In everyday conversations, professional codes, policy debates, and academic literature, the concept of respect is referred to frequently. Bioethical arguments in recent decades equate the idea of respect for persons with individuals who are capable of autonomous decision-making, with the focus being explicitly on ‘autonomy,’ ‘capacity,’ or ‘capability.’ In much of bioethics literature, respect for persons is replaced by respect for autonomy. Though the unconditional respect for persons and their autonomy (irrespective of actual decision-making capacity) is established in Kantian bioethics, (...) current argument and debates often revolve around a thin concept of autonomy, focusing on capacity and capability: persons are owed respect because they are ‘rational beings’ or with a focus on ‘agency’ and ‘decision-making abilities.’ However, these aspects alone are insufficient while engaging the concept of respect for persons, particularly in healthcare settings. This paper sets out to explore if the concept of respect for persons—as opposed to a thin concept of autonomy—could help us engage better in healthcare practices. We shall probe the practical value of the experiential aspect of respect—understood as the recognition of persons as respect-worthy through certain dispositions and deliberative acts—by reflecting on instances in clinical practice that tend to be dismissed as negligible or even unavoidable in a stressful environment such as a busy hospital. We shall argue that these instances are far from trivial but carry moral significance and express an unacceptable—disrespectful—attitude that can compromise the moral habitus in hospital settings. In our conclusion, we call for practicing recognition respect in the health professional–patient encounter by focussing on manners, attitudes, and behaviors. Furthermore, we call for continuous medical ethics education programs to address the moral significance of disrespectful behaviors and their manifestations in particular socio-cultural contexts. (shrink)

Name der Zeitschrift: Deutsche Zeitschrift für Philosophie Jahrgang: 64 Heft: 6 Seiten: 951-977.

Living organ donation has developed into an important therapeutic option in transplantation medicine. However, there are some medico-ethical problems that come along with the increasing reliance on this organ source. One of these concerns is based on the observation that many more women than men function as living organ donors. Whereas discrimination and differential access have been extensively discussed in the context of cadaveric transplantation and other areas of health care, the issue of gender imbalance in living organ donation has (...) received less attention. This paper presents relevant data from the Eurotransplant and UNOS transplantation systems and discusses possible explanations for the documented gender discrepancies. The conclusion calls for are view of existing practice guidelines in order to secure effective protection of particularly vulnerable potential donors and an equitable donor-recipient-ratio in living organ donation. (shrink)

Transplanting organs from emotionally related donors has become a fairly routine procedure in many countries. However, donors have to be chosen carefully in order to avoid not just medically, but also morally, questionable outcomes. This paper draws attention to vulnerabilities that may affect the voluntariness of the donor's decision. Suggestions are made as to how to approach the evaluation and selection of potential donors.

Nanomedicine plays a prominent role among emerging technologies. The spectrum of potential applications is as broad as it is promising. It includes the use of nanoparticles and nanodevices for diagnostics, targeted drug delivery in the human body, the production of new therapeutic materials as well as nanorobots or nanoprotheses. Funding agencies are investing large sums in the development of this area, among them the European Commission, which has launched a large network for life-sciences related nanotechnology. At the same time government (...) agencies as well as the private sector are putting forward reports of working groups that have looked into the promises and risks of these developments. This paper will begin with an introduction to the central ethical themes as identified by selected reports from Europe and beyond. In a next step, it will analyse the most frequently invoked ethical concerns–risk assessment and management, the issues of human identity and enhancement, possible implications for civil liberties (e.g. nanodevices that might be used for covert surveillance), and concerns about equity and fair access. Although it seems that the main ethical issues are not unique to nanotechnologies, the conclusion will argue against shrugging them off as non-specific items that have been considered before in the context of other biomedical technologies, such as gene therapy or xenotransplantation. Rather, the paper will call on ethicists to help foster a rational, fair and participatory discourse on the different potential applications of nanotechnologies in medicine, which can form the basis for informed and responsible societal and political decisions. (shrink)

Artificial intelligence (AI) systems are increasingly being used in healthcare, thanks to the high level of performance that these systems have proven to deliver. So far, clinical applications have focused on diagnosis and on prediction of outcomes. It is less clear in what way AI can or should support complex clinical decisions that crucially depend on patient preferences. In this paper, we focus on the ethical questions arising from the design, development and deployment of AI systems to support decision-making around (...) cardiopulmonary resuscitation and the determination of a patient’s Do Not Attempt to Resuscitate status (also known as code status). The COVID-19 pandemic has made us keenly aware of the difficulties physicians encounter when they have to act quickly in stressful situations without knowing what their patient would have wanted. We discuss the results of an interview study conducted with healthcare professionals in a university hospital aimed at understanding the status quo of resuscitation decision processes while exploring a potential role for AI systems in decision-making around code status. Our data suggest that (1) current practices are fraught with challenges such as insufficient knowledge regarding patient preferences, time pressure and personal bias guiding care considerations and (2) there is considerable openness among clinicians to consider the use of AI-based decision support. We suggest a model for how AI can contribute to improve decision-making around resuscitation and propose a set of ethically relevant preconditions—conceptual, methodological and procedural—that need to be considered in further development and implementation efforts. (shrink)

Name der Zeitschrift: Byzantinische Zeitschrift Jahrgang: 112 Heft: 1 Seiten: 243-246.

Name der Zeitschrift: Klio Jahrgang: 96 Heft: 1 Seiten: 337-346.

Extended Reality (XR) systems, such as Virtual Reality (VR) and Augmented Reality (AR), provide a digital simulation either of a complete environment, or of particular objects within the real world. Today, XR is used in a wide variety of settings, including gaming, design, engineering, and the military. In addition, XR has been introduced into psychology, cognitive sciences and biomedicine for both basic research as well as diagnosing or treating neurological and psychiatric disorders. In the context of XR, the simulated ‘reality’ (...) can be controlled and people may safely learn to cope with their feelings and behavior. XR also enables to simulate environments that cannot easily be accessed or created otherwise. Therefore, Extended Reality systems are thought to be a promising tool in the resocialization of criminal offenders, more specifically for purposes of risk assessment and treatment of forensic patients. Employing XR in forensic settings raises ethical and legal intricacies which are not raised in case of most other healthcare applications. Whereas a variety of normative issues of XR have been discussed in the context of medicine and consumer usage, the debate on XR in forensic settings is, as yet, straggling. By discussing two general arguments in favor of employing XR in criminal justice, and two arguments calling for caution in this regard, the present paper aims to broaden the current ethical and legal debate on XR applications to their use in the resocialization of criminal offenders, mainly focusing on forensic patients. (shrink)

Matters of hospital management do not figure prominently on the medical ethics agenda. However, management decisions that have to be taken in the area of hospital care are in fact riddled with ethical questions and do have significant impact on patients, staff members, and the community being served. In this decision making process evidence based medicine plays an increasingly important role as a tool for rationalising as well as rationing health care resources. In this article, ethical issues of hospital management (...) and the role of EBM will be explored, with particular reference to disease management programs, diagnosis related groups, and clinical pathways as recent developments in the German health care system. (shrink)

Bd. 1. Absenz-Darstellung -- Bd. 2. Dekadent-Grotesk -- Bd. 3. Harmonie-Material -- Bd. 4. Medien-Popular -- Bd. 5. Postmoderne-Synästhesie -- Bd. 6. Tanz-Zeitalter/Epoche -- Bd. 7. Register und Supplemente.

Artificial intelligence has found its way into many areas of human life, serving a range of purposes. Sometimes AI tools are designed to help humans eliminate high-volume, tedious, routine tas...

In lieu of an abstract, here is a brief excerpt of the content:Three Moments in the Crisis of Exemplarity: Boccaccio-Petrarch, Montaigne, and CervantesKarlheinz StierleIn his recent book History as Topic Peter von Moos denies that there was any crisis for the exemplum in the Renaissance. 1 He strongly argues against my essay on “History as exemplum,” where I pointed out that in Montaigne, as earlier in Boccaccio, the pragmatic form of exemplum is put into question. 2 My main interest in (...) this essay, however, was not to mark a break between Middle Ages and Renaissance but to understand the way in which the correlation between sententia and exemplum was transformed into a more complex relation between moral reflection and particular case. Undoubtedly, since Valerius Maximus and his Factorum et dictorum memorabilium libri, there has always been, as in John of Salisbury’s Policratius, the possibility of questioning the exemplary truth of the exemplum by opposing it to a never-ending wealth of counter-examples. This, however, never puts into question the idea of exemplarity itself. The validity of the exemplum as a rhetorical form of narration that tends towards its own conceptual or ideological structure has an anthropological basis. It presupposes that over time, there is more analogy in human experience than diversity, or that in all situations of civil and political life the pole of equality is stronger than that of difference.Boccaccio’s novella is precisely the narrative form that puts this anthropological basis into question. Each novella in the Decameron is essentially a [End Page 581] particular variant of a more general conceptual scheme. The stress of narration, however, is not on the scheme itself but on the autonomy of the variant. Basically the novella is a form of rewriting in the mode of retelling, thus bringing an elementary narration to higher complexity. 3 Each of the “vari casi,” mostly of love-affairs, is a confrontation of exemplarity and contingency. It is the power of contingency or fortuna that brings forth the specific particularity of each novella. The art of the writer Boccaccio, whose primary fiction is oral story-telling, consists in giving aesthetic evidence to this particularity. Reading, not listening, is the form of reception that corresponds to this structure. That Boccaccio adds the other title “Il Prencipe Galeotto” to the Decameron is an allusion to Dante’s Divine Commedy where in the famous episode of Paolo and Francesca (Inf. V), Galeotto becomes the personification of the allegory of reading and its seduction.Contingency, or, in Boccaccio’s own medieval terms, fortuna, is the real poet of the novella. That is why the most important scenes of the novellas are those where the power of contingency comes to light: at the sea and in the city. The particular shape of novella, which results from a balance between contingency and significant configuration, emerges from contingency itself. Its configuration is a particular case of contingency, one that by its immanent structural elegance is aesthetically gratifying. It nevertheless leaves open the question whether there might not be a power of a superior kind behind contingency. Because there is an ambiguity between contingency and sense, the exemplary status of each story is, ironically, placed in question. Contingency overcomes exemplarity; however, it never triumphs definitely. The impact on the exemplum by contingency not only gives to each narrative case its difference or even autonomy, it also opens up a new temporal dimension. The exemplum seems to move in an essential time where all time-aspects are controlled and functionalized by a dominating conceptual structure. In the novella time becomes a primary structure. “Or avviene che” is the narrative formula for this new quality of narrative time, becoming a time of disruption and instability where things and situations may change in a moment for the better or for the worse.I would like to illustrate the structure of the Boccaccian novella by at least one exemplary case. Almost in the middle of the book—which means in the middle of its temporal space of ten days—we find the novella of Federigo degli Alberighi, considered to be one of Boccaccio’s finest (V, 9). Federigo, in a world of merchants and trade, is the perfect nobleman who ruins himself by his... (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 book is a short, up-to-date survey of the science and technology of photography. Modern photographic chemistry and physics is highlighted with emphasis given to current photographic processes and the structure of photographic materials. All technical professionals in the field of photography will find this book of enormous value as it is unique in its concise, detailed presentation of the subject.

Die Welt, in der wir leben, andert sich rasant. Doch nicht nur sie, sondern auch die Religionen, die Gottesvorstellungen. Nach christlicher Vorstellung ist Gott selbst in die Dynamik der Welt verstrickt. Gerade die Prozesstheologie macht Gott im Fluss der Zeit denkbar. Welches ware der Gott, den wir brauchen? Welche Konsequenzen haben mogliche Antworten fur Religion und Politik, Okonomie und Okologie, Gesellschaft und Kultur? Diesen Fragen geht der Band nach.

Further discussion of the ongoing human cloning debate.In the late 1990s cloning was still the subject of passionate debate. While philosophers were crossing swords about the implications of the “Dolly technique” for the meaning of human identity, sweeping declarations were made by major international bodies such as the World Medical Association, UNESCO, and the World Health Organization that unanimously condemned human reproductive cloning as ethically unacceptable and/or contrary to human dignity. By now, the topic elicits a mere frown, sneer, sigh, (...) or yawn from most bioethicists, depending on their temperament or mood. The same may hold true for those delegates at the United Nations who sat through many sessions that included the ominous agenda item entitled “international convention against reproductive cloning of human beings”.Human cloning became an issue at the United Nations when the item was introduced at the request of France and Germany in 2001. The two countries limited their proposal to reproductive cloning. This move, although aiming quite reasonably at the formulation of a minimal consensus among member states, got at least Germany into some trouble at home, as critical voices from different parts of the political spectrum argued that Germany should rather pursue a comprehensive ban on human cloning for any purpose, which would be more in accordance with its own national …. (shrink)

This volume gives an overview on the currently debated ethical issues regarding advance directives from an international perspective. It focuses on a wider understanding of the known and widely accepted concept of patient self-determination for future situations. Although advance directives have been widely discussed since the 1980s, the ethical bases of advance directives still remain a matter of heated debates. The book aims to contribute to these controversial debates by integrating fundamental ethical issues on advance directives with practical matters of (...) their implementation. Cultural, national and professional differences in how advance directives are understood by health care professions and by patients, as well as in laws and regulations, are pinpointed. (shrink)

Artificial intelligence (AI) systems are quickly gaining ground in healthcare and clinical decision-making. However, it is still unclear in what way AI can or should support decision-making that is based on incapacitated patients’ values and goals of care, which often requires input from clinicians and loved ones. Although the use of algorithms to predict patients’ most likely preferred treatment has been discussed in the medical ethics literature, no example has been realised in clinical practice. This is due, arguably, to the (...) lack of a structured approach to the epistemological, ethical and pragmatic challenges arising from the design and use of such algorithms. The present paper offers a new perspective on the problem by suggesting that preference predicting AIs be viewed as sociotechnical systems with distinctive life-cycles. We explore how both known and novel challenges map onto the different stages of development, highlighting interdisciplinary strategies for their resolution. (shrink)

Free and informed consent is generally acknowledged as the legal andethical basis for living organ donation, but assessments of livingdonors are not always an easy matter. Sometimes it is necessary toinvolve psychosomatics or ethics consultation to evaluate a prospectivedonor to make certain that the requirements for a voluntary andautonomous decision are met. The paper focuses on the conceptualquestions underlying this evaluation process. In order to illustrate howdifferent views of autonomy influence the decision if a donor's offer isethically acceptable, three cases (...) are presented – from Germany, theUnited States, and India. Each case features a person with questionabledecision-making capacity who offered to donate a kidney for a siblingwith severe renal insufficiency. Although the normative framework issimilar in the three countries, different or sometimes even contraryarguments for and against accepting the offer were brought forward. Thesubsequent analysis offers two explanations for the differences inargumentation and outcome in spite of the shared reference to autonomyas the guiding principle: (1) Decisions on the acceptability of a livingdonor cannot simply be deducted from the principle of autonomy but needto integrate contextual information; (2) understandings of the wayautonomy should be contextualized have an important influence on theevaluation of individual cases. Conclusion: Analyzing the conceptualassumptions about autonomy and its relationship to contextual factorscan help in working towards more transparent and better justifieddecisions in the assessment of living organ donors. (shrink)