beispiele für die Situation von Patienten vor einer Sedierungsbehandlung dar. Dazu wird ein Vergleich mit Standardsituationen der Sterbehilfe vorgenommen. Für die moralische Bewertung werden Aktionen und Intentionen der Sedierungsformen unter besonderer Berücksichtigung von Aufklärung und Autonomie diskutiert. (...) Aus Perspektive einer klinisch orientierten Ethik sind eine differenzierte Entscheidungsanalyse, die Form informierter Zustimmung sowie der Ablauf der Sedierungs- und Ernährungsbehandlung von Bedeutung. Eine kritische Debatte zur moralischen Legitimität der Sedierung am Lebensende ist notwendig für die medizinethische Kultur ärztlicher Praxis. (shrink)

Das deutsche Gesundheitswesen steht durch die schnell steigende Anzahl an CO- VID-19-Erkrankten vor erheblichen Herausforderungen. In dieser Krisensituation sind alle Beteiligten mit ethischen Fragen konfrontiert, beispielsweise nach gerech- ten Verteilungskriterien bei begrenzten Ressourcen und dem gesundheitlichen Schutz des Personals angesichts einer bisher nicht therapierbaren Erkrankung. Daher werden schon jetzt klinische und ambulante Ethikberatungsangebote verstärkt mit Anfragen nach Unterstützung konfrontiert. Wie können Ethikberater*innen Entscheidungen in der Krankenversorgung im Rahmen der COVID-19-Pandemie unterstützen? Welche Grenzen von Ethikberatung sind zu beachten? Bislang liegen hierzu (...) noch wenige praktische Erfahrungen vor. Angesichts der dynamischen Entwicklung erscheint es der Akademie für Ethik in der Medizin (AEM) wichtig, einen Diskurs über die angemessene Rolle der Ethikberatung bei der Bewältigung der vielfachen Heraus- forderungen durch die COVID-19-Pandemie zu führen und professionelle Hinweise zu geben. Mit dem vorliegenden Diskussionspapier möchte die AEM einen Beitrag zur Beantwortung wesentlicher Fragen leisten, die sich für die Ethikberatung in den verschiedenen Bereichen des Gesundheitswesens stellen. Sie regt an, diesen Dis- kurs weiter zu führen und hat ein Online-Forum (s. unten) eingerichtet, in dem Ethikberater*innen ihre Erfahrungen teilen und die professionelle Selbstreflexion der Ethikberatung in Pandemiezeiten mit Anregungen fördern können. (shrink)

Ausgehend von einem konstruktivistischen Kulturbegriff stellt sich die Frage, wie in konkreten ethischen Konflikten im Gesundheitswesen kulturelle Differenzen konstruiert und moralisch relevant werden. Ein Konzept, das diese intersubjektive Konstruktion von Differenz und die damit verbundenen moralisch relevanten Machtasymmetrien zu analysieren erlaubt, ist das Konzept des „Othering“. Einzelne Aspekte des Othering im Gesundheitswesen und die Frage seiner Reichweite werden diskutiert, insbesondere die Frage, wie sich moralisch problematische Formen des Othering zur anthropologischen Unvermeidbarkeit von Asymmetrien im Verhältnis des Selbst zum fremden Anderen (...) verhalten. Die Autoren benennen Strategien zur Vermeidung der moralisch fragwürdigen Aspekte von Othering. Diese Strategien beruhen auf der Fähigkeit zur kritischen Selbstreflexion der Wahrnehmung des Anderen und der Bewertung moralischer Positionen als basale ethische Kompetenzen. (shrink)

The Hannover qualifying programme ‘ethics consultation in hospitals’, conducted by a four-institution cooperation partnership, is an interdisciplinary, scientifically based programme for healthcare professionals interested in ethics consultation services and is widely acknowledged by hospital managements and healthcare professionals. It is unique concerning its content, scope and teaching format. With its basic and advanced modules it has provided training and education for 367 healthcare professionals with 570 participations since 2003 (until February 2010). One characteristic feature is its attractiveness for health professionals (...) from different backgrounds. Internationally, the Hannover programme is one of the few schedules with both academics and non-academics as target groups and a high participation rate of physicians. The concept of the Hannover programme is in great demand, and its schedule is continuously optimised through evaluation. The goals of enabling healthcare professionals from different professional backgrounds to define and reflect ethical problems, to facilitate and support the process of decision-making and to work out structures for their own institutions seem to have been achieved. However, in order to obtain effective and sustainable results, participation in the programme should be supplemented regularly by in-house training sessions or individual expert consultations. Future challenges include new thematic courses and providing a network for former participants, especially when they come from non-academic hospitals. The network is a reasonable platform to discuss participants' experiences, successes and pitfalls. A further task will be research on how the programme's concept can support the sustainability of ethics structures in the various institutions. (shrink)

Clinical ethics has developed significantly in Europe over the past 15 years and remains an evolving process. While sharing our experiences in different European settings, we were surprised to discover marked differences in our practice, especially regarding the position and role of patients. In this paper, we describe these differences, such as patient access to and participation or representation in ethics consults. We propose reasons to explain these differences, hypothesizing that they relate to the historic and sociocultural context of implementation (...) of clinical ethics consultation services (Cecs), as well as the initial aims for which each structure was established. Then, we analyse those differences with common ethical arguments arising in patient involvement. We conclude that there is no unique model of best practice for patient involvement in clinical ethics, as far as Cecs reflect on how to deal with the challenging ethical issues raised by patient role and position. (shrink)

Evaluation of clinical ethics support services (CESS) has attracted considerable interest in recent decades. However, few evaluation studies are explicit about normative presuppositions which underlie the goals and the research design of CESS evaluation. In this paper, we provide an account of normative premises of different approaches to CESS evaluation and argue that normativity should be a focus of considerations when designing and conducting evaluation research of CESS. In a first step, we present three different approaches to CESS evaluation from (...) published literature. Next to a brief sketch of the well-established approaches of ‘descriptive evaluation’ and ‘evaluation of outcomes’, we will give a more detailed description of a third approach to evaluation—‘reconstructing quality norms of CESS’—which is explicit about the normative presuppositions of its research (design). In the subsequent section, we will analyse the normative premises of each of the three approaches to CESS evaluation. We will conclude with a brief argument for more sensitivity towards the normativity of CESS and its evaluation research. (shrink)

Standard views of good death in human and veterinary medicine considerably differ from one another. Whereas the good death ideal in palliative medicine emphasizes the positive aspects of non-induced dying, veterinarians typically promote a quick and painless killing with the aim to end suffering. Recent developments suggest a convergence of both professions and professional attitudes, however. Palliative physicians are confronted with patients wishing to be ‘put to sleep’, while veterinarians have begun to integrate principles and practices from hospice care. We (...) will argue that the discourses on good human and animal deaths are not distinct, but that they interact and influence each other. On the one hand, veterinary medicine adapts techniques like chemotherapy or sedation from palliative end-of-life care. On the other hand, philosophers, veterinarians, pet owners, patients and the general public alike make certain assumptions about the analogy of human and animal dying or killing. Unfortunately, these interactions have only scarcely been reflected normatively, especially on the part of human medicine. Conflicts and misattributions with potential serious negative consequences for the patients’ wellbeing are provoked. For these reasons, palliative physicians and veterinarians are invited to engage in the debate around human and animal end-of-life care. (shrink)

The interdisciplinary Hannover Qualification Programme on ethics consultation has trained hospital staff to operate clinical ethics services in their respective hospitals since 2003. To evaluate Hannover Qualification Programme, all former participants were contacted using an online questionnaire including four domains: status quo before attending Hannover Qualification Programme, present status, impact of Hannover Qualification Programme, future challenges. Research objectives were the long-term satisfaction with Hannover Qualification Programme and its impact on clinical ethics services. The response rate was 45%. Hannover Qualification Programme (...) was evaluated as helpful and the responders were capable of applying their acquired skills. Most participants could contribute to the implementation of clinical ethics services. They were satisfied with Hannover Qualification Programme and with the degree of changes in their hospitals. In conclusion, clinical ethics education had long-term effects on trainees and on their respective hospitals. Problems were mentioned rather in the field of utilisation than with implementation or quality of clinical ethics services. (shrink)

Die Notwendigkeit guter Arzt-Patienten-Kommunikation für eine angemessene Behandlung und für die Ausübung der Patientenselbstbestimmung ist bekannt. In interkulturell-mehrsprachigen Situationen, in denen ein kommunikationsintensiver Aushandlungsprozess besonders notwendig ist, erhält die Qualität der Verständigung besondere Bedeutung, so dass der Einsatz qualifizierter Dolmetschender hier ethisch geboten ist. Er stellt Ärzte und Ärztinnen, aber auch die Dolmetschenden vor besondere, ethisch zu reflektierende Herausforderungen. Sind zudem keine qualifizierten Dolmetschenden einsetzbar, müssen Ärzte und Ärztinnen in schwierigen ethischen Abwägungsprozessen eine Entscheidung über das weitere Vorgehen treffen. Diese (...) beiden Themen finden in der medizinethischen Literatur bisher wenig Beachtung. Anhand von Erkenntnissen aus der Forschung u. a. zum Gesprächsdolmetschen werden im Folgenden zentrale ethische Herausforderungen eines Dolmetschereinsatzes herausgearbeitet. Diskutiert werden der Bedarf sprachlicher Unterstützung, der drohende Ausschluss von Patientinnen und Patienten in gedolmetschten Gesprächen, die Beachtung der für das Dolmetschen geltenden berufsethischen Prinzipien, die Gewährleistung der Vertraulichkeit sowie die Konsequenzen interkulturellen Vermittelns. Des Weiteren wird für Ärzte und Ärztinnen, die unter nicht-idealen Bedingungen ohne qualifizierte Dolmetschende agieren müssen, erstmals ein strukturierter argumentativer Rahmen vorgestellt. Es werden neun Bewertungskriterien vorgeschlagen, anhand derer in einem Abwägungsprozess über die Eignung einer Person zum (spontanen) Dolmetschen entschieden werden kann. (shrink)

Preface -- Prolegomenon : Hayek's three unsettling theses -- Beyond human nature -- Beyond moral justification -- Beyond human governance -- Three enquiries on the open society -- The rise of a normative species -- A natural history of moral order -- The "starting point" -- The egalitarian revolution -- Self-interest, reciprocity and altruism -- Internalized, enforced, social rules -- The other side of morality -- Cultural evolution -- Part I : the rise and fall of inequality -- A complex (...) moral species -- The diversity and self-organized complexity -- Liberalism and the open society -- Understanding diversity -- Autocatalytic diversity -- Diversity and complexity -- Too much complexity? -- The morality of self-organization -- The social contract -- A self-organization model -- Moral diversity In the open society -- Part II: the complexities of self-governance -- Self-governance -- Macro control -- Macro structure -- Strategic dilemmas and polycentricity -- Meso-level goal pursuit -- Sectoral policy -- Self-governance from the bottom-up : simplifying the problems of governance -- Our moral nature and governance in the open society -- Liberal democracy -- Epilogue -- Appendix A -- Appendix B. (shrink)

Nicolai Hartmann hat philosophische Studien zur Erkenntnistheorie, Ontologie, Ethik, Philosophie des Geistes und Naturphilosophie geschrieben. Die Beiträge des Bandes gehen davon aus, dass seine Arbeit auf all diesen Feldern im Zeichen der Verabschiedung der Systemphilosophie sowie der Begründung einer Konzeption systematischen Philosophierens steht. Im Zentrum von Hartmanns Denken steht das "Kategorienproblem", d. i. die Frage nach den elementaren Strukturen der Wirklichkeit und der menschlichen Erkenntnis. In seinem Bezug auf die philosophische Tradition und seiner Hinwendung zu den Natur- und Sozialwissenschaften unter (...) Einbeziehung auch der alltäglichen Erfahrung macht Hartmann deutlich, dass er an dem Anspruch festhält, die Phänomene der Lebenswelt, Wissenschaft und Geschichte in einem einheitlichen "Aufbau der realen Welt" zu integrieren, ohne ihre Heterogenität und Selbständigkeit zu leugnen. Die Beiträge konzentrieren sich daher auf das Konzept einer "Neuen Ontologie", das Programm der "Kategorienforschung", den Wissenschaftsbezug von Hartmanns Denken, dessen Relevanz für die philosophische Anthropologie und die Problematik des geistigen Seins, der Freiheit sowie der Geschichte. (shrink)

This book, originally published in 1987, considers how the science of linguistics creates its own objects of study. It argues that language is the one essential tool in the ¿social construction of reality¿ ¿ the way in which our environment as we perceive and respond to it is actually created by the cultural constructs we bring to bear on it ¿ and that it is also the means by which this reality, once constructed, is preserved and transmitted from person to (...) person and from generation to generation. Hence it is entirely appropriate to refer to the linguistic construction of reality. (shrink)

In public debates over biotechnology, theologians, philosophers, and political theorists have proposed that biotechnology could have significant implications for human nature. They argue that ethical evaluations of biotechnologies that might affect human nature must take these implications into account. In this book, Gerald McKenny examines these important yet controversial arguments, which have in turn been criticized by many moral philosophers and professional bioethicists. He argues that Christian ethics is, in principle, committed to some version of the claim that human (...) nature has normative status in relation to biotechnology. Showing how both criticisms and defences of this claim have often been facile, he identifies, develops, and critically evaluates three versions of the claim, and contributes a fourth, distinctively Christian version to the debate. Focusing on Christian ethics in conversation with secular ethics, McKenny's book is the first thorough analysis of a controversial contemporary issue. (shrink)

A theory is presented to explain how accurate, single-joint movements are controlled. The theory applies to movements across different distances, with different inertial loads, toward targets of different widths over a wide range of experimentally manipulated velocities. The theory is based on three propositions. (1) Movements are planned according to “strategies” of which there are at least two: a speed-insensitive (SI) and a speed-sensitive (SS) one. (2) These strategies can be equated with sets of rules for performing diverse movement tasks. (...) The choice between SI and SS depends on whether movement speed and/or movement time (and hence appropriate muscle forces) must be constrained to meet task requirements. (3) The electromyogram can be interpreted as a low-pass filtered version of the controlling signal to the motoneuron pools. This controlling signal can be modelled as a rectangular excitation pulse in which modulation occurs in either pulse amplitude or pulse width. Movements to different distances and with loads are controlled by the SI strategy, which modulates pulse width. Movements in which speed must be explicitly regulated are controlled by the SS strategy, which modulates pulse amplitude. The distinction between the two movement strategies reconciles many apparent conflicts in the motor control literature. (shrink)

Identity: The Necessity of a Modern Idea is the first comprehensive history of the concept that answers the question, "who, or what, am I?" Gerald Izenberg contends that our most important identities, while historically conditioned, are rooted in permanent categories of human existence, such as sexuality, sociality, and labor.

In this diverting collection of essays, Gerald Weissmann looks back at the past few decades of his long career working at the intersection of the arts and sciences. The Fevers of Reason features some of his best and most representative works, alongside eleven new essays that have never before been published in book form. Masterfully drawing from an array of subject areas and time periods, he tackles everything from Ebola to Eisenhower, Zika to Zola, Darwin to Dawkins, and once (...) again shows that he is one of the most important voices in humanistic science writing today. (shrink)

Up-to-date and comprehensive, this practical best seller provides students with the basis for discovering their own guidelines for helping within the broad limits of professional codes of ethics and divergent theoretical positions. Respected authors Gerald Corey, Marianne Corey, and Cindy Corey raise what they consider to be central issues, present a range of diverse views on the issues, discuss their position, and provide opportunities for students to refine their thinking and develop an informed position. With new material in every (...) chapter and an emphasis on critical thinking, ISSUES AND ETHICS IN THE HELPING PROFESSIONS, 10th Edition, is useful for students as well as practicing professionals. This edition features MindTap®, the digital learning solution that helps instructors engage and transform today's students into critical thinkers and successful helpers. (shrink)