Originally presented as the author's thesis under the title: "Individualisierung" als soziologisches und sozialethisches "Zeichen der Zeit"- eine sozialethische Auseinandersetzung...

ZusammenfassungEin gelungenes Arzt-Patient-Verhältnis, das auf gegenseitigem Vertrauen und ärztlicher Verantwortung basiert, ist ein zentraler Bestandteil des Ideals der ärztlichen Profession. Aktuell wird vielfach von einem neuen „ökonomischen Paradigma“ in der Medizin gesprochen, das dieses Verhältnis vermeintlich unterminiert. Als ein wichtiges Merkmal dieses Paradigmas gilt das Verständnis vom Patienten als Kunden, der charakterisiert ist durch seine Selbstbestimmung bzw. Autonomie. Wie stellt sich die Kundenrolle nun aber bei vulnerablen Patientengruppen dar, die in ihrer Autonomie eingeschränkt sind, und was bedeutet dies wiederum für (...) das Arzt-Patient-Verhältnis? In dem vorliegenden Artikel wollen wir deshalb die Fragestellung verfolgen, ob sich ärztliche Verantwortung bzw. das Arzt-Patient-Verhältnis ändert, wenn sich der (vulnerable) Patient als Kunde begreift. Als Analysesetting dient die Palliativmedizin, da sie als Beispiel für eine besonders vulnerable Patientengruppe gelten kann. Als Basis der Argumentation werden die Ergebnisse einer qualitativen Studie herangezogen, welche die Einstellungen von Palliativpatienten zum Thema „der Patient als Kunde“ erhob sowie der Frage nachging, ob sich Palliativpatienten, speziell im Rahmen von medizinischen Entscheidungen, als selbstbestimmt begreifen. Die Studienergebnisse zeigen, dass Autonomie relational verstanden werden muss und dem Arzt eine entscheidende Rolle in der Ermöglichung von Patientenselbstbestimmung zukommt – ganz unabhängig von der Selbstattribuierung der Befragten als Kunde oder Patient. Anschließend werden diese Ergebnisse dahingehend analysiert, ob sie als Ausdruck einer Veränderung des Arzt-Patient-Verhältnisses und der ärztlichen Verantwortung gegenüber den Patienten zu werten sind. Hieraus folgernd wird nach den praktischen Implikationen für das Arzt-Patient-Verhältnis auf der Grundlage der „Ethics of Care“ gefragt sowie auf die individuelle Betreuungsnotwendigkeit, speziell von vulnerablen Patientengruppen, verwiesen. (shrink)

Ein gelungenes Arzt-Patient-Verhältnis, das auf gegenseitigem Vertrauen und ärztlicher Verantwortung basiert, ist ein zentraler Bestandteil des Ideals der ärztlichen Profession. Aktuell wird vielfach von einem neuen „ökonomischen Paradigma“ in der Medizin gesprochen, das dieses Verhältnis vermeintlich unterminiert. Als ein wichtiges Merkmal dieses Paradigmas gilt das Verständnis vom Patienten als Kunden, der charakterisiert ist durch seine Selbstbestimmung bzw. Autonomie. Wie stellt sich die Kundenrolle nun aber bei vulnerablen Patientengruppen dar, die in ihrer Autonomie eingeschränkt sind, und was bedeutet dies wiederum für (...) das Arzt-Patient-Verhältnis? In dem vorliegenden Artikel wollen wir deshalb die Fragestellung verfolgen, ob sich ärztliche Verantwortung bzw. das Arzt-Patient-Verhältnis ändert, wenn sich der (vulnerable) Patient als Kunde begreift. Als Analysesetting dient die Palliativmedizin, da sie als Beispiel für eine besonders vulnerable Patientengruppe gelten kann. Als Basis der Argumentation werden die Ergebnisse einer qualitativen Studie herangezogen, welche die Einstellungen von Palliativpatienten zum Thema „der Patient als Kunde“ erhob sowie der Frage nachging, ob sich Palliativpatienten, speziell im Rahmen von medizinischen Entscheidungen, als selbstbestimmt begreifen. Die Studienergebnisse zeigen, dass Autonomie relational verstanden werden muss und dem Arzt eine entscheidende Rolle in der Ermöglichung von Patientenselbstbestimmung zukommt – ganz unabhängig von der Selbstattribuierung der Befragten als Kunde oder Patient. Anschließend werden diese Ergebnisse dahingehend analysiert, ob sie als Ausdruck einer Veränderung des Arzt-Patient-Verhältnisses und der ärztlichen Verantwortung gegenüber den Patienten zu werten sind. Hieraus folgernd wird nach den praktischen Implikationen für das Arzt-Patient-Verhältnis auf der Grundlage der „Ethics of Care“ gefragt sowie auf die individuelle Betreuungsnotwendigkeit, speziell von vulnerablen Patientengruppen, verwiesen. (shrink)

Research involving transgender and gender diverse people (TGD) increased in the last years, mostly concerning healthcare associated to this population. Few studies dedicated their analysis to the impact of parental support on transgender people, even though this is an important aspect in creating a safe environment on which these individuals can build their identity. In addition, the link between family support, TGD identity and homelessness is not completely established. Thus, due to the specificities of the family context of TGD individuals, (...) the aim of this study is to investigate the association between family support and TGD in different moments of the process of gender affirmation. In addition, this study also aims to explore the relationship between a lack of social support and low self-esteem, home abandonment, and dwelling in the street. The survey was designed based on the TransPULSE project and was made available in electronic format. The sample was constituted of 423 TGD residents in two Brazilian states. A Structural Equation Model analysis suggested that the impact of gender affirmation status on homelessness was mediated by parental support, through self-esteem, and the need to move from home. The association between the status of the gender affirmation procedures, family support and self-esteem was significant and indicated that the further TGD individuals advanced in gender affirmation, the more self-esteem and family support they would have. The association between family support and self-esteem indicated that family support was associated with higher self-esteem. Low family support was associated with the willingness to move from home due to one’s TGD status and there was also a significant correlation between low self-esteem and the willingness to move from home due to one’s TGD status. Finally, homelessness was associated with the willingness to move with a large effect size. Limitations include the sample that was constituted by individuals with Internet access and who had more contact with TGD communities. The findings indicate directions for interventions involving TGD people and their families, considering the parental relationship as a critical variable to improve TGD quality of life in the process of gender affirmation. (shrink)

In the article the parameters of the crime novel and crime story that were used by the postwar German novel of the investigation were highlighted and analyzed. The transformation of the range of problems of criminal literature in the new conditions is showed on the material of such works as ‘Aula‘ Kant, ‘Der Fall d’Arthez‘ G.-E. Nossack ‘Buridan’s ass‘ G. de Breun, ‘Gruppenbild mit Dame‘ G. Boell, ‘Black ass‘ L. Rinzer et al. It is demonstrated which formal elements that organize (...) the system of images, time-space and the intersection of ‘voice streams‘, the texts succeed from the twentieth-century enlightenment ‘postpitaval’s‘ prose. Traditions of Schiller, Goethe and others expressed through the ideological setting of the novel of the investigation, the duality of its structure and the relationship of narrative plans. The narrators of investigation novel work for underlining their detachment; they are out of the events and cherish their independence. Masks and aliases are actively used with the view of creating of the effect of ‘non-presence‘. Authors play with the grammatical forms: I am - you are - he is. Therefore, the novel of investigation adopts the social agenda and coherence with the historical period from the tradition of a criminal novel. Ethical measures used by narrators to evaluate the events described are succeeded from tradition as well. Some elements, which stay relevant, are used as productive. (shrink)

Farming of fish and other aquatic species has increased in recent decades and never before have there been more controversial debates on animal welfare in fish husbandry. The practices used and associated welfare issues are becoming increasingly focused on by scientists, consumers and policy makers. International and national organisations have issued recommendations and guidelines concerning fish welfare but there is still a lot of information lacking. Due to § 2 of the German animal protection law, animals must be adequately nourished, (...) cared for and behaved in a proper manner, and pain or avoidable suffering or damage must be avoided. Keeping fish in accordance with the animal protection laws should be part of a good professional aquaculture practice and is indispensable for ethical, legal and economic reasons. As other vertebrates fish have the right of a healthy life with physical and mental integrity, under which they can perform adequately.The paper provides and discusses legal aspects of animal protection applied to fish taking the German welfare act and EU regulations as example. First possible indicators for the assessment of well-being will be mentioned. The assessment of fish welfare indicators should be carried out within the frame of daily and regular working routines, e. g. feeding, harvesting, grading or slaughtering. Further customer’s perception and human interpretation of welfare in fish are discussed and set into the context of human sentiments, projected on fish and the debate on consciousness in fish. (shrink)

The Dutch Republic had a broad range of means to establish an individual's identity, and a rudimentary ‘system’ of identity registration, essentially established at the local levels of town and parish. This chapter seeks to provide a description of the ways in which the Dutch established an individual's identity. The various registration methods covered almost the entire population of the Dutch Republic at some stage in their life, and it is argued that on balance identity registration in the Dutch Republic (...) was fairly successful. The chapter contends that the degree to which identity was registered and monitored in the early modern era in the Netherlands, while certainly not wholly effective, is remarkable given the absence of a centralized state and the lack of a large bureaucracy. (shrink)

The contribution of action-perception systems of the brain to lexical semantics remains controversial. Here, we used high-definition transcranial direct current stimulation (HD-tDCS) in healthy adults to examine the role of primary (left hand motor area; HMA) and higher-order (left anterior inferior parietal lobe; aIPL) action areas in action-related word processing (action verbs and manipulable nouns) compared to non-action-related control words (non-action verbs and non-manipulable nouns). We investigated stimulation-related effects at three levels of semantic processing: subliminal, implicit, and explicit. Broadly, we (...) found that stimulation of HMA and aIPL resulted in relative facilitation of action-related language processing compared to non-action. HMA stimulation facilitated action verb processing in subliminal and implicit task contexts, suggesting that HMA helps represent action verbs even in semantically shallow tasks. HMA stimulation also facilitated manipulable noun comprehension in an explicit semantic task, suggesting that HMA contributes to manipulable noun comprehension when semantic demands are high. aIPL stimulation facilitated both manipulable noun and action verb processing during an implicit task. We suggest that both HMA and aIPL play a functional role in action semantics. HMA plays a general role in the semantics of actions and manipulable objects, while aIPL is important only when visuo-motor coordination is required for the action. (shrink)

The exciting world of HD video is in your hands Your Canon VIXIA HD camcorder delivers crisp video and still images with eye-catching, brilliant colors, enabling you to create amazing video works of art. To help you get all that your camcorder has to offer, this convenient, portable guide shows you how to use the various modes, settings, and features, but that's not all. It also provides an overview of videography fundamentals, then takes you into the field with advice on (...) using sound and light to their best advantage, editing your footage, choosing useful accessories, and more. Master the settings for VIXIA HD camcorder models HF10, HF11, HF100, HG10, HG20, and HG21, as well as HV20, HV30, and HR10. Experiment with exposure settings, white balance, image effects, zoom speed, and audio recording levels Learn more about developing a story, manipulating depth of field, composing shots, and protecting yourself with releases Transfer and edit your footage with iMovie® '09 or Pixela ImageMixer. (shrink)

Executive functions are of vital importance in the process of active cognition, which is thought to be associated with the dorsolateral prefrontal cortex. As a valid brain stimulation technology, high-definition transcranial direct current stimulation has been used to optimize cognitive function in healthy adults. Substantial evidence indicates that short-term or single anodal tDCS sessions over the left DLPFC will enhance the performance of executive functions. However, the changes in performance and cortical activation of executive functions after modulation by repeated anodal (...) HD-tDCS is as yet unexplored. This study aims to examine changes in three core components of executive functions produced by nine HD-tDCS sessions, and to use functional near-infrared spectroscopy to bilaterally record DLPFC neural activity. A total of 43 participants were divided randomly into two study groups to complete nine interventions. Our results demonstrate that the enhancement of cognitive flexibility in the anodal group was significantly better than that in the sham group. Additionally, a Stroop effect-related decrease in oxygenated hemoglobin concentration in the DLPFC was observed in the anodal group but not the sham group. In conclusion, our study found that repeated anodal HD-tDCS sessions can significantly promote cognitive flexibility, one of the core components of executive function, and that alterations in DLPFC activation can enhance our understanding of the neuroplastic modifications modulated by HD-tDCS. (shrink)

High-definition transcranial direct current stimulation is a valid brain stimulation technology to optimize cognitive function. Recent evidence indicates that single anodal tDCS session enhances attention; however, the variation in attention produced by repeated anodal HD-tDCS over a longer period of time has not been explored. We examined the modulation of attention function in healthy young participants who received repeated HD-tDCS sustained for 4 weeks. The results showed a robust benefit of anodal HD-tDCS on executive control and psychomotor efficiency, but not (...) on orienting, alerting, or selective attention ; the benefit increased successively over 4 weeks; and the enhancement on executive control of each week was significant compared to baseline in the anodal group. In addition, the subjects’ performances on the test of executive control and psychomotor efficiency gradually restored to the initial level in the sham group, which appeared obviously from week 3, but the improvement of attention in the anodal group was persistent. We conclude that repeated anodal HD-tDCS provides a positive benefit on executive control and psychomotor efficiency and has obvious accumulative effect after 9 or more times intervention compared to sham HD-tDCS. Additionally, our findings might provide pivotal guidance for the formulation of a strategy for the use of repeated anodal HD-tDCS to modulate on attention function. (shrink)