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)

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)

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)

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)

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)

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)

This editorial examines the evolving role of patients in European clinical ethics consultation services. While patient involvement has been theoretically supported in North America but often neglected in practice, European approaches show varying levels of patient participation - from committee membership to consultation involvement to full participation in ethical deliberations. Through analysis of a case involving end-of-life care and several commissioned papers exploring different national contexts, the authors highlight how patient involvement varies across Europe based on different healthcare systems and (...) cultural contexts. They note that while no single model of patient involvement is superior, ethics consultation without patient and family participation may miss critical perspectives needed for inclusive ethical deliberation. The authors conclude that practical considerations around consent, participation procedures and documentation need to be addressed as patient involvement increases, while acknowledging that cultural diversity across Europe will lead to different mechanisms for including patient voices. (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)

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)

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% (167/369). 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)

Der Widerspruch zwischen dem empirischen Befund faktischer gesellschaftlicher Ungleichheit und der idealen Forderung nach Gleichheit ist der Ausgangspunkt des Jahrbuchs: Soziale Ungleichheit und ihre Folgen stellen ein massives Problem für die Stabilität moderner menschlicher Gesellschaften dar. Der Diskurs thematisiert einen primatologisch-ethologischen Zugang, in dem die Sozialität nicht-menschlicher Primaten analysiert wird. Die Dynamik der Koevolution zwischen kultureller Veränderung und evolutionärer Anpassung ist dabei eine der grundlegenden Herausforderungen für die evolutionäre/ interdisziplinäre Anthropologie: Welche Auswirkungen hätte eine Anerkennung der Ungleichheit als Faktum in (...) biologischer, soziologischer, vielleicht sogar moralischer und politischer Hinsicht auf unsere Konzeption der conditio humana? Der InhaltDiskurs „Soziale Ungleichheit“ • Beiträge • Berichte • Rezensionen • Kalender Die Zielgruppen• Philosophen• Anthropologen• Psychologen• Geistes-, Natur-, Religions- und Sozialwissenschaftler Die HerausgeberDr. Gerald Hartung ist Professor für Philosophie mit den Schwerpunkten Kulturphilosophie/Ästhetik an der Bergischen Universität Wuppertal. Dr. Matthias Herrgen studierte Anthropologie & Philosophie und lehrt am Fachbereich Gesellschaftswissenschaften der Hochschule Darmstadt. (shrink)

With technology beyond the comprehension of any other country (thanks to their supply of vibranium), Wakanda has enough power to rival any nation on Earth. T'Challa oversees this power with wisdom, leading his kingdom with benevolence. Despite Wakanda's isolationism, T'Challa views outsiders positively, and ultimately he comes to see humanity as one tribe. Killmonger's perspective is different. One way to look at Black Panther is through the lens of the Civil Rights Movement, comparing T'Challa to Dr. Martin Luther King, Jr. (...) and comparing Killmonger to Malcolm X. Like T'Challa, Dr. King was an inspirational leader, beloved by those who followed him. King wanted to build bridges and establish an open line of communication between the African American community and the Caucasian community. (shrink)

The following transcript is adapted from a case conference held in the Barnes and Wohl Hospitals, St. Louis, Missouri. The participants are members of the Departments of Internal Medicine and Pathology of the Washington University School of Medicine. Dr. Renée Fox, professor and chairman of the Department of Sociology at the University of Pennsylvania and co‐author of the book The Courage to Fail, was a guest at the conference.

"This essay is an expansion of a lecture delivered by Dr. Phelan in New York City, January 21, 1936." Includes bibliographical references (pages 55-57).

A very material question has been started concerning abstract or general ideas, whether they be general or particular in the mind's conception of them. A great philosopher [Dr. Berkeley] has disputed the receiv'd opinion in this particular, and has asserted, that all general ideas are nothing but particular ones, annexed to a certain term, which gives them a more extensive signification, and makes them recall upon occasion other individuals, which are similar to them. As I look upon this to be (...) one of the greatest and most valuable discoveries that has been made of late years in the republic of letters, I shall here endeavour to confirm it by some arguments, which I hope will put it beyond all doubt and controversy. (shrink)

In recent literature, the famous Millikan oil-drop experiment appears as a case of “good scientific judgment” on the one hand, and scientific misconduct on the other. This article discusses different interpretations of the fact that Nobel laureate Robert Millikan’s notebooks show that he eliminated a number of oildrops in his published 1913 paper on the charge of the electron, while reporting that he had included all the drops. Starting with the common source of all Millikan stories, historian of physics (...) class='Hi'>Gerald Holton’s 1978 paper, I discuss recent “canned” versions of Millikan-as-misbehaver in books on scientific fraud. Then I examine some versions of Millikan-as-good-scientist, particularly the reconstruction by historian of physics Allan Franklin, and the views of some practicing physicists. Finally, we have an instructive head-on collision between the two standard treatments of Millikan. The problem with canned stories is not only insufficient information; we also lack a realistic evaluation of the role of ethics in science. As a fundamentally knowledge-seeking enterprise, science may harbor an inherent, perhaps irresolvable, conflict between scientific and ethical concerns. (shrink)

ABSTRACT:Psychedelics have again become a subject of widespread interest, owing to the reinvigoration of research into their traditional uses, possible medical applications, and social implications. As evidence for psychedelics' clinical potential mounts, the field has increasingly focused on searching for mechanisms to explain the effects of psychedelics and therapeutic efficacy of psychedelic-assisted therapy (PAT). This paper reviews three general frameworks that encompass several prominent models for understanding psychedelics' effects—specifically, neurobiological, psychological, and spiritual frameworks. Following our review, the implications of each (...) framework for ethics and professional competencies in the implementation of psychedelics as medicines are explored. We suggest that interdisciplinary education may be necessary to improve communication between researchers, develop models that effectively incorporate multiple levels of analysis, and facilitate collaboration between professionals with diverse backgrounds in the implementation of psychedelic medicines. We also address pitfalls associated with overemphasis on neuro-mechanisms, risks associated with instigating vulnerable states of consciousness, and hurdles associated with the integration of spiritual frameworks in medicine. Ultimately, as psychedelics push the boundaries of explanatory frameworks focused on one level of analysis, developing new and more useful models to reflect knowledge being produced in this field should be a central aim of psychedelic science going forward. (shrink)

Psychedelic experiences are often compared to “transformative experiences” due to their potential to change how people think and behave. This study empirically examines whether psychedelic experiences constitute transformative experiences. Given psychedelics’ prospective applications as treatments for mental health disorders, this study also explores neuroethical issues raised by the possibility of biomedically directed transformation—namely, consent and moral psychopharmacology. To achieve these aims, we used both inductive and deductive coding techniques to analyze transcripts from interviews with 26 participants in psychedelic retreats. Results (...) indicate that psychedelic experiences can constitute transformative experiences. Twenty participants reported experiences or insights that were seemingly inaccessible or impossible to attain if not for the psychoactive effects of psychedelics. All participants besides one reported some change in identity, values, beliefs, desires, and behavior—changes in behavior being the most common. Participants also reported feeling capable deciding to use psychedelics in part due to information seeking prior to their retreats. Finally, several participants reported an enhanced capacity for enacting changes in their lives. Our results underscore both the importance of subjective embodiment to transformation and the role of transformative agency in shaping outcomes of the psychedelic experience. We examine our results relative to neuroethical issues and advocate for centering the person in psychedelic research and neuroethical inquiry about psychedelics to avoid pitfalls associated with psychedelics’ potential as moral psychopharmacological agents. (shrink)

In August 2024, The U.S. Food and Drug Administration rejected Lykos Therapeutics, Inc.'s new drug application for midomafetamine with psychological intervention (MDMA-AT) to treat post-traumatic stress disorder (PTSD). Among the many issues raised during review was concern about a highly publicized case of alleged sexual misconduct by an unlicensed therapist during a Phase 2 study of MDMA and the potential risk of future abuse. This incident of misconduct, along with several other publicized cases of misconduct by guides, facilitators, and shaman (...) offering psychedelic retreats, has raised the question of whether physical contact is ever appropriate during psychedelic-assisted therapy (PAT). Drawing on research about supportive touch in other clinical contexts and taking into consideration features of psychedelics that exacerbate the potential for harm associated with supportive touch, we advocate for a precautionary approach to harm-reduction while arguing that supportive touch ought not be thrown out whole-cloth. (shrink)

In this book G. A. Cohen examines the libertarian principle of self-ownership, which says that each person belongs to himself and therefore owes no service or product to anyone else. This principle is used to defend capitalist inequality, which is said to reflect each person's freedom to do as as he wishes with himself. The author argues that self-ownership cannot deliver the freedom it promises to secure, thereby undermining the idea that lovers of freedom should embrace capitalism and the inequality (...) that comes with it. He goes on to show that the standard Marxist condemnation of exploitation implies an endorsement of self-ownership, since, in the Marxist conception, the employer steals from the worker what should belong to her, because she produced it. Thereby a deeply inegalitarian notion has penetrated what is in aspiration an egalitarian theory. Purging that notion from socialist thought, he argues, enables construction of a more consistent egalitarianism. (shrink)

Is socialism desirable? Is it even possible? In this concise book, one of the world's leading political philosophers presents with clarity and wit a compelling moral case for socialism and argues that the obstacles in its way are exaggerated. There are times, G. A. Cohen notes, when we all behave like socialists. On a camping trip, for example, campers wouldn't dream of charging each other to use a soccer ball or for fish that they happened to catch. Campers do not (...) give merely to get, but relate to each other in a spirit of equality and community. Would such socialist norms be desirable across society as a whole? Why not? Whole societies may differ from camping trips, but it is still attractive when people treat each other with the equal regard that such trips exhibit. But, however desirable it may be, many claim that socialism is impossible. Cohen writes that the biggest obstacle to socialism isn't, as often argued, intractable human selfishness--it's rather the lack of obvious means to harness the human generosity that is there. Lacking those means, we rely on the market. But there are many ways of confining the sway of the market: there are desirable changes that can move us toward a socialist society in which, to quote Albert Einstein, humanity has "overcome and advanced beyond the predatory stage of human development.". (shrink)