Background The significance of medical implants goes beyond technical functioning and reaches into everyday life, with consequences for individuals as well as society. Ethical aspects associated with the everyday use of implants are relevant for individuals’ lifeworlds and need to be considered in implant care and in the course of technical developments. Methods This scoping review aimed to provide a synthesis of the existing evidence regarding ethically relevant psychosocial and cultural aspects in cochlear, glaucoma and cardiovascular implants in patient-centered empirical (...) research. Systematic literature searches were conducted in EBSCOhost, Philpapers, PsycNET, Pubmed, Web of Science and BELIT databases. Eligible studies were articles in German or English language published since 2000 dealing with ethically relevant aspects of cochlear, glaucoma and passive cardiovascular implants based on empirical findings from the perspective of (prospective) implant-wearers and their significant others. Following a descriptive-analytical approach, a data extraction form was developed and relevant data were extracted accordingly. We combined a basic numerical analysis of study characteristics with a thematically organized narrative synthesis of the data. Results Sixty-nine studies were included in the present analysis. Fifty were in the field of cochlear implants, sixteen in the field of passive cardiovascular implants and three in the field of glaucoma implants. Implant-related aspects were mainly found in connection with autonomy, freedom, identity, participation and justice, whereas little to no data was found with regards to ethical principles of privacy, safety or sustainability. Conclusions Empirical research on ethical aspects of implant use in everyday life is highly relevant, but marked by ambiguity and unclarity in the operationalization of ethical terms and contextualization. A transparent orientation framework for the exploration and acknowledgment of ethical aspects in “lived experiences” may contribute to the improvement of individual care, healthcare programs and research quality in this area. Ethics-sensitive care requires creating awareness for cultural and identity-related issues, promoting health literacy to strengthen patient autonomy as well as adjusting healthcare programs accordingly. More consideration needs to be given to sustainability issues in implant development and care according to an approach of ethics-by-design. (shrink)

In Anknüpfung an eine Arbeit von 2006 zur Frequenzvereinbarung am Behandlungsbeginn greifen die Autorinnen das Thema des Settings und des Handlungsdialogs erneut auf, diesmal anhand eines Behandlungsverlaufs. Bei Patienten, die frühe Traumata erlebt haben, die nicht erzählbar sind, weil sie vor der Zeit liegen, in der das autobiographische Gedächtnis etabliert ist, spielt die Angstregulierung eine fundamentale Rolle. Hochfrequenz kann bei diesen Patienten Ängste auslösen, die als nicht steuerbar erlebt oder befürchtet werden. Ein niederfrequentes Setting ist hier oft – vor allem (...) am Beginn der Behandlung – das, worauf Analytiker und Patient sich verständigen können. Ein Frequenzwechsel wird möglich, wenn Fortschritte in der Symbolisierungsfähigkeit es erlauben, dass Ängste als solche wahrnehmbar und nicht mehr überwiegend agiert oder somatisiert werden. Dieser Entwicklungsprozess wird ausführlich an einer Behandlung dargestellt, die in wiederholten Intervisionen begleitet wurde. (shrink)