Full ectogenesis as the complete externalization of human reproduction by bypassing the bodily processes of gestation and childbirth can be considered the culmination of genetic and reproductive technologies. Despite its still being a hypothetical scenario, it has been discussed for decades as the ultimate means to liberate women from their reproductive tasks in society and hence finally end fundamental gender injustices generally. In the debate about the application of artificial wombs to achieve gender equality, one aspect is barely mentioned but (...) is of crucial relevance from a medical‐ethical perspective: whether and how could full ectogenesis be justified as a proper use of medicine? After characterizing the technology as a special form of human enhancement and as an extension of medical practice that goes beyond the traditional field of medicine, this paper critically assesses the theoretical possibilities of legitimizing this extension. We identify two ways of justification: either one argues that ectogenesis fulfils a proper goal of medicine (a justification we call pathologization), or one argues that the application of ectogenesis achieves a non‐medical goal (which we call medicalization). Because it is important from a medical‐ethical point of view to avoid an inappropriate instrumentalization or misuse of medicine and thus an undue medicalization of non‐medical problems, a set of necessary conditions has to be met. It is doubtful whether full ectogenesis for non‐medical purposes could fulfil these conditions. Rather, its comprehensive usage could be seen as a revolutionary modification of what it means to be human. (shrink)

The principle of non-directiveness remains an important tenet in genetics. However, the concept has encountered growing criticism over the last two decades. There is an ongoing discussion about its appropriateness for specific situations in genetics, especially in light of recent significant advancements in genetic medicine. Despite the debate surrounding non-directiveness, there is a notable lack of up-to-date international research empirically investigating the issue from the perspective of those who actually do genetic counselling. Addressing this gap, our article delves into the (...) viewpoints and experiences of medical geneticists in Germany and Switzerland. Twenty qualitative interviews were analysed employing reflexive thematic analysis. Participants’ responses revealed substantial uncertainties and divergences in their understanding and application of the concept. It seems to cause distress since many geneticists stated that the principle was difficult to put into clinical practice and was no longer ethically justified given the increasing likelihood of therapeutic implications resulting from genomic testing outcomes. The insights provided by our qualitative empirical study accord with the ongoing theoretical debate regarding the definition, legitimacy, and feasibility of the principle. An adequately nuanced understanding and application of non-directiveness seems crucial to circumvent the risks inherent in the principle, while promoting patient autonomy and beneficence. (shrink)

Durch Fortschritte in der modernen Reproduktionsmedizin ist es Frauen heute möglich, auch nach der Menopause mit eigenen Eizellen schwanger zu werden. Damit wird die Fortpflanzung im homologen System auch im Alter zu einer realistischen Option. Gegen derartige späte Schwangerschaften gibt es vielfältige Argumente, die vor allem auf mögliche Schädigungen aufgrund des hohen Alters der Mutter verweisen. Maßnahmen der Anti-Aging-Medizin zum Erhalt bzw. zur Verbesserung der kognitiven und physischen Leistungsfähigkeit im fortgeschrittenen Alter könnten diese Einwände gegen den Einsatz von Reproduktionstechniken nach (...) der Menopause entkräften. Der Beitrag geht der Frage nach, wie erstrebenswert postmenopausale Schwangerschaften unter diesen Voraussetzungen eigentlich sind. Es wird die These vertreten, dass eine Schadensargumentation für eine ethische Bewertung allein nicht ausreichend ist, sondern auch Überlegungen zu Status und Authentizität des Kinderwunsches, zum Selbstverständnis der Medizin, zur Autonomie der Betroffenen sowie zur Natürlichkeit der Lebensführung berücksichtigt werden müssen. Darüber hinaus zeigt sich, wie Entwicklungen in zwei spezifischen Anwendungsbereichen (Anti-Aging- und Reproduktionsmedizin) in einer gemeinsamen Betrachtung zusammengeführt und mit Gewinn für allgemeinere medizinethische Überlegungen bewertet werden können. (shrink)

The definition of ‘patient’ is commonly taken for granted and considered as obvious, but the term is rather underconceptualised in the literature. In this paper, it will be argued that the criterion of suffering can be considered a sufficient criterion for a parent to be considered a secondary patient when their seriously ill child is receiving medical care (i.e. not necessarily the parents themselves) – these parents are sufferers in virtue of the suffering of others. The nature of parental and (...) child health and well-being is clearly relational and bidirectional, thus also a bidirectional and relational integration of parental and paediatric patient care is necessary. A genuine expansion of the concept ‘patient’ to parents, both practically and theoretically, can help to bring awareness to the closely intertwining, interacting and interdependent vulnerabilities of both parties, the potential conflicts of interests involved, and also to demand support and reduce hurdles, for example, in reimbursement by health insurers. Treating parents as patients will (1) help the affected child (the primary patient), as unhealthy and/or mentally unstable parents are likely to negatively influence a child's treatment and (2) prevent the parents (the secondary patients) from becoming primary patients themselves due to their suffering because of their child's illness. (shrink)

Evidence shows that during birth women frequently experience unconsented care, coercion, and a loss of autonomy. For many countries, this contradicts both the law and medical ethics guidelines, which emphasize that competent and fully informed women’s autonomy must always be respected. To better understand this discordance, we empirically describe perinatal maternity care providers’ and women’s moral deliberation surrounding coercive measures during birth. Data were obtained from 1-on-1 interviews with providers (N = 15) and women (N = 14), and a survey (...) of women (N = 118). Analyses focused on an in-depth exploration of responses to a question on the permissibility of coercion in birth whose wording was borrowed from a Swiss medical-ethical guideline. Reasons for and against a principle permissibility of coercive measures in birth were grouped into clusters of reasons to build a coherent explanatory framework. Factors considered morally relevant when deliberating on coercion included women’s decisional capacity, beneficence/non-maleficence, authority through knowledge on the part of providers, flaws of the medical system, or the imperative to protect the most vulnerable. Also, we identified various misconceptions, such as the conviction that a pathological birth can justify coercion or that fetal rights can justifiably infringe on women’s autonomy. Information and education on the issue of coercion in birth are urgently needed to enable women to fully exercise their reproductive autonomy, to prevent long-term adverse health outcomes of women and children, and to reconcile the medical vigilance which has lead to a reduction of perinatal morbidity and mortality with women’s enfranchisement in their own care. (shrink)

ZusammenfassungObwohl Film nicht nur eine große Popularität und mediale Vertrautheit genießt, sondern auch als eine der bedeutendsten kulturprägenden Kunstformen der Gegenwart sowie als Mittel kollektiver Selbstverständigung und Ausdruck gesellschaftlicher Reflexion gelten kann, finden filmische Auseinandersetzungen mit aktuellen bioethischen Problemkonstellationen bislang kaum Beachtung im akademischen Diskurs. Dies gilt nicht nur für die vielschichtige Symbolbildung von Spielfilmen, sondern auch für das narrative Potenzial von Dokumentarfilmen. Dabei können dokumentarische Erzählformen wichtige Bedeutungsebenen ethischer Fragestellungen erschließen, indem sie Einblick in die individuellen Lebenslagen der Betroffenen (...) und ihre jeweiligen Perspektiven gewähren. Wie kaum ein anderes Medium ist der Dokumentarfilm geeignet, dabei die persönliche Dimension medizinischer Entscheidungen jenseits theoretischer Argumentationen erfahrbar zu machen. Dieser diskursive Mehrwert, den die Einbeziehung von Dokumentarfilmen in die bioethische Debatte haben kann, wird in diesem Beitrag zunächst als Theorie formuliert und anschließend an zwei Filmbeispielen erläutert, welche die Thematik der Leihmutterschaft aufgreifen und somit eine aktuelle Fragestellung der Reproduktionsmedizin ins Bild setzen. (shrink)

Entamoeba histolytica is a protozoan parasite of humans, and the causitive agent of intestinal amebiasis. The disease‐causing stage of the parasite is an osmotically sensitive ameboid form, which differentiates into a thick‐walled cyst for transmission from person to person. The conditions within the human intestine that induce encystment of the amoeba are unknown, but studies using an amoebic parasite of reptiles are now yielding information about the molecules and host:parasite interactions involved in the process. An understanding of the amoeba's obligatory (...) encystment pathway should provide an approach for interrupting the transmission of this parasite, for which there is currently no vaccine. (shrink)

It is suggested that the world is locally projectively flat rather than Euclidean. From this postulate it is shown that an (N+1)-particle system has the global geometry of the symmetric spaceSO(4,N+1)/SO(4)×SO(N+1). A complex representation also exists, with structureSU(2,N+1)/S[U(2)×U(N+1)]. Several aspects of these geometrics are developed. Physical states are taken to be eigenfunctions of the Laplace-Beltrami operators. The theory may provide a rational basis for comprehending the groupsSO(4, 2),SU(2)×U(1),SU(3), etc., of current interest.

Die Bestimmung des Herstellungsbegriffs setzt bei der aristotelischen Unterscheidung zwischen den Tätigkeitsformen der poiesis sowie praxis an. Anders als das selbstzweckliche Handeln ist das herstellende Hervorbringen immer zweckorientierte, auf etwas außerhalb ihrer selbst gerichtete Tätigkeit. Anthropologisch gewendet, lässt sich die entsprechende Fähigkeit zur instrumentellen Mittel erfindung und systematischen Mittelherstellung als zentrales Wesensmerkmal des Menschen bestimmen. Nach Hannah Arendt sind veschiedene Aspekte des Herstellens als einzigartiger Fähigkeit des Menschen zu unterscheiden. Auf der Seite des Herstellungsprozesses sind die eindeutig bestimmbare Abgeschlossenheit und (...) die Finalität das Herstellens charakteristisch; auf der Seite des hergestellten Produktes sind die Gegenständlichkeit des Hergestellten sowie die von diesem unabhängige Beständigkeit des Produktentwurfs bestimmend, in dem wiederum die grundsätzliche Anlage zur Vervielfältigung und Massenproduktion jeder Hervorbringung gründet. Hieraus ergibt sich die Haltbarkeit als inhärente Eigenheit des Hergestellten, das somit seinen Hersteller potenziell überdauert. Schließlich wird die anthopologische Bedeutung des Herstellungshandelns deutlich: der unstete Mensch, dessen Leben in Struktur und Verlauf dauerhaft anfällig und beständig unbeständig ist, benötigt zum Überleben verlässlich Dauerhaftes, Beständiges. Als Homo faber gelingt es ihm, seine eigene Unnatürlichkeit durch selbstgemachte Künstlichkeit zu ergänzen und sich so eine “Heimat” zu schaffen. (shrink)

The definition of ‘patient’ is commonly taken for granted and considered as obvious, but the term is rather underconceptualised in the literature. In this paper, it will be argued that the criterion of suffering can be considered a sufficient criterion for a parent to be considered a secondary patient when their seriously ill child is receiving medical care (i.e. not necessarily the parents themselves) – these parents are sufferers in virtue of the suffering of others. The nature of parental and (...) child health and well-being is clearly relational and bidirectional, thus also a bidirectional and relational integration of parental and paediatric patient care is necessary. A genuine expansion of the concept ‘patient’ to parents, both practically and theoretically, can help to bring awareness to the closely intertwining, interacting and interdependent vulnerabilities of both parties, the potential conflicts of interests involved, and also to demand support and reduce hurdles, for example, in reimbursement by health insurers. Treating parents as patients will (1) help the affected child (the primary patient), as unhealthy and/or mentally unstable parents are likely to negatively influence a child's treatment and (2) prevent the parents (the secondary patients) from becoming primary patients themselves due to their suffering because of their child's illness. (shrink)

The ethics of human enhancement has been a hotly debated topic in the last 15 years. In this debate, some advocate examining science fiction stories to elucidate the ethical issues regarding the current phenomenon of human enhancement. Stories from science fiction seem well suited to analyze biomedical advances, providing some possible case studies. Of particular interest is the work of screenwriter Andrew Niccol (Gattaca, S1m0ne, In Time, and Good Kill), which often focuses on ethical questions raised by the use of (...) new technologies. Examining the movie In Time (2011), the aim of this paper is to show how science fiction can contribute to the ethical debate of human enhancement. In Time provides an interesting case study to explore what could be some of the consequences of radical life-extension technologies. In this paper, we will show how arguments regarding radical life-extension portrayed in this particular movie differ from what is found in the scientific literature. We will see how In Time gives flesh to arguments defending or rejecting radical life-extension. It articulates feelings of unease, alienation and boredom associated with this possibility. Finally, this article will conclude that science fiction movies in general, and In Time in particular, are a valuable resource for a broad and comprehensive debate about our coming future. (shrink)

Die Frage nach den Faktoren, die eine wirksame Ethik-Lehre in der Medizin ausmachen, blieb bislang weitgehend unbeantwortet. Vor allem im deutschsprachigen Raum wird hier zu wenig Forschung betrieben. Aufgrund fehlender wissenschaftlich aussagekräftiger Evaluationsstudien lässt sich somit mitunter nur vermuten, wie wirksam bestimmte Lehrformate und -methoden in der Ethik-Lehre tatsächlich sind. Die Auswahl von Lehrformaten und -methoden, die Ethik-Dozierende für das Erreichen eines festgelegten Lernziels einsetzen, wird häufig nicht nach evidenzbasierten Kriterien, sondern auf der Grundlage von guten oder schlechten Lehrerfahrungen sowie (...) von unmittelbarem Feedback der Studierenden getroffen. Im vorliegenden Beitrag werden nach einem kurzen Überblick über Evaluationsverfahren ethischer Kompetenzen Erkenntnisse aus ausgewählten internationalen Wirksamkeitsstudien vorgestellt und auf ihre Relevanz für den Medizinethik-Unterricht diskutiert. Wenngleich die Erkenntnisse aus diesen Evaluations- und Meta-Studien aus anderen, angrenzenden Bereichen wie der Forschungsethik und anderen Lehrkontexten kommen, so können sie doch als Diskussionsanstoß dienen und dazu beitragen, Eckpunkte für die Gestaltung wirksamer Ethik-Lehre in der Medizin im deutschsprachigen Raum zu definieren. (shrink)

PurposeTo evaluate the relationship between intraocular straylight perception and: (i) contrast sensitivity (CS), (ii) halo size, and (iii) hazard recognition distance, in the presence and absence of glare.Subjects and methodsParticipants were 15 (5 female) ophthalmologically healthy adults, aged 54.6–80.6 (median: 67.2) years. Intraocular straylight (log s) was measured using a straylight meter (C-Quant; Oculus GmbH, Wetzlar, Germany). CS with glare was measured clinically using the Optovist I device (Vistec Inc., Olching, Germany) and also within a driving simulator using Landolt Cs. (...) These were presented under both static or dynamic viewing conditions, and either with or without glare. Hazard detection distance was measured for simulated obstacles of varying contrast. For this, the participant was required to maintain a speed of 60 km/h within a custom-built nighttime driving simulator. Glare was simulated by LED arrays, moved by cable robots to mimic an oncoming car’s headlights. Halo size (“halometry”) was measured by moving Landolt Cs outward originating from the center of a static glare source. The outcome measure from “halometry” was the radius of the halo (angular extent, in degrees visual angle).ResultsThe correlation between intraocular straylight perception, log s, and hazard recognition distance under glare was poor for the low contrast obstacles (leading/subdominant eye: r = 0.27/r = 0.34). Conversely, log CS measured with glare strongly predicted hazard recognition distances under glare. This was true both when log CS was measured using a clinical device (Optovist I: r = 0.93) and within the driving simulator, under static (r = 0.69) and dynamic (r = 0.61) conditions, and also with “halometry” (r = 0.70). Glare reduced log CS and hazard recognition distance for almost all visual function parameters.ConclusionIntraocular straylight was a poor predictor of visual function and driving performance within this experiment. Conversely, CS was a strong predictor of both hazard recognition and halo extent. The presence of glare and motion lead to a degradation of CS in a driving simulator. Future studies are necessary to evaluate the effectiveness of all above-mentioned vision-related parameters for predicting fitness to drive under real-life conditions. (shrink)

Mexico's pandemic management and the absence of measures have been harshly criticized as being disproportionate. This paper examines whether the proportionality principle was properly applied to Mexico's COVID-19 response and outlines three reasons against such an endeavor, namely (i) the content of “proportionate measures” remained insufficiently well defined, (ii) there were yet fundamental rights conflicts to resolve, and (iii) the situation was moreover characterized by epistemic uncertainty.

Dieser Band präsentiert einen Überblick über die Medizinethik. Er stellt konzeptuelle und methodische Zugänge zum Fach dar und bietet Einblicke in zentrale Themenfelder. Kurze Einführungen und Lektürefragen zu ausgewählten Texten erleichtern die systematische Einordnung der verschiedenen theoretischen und praktischen Fragestellungen der Medizinethik.

In den Publikationen der Synthetischen Biologie und in Darstellungen dieser neuen Biotechnologie finden sich häufig Begriffe des Herstellens, Konstruierens, Erschaffens und Kreierens. Im folgenden Beitrag wird dieses Begriffsfeld auf der Basis von technikphilosophischen und kunsttheoretischen Ansätzen systematisiert. Es wird erstens untersucht, inwiefern sich die verschiedenen Forschungsrichtungen in der Synthetischen Biologie mit diesem Begriffsinstrumentarium angemessen beschreiben lassen; zweitens wird analysiert, welche ethischen Fragestellungen mit den unterschiedlichen Begriffen des Herstellens und Erschaffens im Fall der Synthetischen Biologie verbunden sind.

Der Umgang mit Gesundheit und Krankheit, noch mehr aber die Übergänge zwischen dem einen und dem anderen Zustand, weisen mit der Entwicklung des therapeutischen Wissens und Könnens und der Strukturen in der Gesundheitsversorgung eine Vielfalt an ethischen Bezügen auf.

Schon ein oberflächlicher Blick in die Tagespresse, in Printmedien und einschlägige Webressourcen zeigt, dass in vielen Industrieländern medizinethische Fragen zunehmend auf der Tagesordnung stehen. Auch ethische Expertise in Klinik, Lehre und Forschung hat mittlerweile ihren festen Stellenwert, ist etabliert, in zahlreichen Formen institutionalisiert und Teil eines ?bioethics biz?. Die Verbreitung von Medizinethik zeigt sich in vier Dimensionen: in der klinischen Praxis (Ethikberatung, Ethikkomitees, Ethik-Konsiliardienste, ethische Fallbesprechungen etc.), in der Lehre (im Medizinstudium und in vielen anderen gesundheitsbezogenen Ausbildungsgängen), in der Wissenschaft (...) (medizinethische Forschung, nationale und internationale Förderprogramme, medizinethische Institute und Forschungszentren) und in der Gesellschaft (Ethikkommissionen zu Humanforschung und für die Beratung von Politik und Öffentlichkeit). (shrink)

In this paper, we examine the use of the term ‘life’ in the debates within and about synthetic biology. We review different positions within these debates, focusing on the historical background, the constructive epistemology of laboratory research and the pros and cons of metaphorical speech. We argue that ‘life’ is used as buzzword, as folk concept, and as theoretical concept in inhomogeneous ways. Extending beyond the review of the significant literature, we also argue that ‘life’ can be understood as aBurstwordin (...) two concrete senses. Firstly, terms such as life easily turn into fuzzy, foggy and buzzy clouds of nonsense, if their use is not appropriately reflected. In these cases, the semantic orientation is detonated. This is theBurstword Icharacteristic of the concept of ‘life’ that we reveal for its unclear terminological use. Secondly, and in contrast toBurstword I, we show that the concept of ‘life’ can be used in a methodologically controlled way. We call this kind of useBurstword II. Here the concept of ‘life’ fulfils the function of expanding an inadequately narrow disciplinary or conceptual focus in different discursive contexts. In this second sense, ‘life’ receives an important operational function, for instance as a transdisciplinary research principle. It turns out that the innovative function and paradigm-changing power of metaphorical speech belong here as well. Finally, we illustrate three ethically relevant examples that show how ‘life’ can be applied asBurstword IIin the context of synthetic biology. (shrink)