Die demografische Entwicklung und der medizinische Fortschritt werden die Problematik der Ressourcenknappheit im Gesundheitswesen in Zukunft weiter verschärfen. Auch Deutschland steht eine Prioritätensetzung im Gesundheitswesen bevor. Diese sollte in möglichst transparenter Weise nach klaren Kriterien erfolgen. Ein nur selten in diesem Kontext besprochenes Kriterium der Verteilung von Mitteln in der Gesundheitsversorgung ist die marginale Wirksamkeit medizinischer Leistungen. Im vorliegenden Beitrag wird dieses Kriterium vorgestellt und auf seine Fairness hin untersucht. Nach der kritischen Diskussion einiger Argumente gegen den offenen Einsatz von (...) Rationierungskriterien und einer Definition von marginaler Wirksamkeit in zwei unterschiedlichen Dimensionen werden verschiedene Vorzüge und eventuelle Nachteile des Kriteriums beleuchtet. (shrink)

ZusammenfassungDie demografische Entwicklung und der medizinische Fortschritt werden die Problematik der Ressourcenknappheit im Gesundheitswesen in Zukunft weiter verschärfen. Auch Deutschland steht eine Prioritätensetzung im Gesundheitswesen bevor. Diese sollte in möglichst transparenter Weise nach klaren Kriterien erfolgen. Ein nur selten in diesem Kontext besprochenes Kriterium der Verteilung von Mitteln in der Gesundheitsversorgung ist die marginale Wirksamkeit medizinischer Leistungen. Im vorliegenden Beitrag wird dieses Kriterium vorgestellt und auf seine Fairness hin untersucht. Nach der kritischen Diskussion einiger Argumente gegen den offenen Einsatz von (...) Rationierungskriterien und einer Definition von marginaler Wirksamkeit in zwei unterschiedlichen Dimensionen werden verschiedene Vorzüge und eventuelle Nachteile des Kriteriums beleuchtet. (shrink)

ZusammenfassungDie demografische Entwicklung und der medizinische Fortschritt werden die Problematik der Ressourcenknappheit im Gesundheitswesen in Zukunft weiter verschärfen. Auch Deutschland steht eine Prioritätensetzung im Gesundheitswesen bevor. Diese sollte in möglichst transparenter Weise nach klaren Kriterien erfolgen. Ein nur selten in diesem Kontext besprochenes Kriterium der Verteilung von Mitteln in der Gesundheitsversorgung ist die marginale Wirksamkeit medizinischer Leistungen. Im vorliegenden Beitrag wird dieses Kriterium vorgestellt und auf seine Fairness hin untersucht. Nach der kritischen Diskussion einiger Argumente gegen den offenen Einsatz von (...) Rationierungskriterien und einer Definition von marginaler Wirksamkeit in zwei unterschiedlichen Dimensionen werden verschiedene Vorzüge und eventuelle Nachteile des Kriteriums beleuchtet. (shrink)

This article opens with a discussion of incarceration in the time of Covid 19. The story of one of the inmates in the high-security prison of Puente Grande leads us back to the beginning of the fifteen-year-long imprisonment of an innocent and, with it, to a complex narrative. The story concerns the use of the juridical concepts of delincuencia organizada, racketeering, and kidnapping. As a charge it has been repeatedly implemented in what has come to be called la fabricaciόn de (...) culpables in Mexico, Columbia, Argentina, and Brazil. Although the legal terminology changes, false incarceration is hardly limited to Central and South America. This is therefore a cautionary tale about how charges – and people – are framed, and how the latter are tried on social and corporate media, even before their official trials begin. (shrink)

Debates on the moral status of human embryos have been highly and continuously controversial. For many, these controversies have turned into a fruitless scholastical endeavor. However, recent developments and insights in cellular biology have cast further doubt on one of the core points of dissent: the argument from potentiality. In this article we want to show in a nonscholastical way why this argument cannot possibly survive. Getting once more into the intricacies of status debates is a must in our eyes. (...) Not merely intellectual coherence but the standing and self-understanding of current stem cell research might profit from finally taking leave of the argument from potentiality. (shrink)

„Medizinische Notwendigkeit“ (MedN) ist der zentrale Steuerungsbegriff für die Finanzierung medizinischer Versorgung in der deutschen Gesetzlichen Krankenversicherung. Trotz seiner scheinbaren Objektivität und Bestimmtheit durch ärztliche Expertise ist der Begriff alles andere als eindeutig definiert. In diesem ersten von fünf geplanten Aufsätzen zur Begriffsklärung von MedN aus medizintheoretischer, -ethischer, rechtlicher und (sozial)medizinischer Perspektive geht es um eine Systematisierung der aktuellen Kontroversen. Damit soll eine Fundierung für Detaildebatten gelegt werden, die bisher fehlt. Geklärt werden sollen die begriffliche Struktur, Funktion, Kontextualität und Missverständlichkeit (...) von MedN sowie die grundsätzlichen Grenzen einer Begriffsanalyse für die anstehenden normativen Fragen medizinischer Leistungssteuerung. (shrink)

“Die Gedanken sind frei,” in the words of the old song. But in Germany, thoughts are no longer free. Peter Singer, the “death ethicist,” has become a special target for activists attempting to silence bioethical debate in Germany. In the context of the trauma inflicted by National Socialism, a profound unease over issues at the end of life is accompanied by an insistence that these issues are not to be discussed.

“Die Gedanken sind frei,” in the words of the old song. But in Germany, thoughts are no longer free. Peter Singer, the “death ethicist,” has become a special target for activists attempting to silence bioethical debate in Germany. In the context of the trauma inflicted by National Socialism, a profound unease over issues at the end of life is accompanied by an insistence that these issues are not to be discussed.

Background This paper addresses sedation at the end of life. The use of sedation is often seen as a last resort for patients whose death is imminent and whose symptoms cannot be treated in any other way. This paper asks how to assess constellations, where patients want to hasten their death by refusing (further) life-sustaining treatment, or by voluntarily stopping eating and drinking (VSED), and wish this to be accompanied by sedation. Argument We argue that sedation is ethically and legally (...) permissible not only as a last resort, but in principle. Furthermore, we see a clear obligation to sedate in cases of acute suffering of any kind, while in some other constellations individual physicians’ objections to supposedly premature or unnecessary sedation must be respected. Such possible reservations should, however, be reconsidered in light of the fundamental ethical and legal right to a self-determined death. Conclusion In general, sedation practices should be less restrictive, and existing guidelines should be revised accordingly. (shrink)

Beauchamp and Childress’ definition of autonomous decision‐making includes the conditions of intentionality, understanding, and non‐control. In genetics, however, a relational conception of autonomy has been increasingly recognized. This article aims to empirically assess aspects of social influence in genetic testing decision‐making and to connect these with principlist and relational theories of autonomy. We interviewed 18 adult genetic counsellees without capacity issues considering predictive genetic testing for cancer predisposition for themselves and two counselling physicians in Switzerland. We conducted a qualitative analysis, (...) building on a grounded theory study about predictive genetic testing decision‐making. We found that some participants agreed to predictive genetic testing predominantly because relatives wanted them to do it, with some even acting contrary to their own convictions. Others, in contrast, based their decision on purely individualistic reasons but expressed difficulties in explaining their decision to their social environment. Healthcare professionals had a critical influence on decision‐making in many cases without being manipulative, as perceived by counsellees. Still, cases of coercion and social pressure occurred within social relationships. In conclusion, predictive genetic testing decision‐making includes relational and individualistic aspects, and both are compatible with autonomous decision‐making. While the principlist and relational notions of autonomy compete on a theoretical level, they are two sides of the same coin when used as analytical lenses for genetic testing decision‐making. Social acceptance of refusal of testing should be improved to mitigate social pressure. Individuals should be encouraged to decide for themselves how much their social environment influences their decision regarding predictive genetic testing. (shrink)

The representation of history continues to evolve in the domain of museum exhibitions. This evolution is informed in part by the creation of new display methods—many of which depart from the traditional conventions used to achieve the “museum effect”—in part by an increased attention to the museum–visitor relationship. In this context the ethical force of bearing witness, at times a crucial aspect of the museum experience, has emerged as a particularly compelling issue. In seeking to represent and address atrocity, injustice, (...) and the abrogation of human rights, museums have the potential to become “sites of conscience” and to encourage “historical consciousness.” Through a series of three exhibitions devoted to slavery, the New-York Historical Society demonstrated how such sites can be constructed and how objects can be deployed to represent extreme or “limit cases.” In this review/essay I investigate and interrogate these exhibitions, looking closely at the use of objects as a source of “indirect testimony” and at the “dialogical situation” that might arise in an encounter among objects, exhibit narratives, and visitors. Thinking in terms of point of view, I look at the variety of rhetorical platforms from which objects speak in these exhibitions; thinking in terms of syntax, I look at the effects of ordering and of the radical juxtaposition of objects; thinking in terms of irony, I look at the provocations of double-voiced narratives and at how objects are used to support those historical sentences. (shrink)

ZusammenfassungDie Odysseus-Verfügung ist als besondere Form der Patientenverfügung zumindest in der Literatur hinlänglich bekannt. Die Verwendung des Begriffs und damit sein Gegenstandsbereich sind hingegen noch immer umstritten. Zudem wird oft nicht beachtet, dass es innerhalb dieses Gegenstandsbereichs Varianten von OVs zu differenzieren gilt, die sich auch in ihrer moralischen Rechtfertigung unterscheiden. Nicht zuletzt ist die Grundstrukturstruktur dieser Rechtfertigung umstritten. Vor diesem Hintergrund plädieren wir im Folgenden zunächst für eine Eingrenzung des Begriffs, mit der argumentative und klinisch-praktische Verwirrungen vermieden werden können. (...) Anschließend betrachten wir zwei Varianten von – Zwang legitimierenden – OVs, die sich in der individuellen Kompetenz des Destinatärs unterscheiden. Schließlich zeigen wir, dass deren Rechtfertigung ungeachtet des Umstandes, dass OVs auf Wiedererlangung der Urteils- und Steuerungsfähigkeit des Patienten angelegt sind, weder in einer gemutmaßten noch gar in einer faktischen retrospektiven Billigung von Zwang durch den Patienten liegt. Die primäre Legitimationsgrundlage von OVs besteht vielmehr in der ex ante erfolgenden Autorisierung durch den Betroffenen selbst. Die hier einzuräumende Autorität wiederum basiert auf dem Recht jeder Person auf lebensplanerische Selbstbestimmung. In einem kurzen abschließenden Teil skizzieren wir dann noch die besondere Bedeutung der Odysseus-Vereinbarung als einer Unterform der OV. (shrink)

This article examines how local experiments and negotiation processes contribute to social and field-level learning. The analysis is framed within the niche development literature, which offers a framework for analyzing the relation between projects in local contexts and the transfer of local experiences into generally applicable rules. The authors examine 2 case studies drawn from a meta-analysis of 27 new energy projects. The case studies, both pertaining to biogas projects for local municipalities, illustrate the diversity of applications for a technology (...) through processes of local variation and selection. The authors examine the diversity of expectations and the negotiation and alignment of these expectations underlying the diversity of local solutions. Moreover, the authors address how the transfer of lessons from individual local experiments can follow different pathways and yet always require due attention to the social and cultural limits to the transferability of solutions. (shrink)

"Based upon an interdepartmental student project in systems engineering at the Massachusetts Institute of Technology, spring term, 1971... and a study at the College of Petroleum and Minerals, Dhahran, Saudi Arabia.".

The objective of Working Group 4 of the COST Action NET4Age-Friendly is to examine existing policies, advocacy, and funding opportunities and to build up relations with policy makers and funding organisations. Also, to synthesize and improve existing knowledge and models to develop from effective business and evaluation models, as well as to guarantee quality and education, proper dissemination and ensure the future of the Action. The Working Group further aims to enable capacity building to improve interdisciplinary participation, to promote knowledge (...) exchange and to foster a cross-European interdisciplinary research capacity, to improve cooperation and co-creation with cross-sectors stakeholders and to introduce and educate students SHAFE implementation and sustainability. To enable the achievement of the objectives of Working Group 4, the Leader of the Working Group, the Chair and Vice-Chair, in close cooperation with the Science Communication Coordinator, developed a template to map the current state of SHAFE policies, funding opportunities and networking in the COST member countries of the Action. On invitation, the Working Group lead received contributions from 37 countries, in a total of 85 Action members. The contributions provide an overview of the diversity of SHAFE policies and opportunities in Europe and beyond. These were not edited or revised and are a result of the main areas of expertise and knowledge of the contributors; thus, gaps in areas or content are possible and these shall be further explored in the following works and reports of this WG. But this preliminary mapping is of huge importance to proceed with the WG activities. In the following chapters, an introduction on the need of SHAFE policies is presented, followed by a summary of the main approaches to be pursued for the next period of work. The deliverable finishes with the opportunities of capacity building, networking and funding that will be relevant to undertake within the frame of Working Group 4 and the total COST Action. The total of country contributions is presented in the annex of this deliverable. (shrink)

We present a new road map for research on “How the Brain Got Language” that adopts an EvoDevoSocio perspective and highlights comparative neuroprimatology – the comparative study of brain, behavior and communication in extant monkeys and great apes – as providing a key grounding for hypotheses on the last common ancestor of humans and monkeys and chimpanzees and the processes which guided the evolution LCA-m → LCA-c → protohumans → H. sapiens. Such research constrains and is constrained by analysis of (...) the subsequent, primarily cultural, evolution of H. sapiens which yielded cultures involving the rich use of language. (shrink)

We present a new road map for research on “How the Brain Got Language” that adopts an EvoDevoSocio perspective and highlights comparative neuroprimatology – the comparative study of brain, behavior and communication in extant monkeys and great apes – as providing a key grounding for hypotheses on the last common ancestor of humans and monkeys and chimpanzees and the processes which guided the evolution LCA-m → LCA-c → protohumans → H. sapiens. Such research constrains and is constrained by analysis of (...) the subsequent, primarily cultural, evolution of H. sapiens which yielded cultures involving the rich use of language. (shrink)