BackgroundResearch using data from medical care promises to advance medical science and improve healthcare. Academia is not the only sector that expects such research to be of great benefit. The research-based health industry is also interested in so-called ‘real-world’ health data to develop new drugs, medical technologies or data-based health applications. While access to medical data is handled very differently in different countries, and some empirical data suggest people are uncomfortable with the idea of companies accessing health information, this paper (...) aims to advance the ethical debate about secondary use of medical data generated in the public healthcare sector by for-profit companies for medical research (ReuseForPro).MethodsWe first clarify some basic concepts and our ethical-normative approach, then discuss and ethically evaluate potential claims and interests of relevant stakeholders: patients as data subjects in the public healthcare system, for-profit companies, the public, and physicians and their healthcare institutions. Finally, we address the tensions between legitimate claims of different stakeholders in order to suggest conditions that might ensure ethically sound ReuseForPro.ResultsWe conclude that there are good reasons to grant for-profit companies access to medical data if they meet certain conditions: among others they need to respect patients’ informational rights and their actions need to be compatible with the public’s interest in health benefit from ReuseForPro. (shrink)

Contrary to the widespread concern about over-treatment at the end of life, today, patient preferences for palliative care at the end of life are frequently respected. However, ethically challenging situations in the current healthcare climate are, instead, situations in which a competent patient requests active treatment with the goal of life-prolongation while the physician suggests best supportive care only. The argument of futility has often been used to justify unilateral decisions made by physicians to withhold or withdraw life-sustaining treatment. However, (...) we argue that neither the concept of futility nor that of patient autonomy alone is apt for resolving situations in which physicians are confronted with patients' requests for active treatment. Instead, we integrate the relevant arguments that have been put forward in the academic discussion about ‘futile’ treatment into an ethical algorithm with five guiding questions: (1) Is there a chance that medical intervention will be effective in achieving the patient's treatment goal? (2) How does the physician evaluate the expected benefit and the potential harm of the treatment? (3) Does the patient understand his or her medical situation? (4) Does the patient prefer receiving treatment after evaluating the benefit-harm ratio and the costs? (5) Does the treatment require many resources? This algorithm shall facilitate approaching patients' requests for treatments deemed futile by the physician in a systematic way, and responding to these requests in an ethically appropriate manner. It thereby adds substantive considerations to the current procedural approaches of conflict resolution in order to improve decision making among physicians, patients and families. (shrink)

In this chapter, I clarify the notions of mental content and of concept. I present competing views on these notions and indicate my own position. I introduce content in terms of correctness conditions and distinguish several kinds of propositions, as well as non-propositional scenario content, with which perceptual content might be identified. I relate this discussion to a wide-spread commitment in philosophy of perception to respect the subject’s perceptual perspective in ascriptions of perceptual content. Then I compare views of concepts (...) as Fregean senses, as mental representations, and as cognitive abilities and investigate how they relate to the central idea that concepts are possessed by subjects. I suggest that our talk of concept possession and exercise is anchored in subjects’ abilities for re-identification and for general thought and in their inferential abilities. I clarify how possession and exercise of these three conceptual abilities relate. (shrink)

Die Entscheidung für oder gegen lebensverlängernde Behandlungsmaßnahmen geht inzwischen der Hälfte aller Todesfälle in Europa voraus. Sie wird im klinischen Alltag häufig als ethische Herausforderung wahrgenommen, zudem sind unter Klinikern juristische Unsicherheiten und Fragen der korrekten Vorgehensweise verbreitet. Die hier vorgestellte Münchner Leitlinie zu Entscheidungen am Lebensende soll rechtliche Unsicherheit reduzieren, Klinikumsmitarbeiter für die ethische Dimension von Therapieentscheidungen am Lebensende sensibilisieren und ethisch begründete Entscheidungen fördern. Aus organisationsethischer Perspektive soll mit der Leitlinie eine Reflexion und Meinungsbildung zu einem ethisch relevanten (...) Themenbereich erfolgen und ein Beitrag zur Qualitätssicherung der Patientenversorgung und damit auch zur Patientenzufriedenheit geleistet werden. Die Prozesse der Leitlinienentwicklung, -aktualisierung und -implementierung werden vorgestellt. Die wesentlichen inhaltlichen Elemente der Leitlinie mit Darstellung der Rechtslage, der Definition zentraler Begriffe und Klärung medizinischer Entscheidungskriterien werden an Hand eines Entscheidungsalgorithmus dargestellt. Inhalt und Prozess der Leitlinienentwicklung werden auf die folgenden organisationsethischen Qualitätskriterien hin überprüft: deliberativer Prozess, inhaltliche Transparenz, repräsentative Zusammensetzung der Arbeitsgruppe, Implementierung und Evaluation der Leitlinie. Institutionen, die diese Leitlinie übernehmen wollen, sollten diese von einem autorisierten Gremium überprüfen lassen und auf die spezifischen Bedürfnisse ihrer Institution adaptieren. Hierfür ist eine vorgeschaltete Bedarfserhebung hilfreich. In dem Gremium sollten all diejenigen vertreten sein, die in der Folge mit der Leitlinie arbeiten werden. (shrink)

The children of today live in a time when the images of themselves and their childhood, their needs, interests, and skills, are discussed, researched, challenged, and changed. Childhood, education and educational settings for young children are to a great extent governed by temporality. In this paper, temporality and temporal notions in education are explored and discussed. We especially illuminate two different ways of thinking about children in education and care for younger children in the West— the predominant biased notions of (...) the child as becoming or being. The child as becoming, is manifested primarily in classical developmental psychology while the notion of the child as being, has been highlighted mainly by sociological researchers in their critique of developmental psychology. This latter notion is also visible in a totally different manner in the philosophy of Rousseau, emphasizing the free and natural child. In addition, we explore an alternative way of thinking about temporality and children. Drawing upon the philosophy of Maurice Merleau-Ponty and Gilles Deleuze, we argue for a rethinking of temporality beyond linear views on time and biased notions of children as ‘either or’. A movement towards a perspective which not only combines notions, but where the whole is more than merely the sum of the parts, is proposed. This leads to an ambiguous, intertwined and ongoing connection between the temporal notions of have been, being and becoming, described by a novel concept—a chiasmic be(com)ing. We suggest that this alternative may be a fruitful way to overcome binary approaches and expand the discussion of temporality, and temporal notions of children, in education. Such an alternative could function as a counterweight to the predominant notions of education and teachers’ work. It may also be seen as a significant foundation for an ethical education since it is built upon ongoing and intertwined relationships, which appreciate openness and unpredictability. (shrink)

The debate on abortion has tended to avoid the psychological significance of an unwanted pregnancy, dominated istead by the strong emotions the subject excites. Eva Pattis Zoja examines the thoughts that surround a woman's decision to end a pregnancy, and presents the challenging thesis that voluntary abortion can often be a violent and unconscious act of self-realisation. Treating a theme which is central to our existence, the author makes no attempt to argue for or against, or to deny the painful (...) nature of the subject which she tackles, but instead looks at the way in which a decision to abort can affect a woman's inner life. (shrink)

Mary Shelley in her writings relies on the romanticised notions of nature: in addition to its beauties, the sublime quality is highlighted in its overwhelming greatness. In her ecological fiction, The Last Man (1826), the dystopian view of man results in the presentation of the declining civilization and the catastrophic destruction of infested mankind. In the novel, all of the characters are associated with forces of culture and history. On the one hand, Mary Shelley, focussing on different human bonds, warns (...) against the sickening discord and dissonance, the lack of harmony in the world, while, on the other hand, she calls for the respect of nature and natural order. The prophetic caring female characters ‘foresee’ the events but cannot help the beloved men to control their building and destroying powers. Mary Shelley expresses her unmanly view of nature and the author’s utopian hope seems to lie in ‘unhuman’ nature. While the epidemic, having been unleashed by the pests of patriarchal society and being accelerated by global warming, sweeps away humanity, Mother Nature flourishes and gains back her original ‘dwelling place’. (shrink)

Esta entrevista tem como escopo registrar algumas das experiências e saberes de uma das maiores sociólogas do Brasil, Mary Garcia Castro. Graduada em Ciências Sociais pela Universidade Federal da Bahia, mestre em Sociologia da Cultura pela mesma instituição. Também possui mestrado em Planejamento Urbano e Regional pela Universidade Federal do Rio de Janeiro e doutorado em Sociologia pela University of Florida. Ela tem um vasto currículo marcado por atuações e publicações nacionais e internacionais. Mary Castro foi professora e pesquisadora da (...) UFBA, além de pesquisadora associada da Universidade Estadual de Campinas e da Universidade Católica de Salvador. (shrink)

Since the middle of the 20th century, suicidology, as a group of disciplines working to understand and prevent suicide, has reinforced the long-held view that suicide is caused first and foremost b...