A Palestinian administrative detainee in Israel asked for the author to care for him as an independent physician while in hospital on two hunger strikes, lasting 66 and 55 days, respectively. Hunger striking is placed in the context of other forms of food refusal and artificial feeding. The various perspectives on the challenge of the medical care of hunger strikers are reviewed, as seen by the state, the public, the doctor and the patient. Institutional statements on the management of hunger (...) strikers are reviewed and the local political considerations are highlighted. In conclusion, a trusting doctor–patient relationship is presented as the crucial element for securing a successful outcome, preserving the prisoner's life and dignity with no significant political damage incurred by the State. (shrink)
Der Sammelband versammelt verschiedene Autoren, die mehr oder weniger dem methodischen Kulturalismus nahestehen. Der Band ist Herrn Prof. Dr. Peter Janich zum 60. Geburtstag gewidmet und die Beiträge befassen sich mit Themen, die das philosophische Schaffen von Herrn Janich ausgemacht haben.
In this article I argue that the four guiding principles of medical ethics—autonomy, beneficence, non-maleficence, and justice—reflect the values of western culture, but do not necessarily apply outside of it. Western medical practitioners faced with the care of nonwestern patients need to examine their own prejudices in order to accept, not merely tolerate, other values. Acceptance of the other requires that the doctor welcome the patient as one welcomes a guest, openly and equally, with a willingness to listen and to (...) be changed by the encounter. It is through the nurture of trusting relationships that ethical dilemmas in clinical medicine may be resolved, without recourse to the colonial moral hegemony of the principlist approach. (shrink)
Objective To compare the coping patterns of physicians and clinical psychologists when confronted with clinical ethical dilemmas and to explore consistency across different dilemmas. Population 88 clinical psychologists and 149 family physicians in Israel. Method Six dilemmas representing different ethical domains were selected from the literature. Vignettes were composed for each dilemma, and seven possible behavioural responses for each were proposed, scaled from most to least ethical. The vignettes were presented to both family physicians and clinical psychologists. Results Psychologists’ aggregated (...) mean ethical intention score, as compared with the physicians, was found to be significantly higher =22.44, p<0.001, η2=0.37). Psychologists showed higher ethical intent for two dilemmas: issues of payment and dual relationships. In the other four vignettes, psychologists and physicians responded in much the same way. The highest ethical intent scores for both psychologists and physicians were for confidentiality and a colleague’s inappropriate practice due to personal problems. Conclusions Responses to the dilemmas by physicians and psychologists can be categorised into two groups: similar behaviours on the part of both professions when confronting dilemmas concerning confidentiality, inappropriate practice due to personal problems, improper professional conduct and academic issues and different behaviours when confronting either payment issues or dual relationships. (shrink)
Biodiversity is a term easily applied in different and differing contexts. At first glance it seems to be a biological concept, defined and used in the realm of biological theory, serving for the description of particular aspects of the human and non-human environment. In this sense biodiversity even found its way into the texts of international conventions: “Biological diversity means the variability among living organisms from all sources including, inter alia, terrestrial, marine and other aquatic systems and the ecological complexes (...) of which they are part; this includes diversity within species, between species and of ecosystem.” [Harper and Hawksworth (1995)] But despite this clear and distinct definition, the intension of the term BD seems to be ambiguous. This is true for the single aspects of the definition itself, for example, the discussion over “what is a species?” took place in biology during the last 200 years and it is far from being finished [Claridge et al. (1997) Species]. This discussion asks not only for the “correct” biological definition of the term, but at the same time the methodological status of this term is in question. The result of this situation can be seen in the existence of at least 10–20 different definitions, considering biological as well as methodological aspects [Bachmann (1998) Theor Biosci 117:213–230]. Setting aside the fundamental scientific problems even the application of the term, its parametrisation and finally its relevance for biological theory-building is subject matter of controversies. The same is true for further particles of the definition, e.g. the term “ecosystem”, “complexity”, “gen”, “organisms”, etc. The intensity of the debate contrasts in a peculiar way to the reaction of (non-evolutionary) biologists, insofar as the biological research seems to be untouched by the irritating results of the debate itself. Referring to this strange situation, the aim of our article is a reconsideration of the term “biodiversity”. From an epistemological point of view it can be shown that a definition of biodiversity is possible which does not refer to biological knowledge and know-how—at least in its very first steps. Biodiversity then turns out to be a metaphor for specific aspects of societal organisation, the structuration and reproduction of nature-society relations within societies, and not for biological facts at all. (shrink)
Responsibility Without Understanding? How the Debate on the Ethics of Genetic Engineering Depends on Its Philosophy of Science. The main thesis in this paper is that bioethics has no own criteria to judge the chances and risks of genetic engineering. But if we distinguish (1) between different types of genetic, (2) between genetic engineering as a set of methods for experimentation and genetic engineering as an industrial technique and (3) reconstruct the metaphors and the terminology in general, which are used (...) by biologists describing their practice, it is possible to formulate such criteria. As the distinction between nature and culture is the result of human actions (not drawn by nature) and the communication about these actions and distinctions in a given cultural context, the criteria are the result of a discourse, in which not only biologists, but all members of a society argue about the reproduction and structuration of their society. (shrink)