The efforts of the European Commission to create a European Research Area in the field of biotechnology are accompanied by a growing demand for an ethical discourse. Cultural differences between the European Union's member states create a vital need to improve bioethical information structures in Europe so as to foster European bioethics discourses and to cope with ethical pluralism. Responding to the need for an increased European contribution to the international discussion on ethics in medicine and biotechnology, some of Europe's (...) leading bioethics institutions have joined forces to establish the international network EURETHNET . 18 partners from nine European countries agreed to develop an information network and knowledge base in the field of ethics in medicine and biotechnology. This short communication displays the aims, scope and realisation of the network. (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%. 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)

Der Beitrag untersucht mögliche Kriterien für die normative Bewertung der künstlichen Ernährung bei nichteinwilligungsfähigen Patienten. Der in der aktuellen Diskussion immer wieder unternommene Versuch, den verpflichtenden Charakter bestimmter Formen der Ernährung aufgrund ihrer Zuordnung zu den Kategorien „Basisbetreuung“ oder „Remedia ordinaria“ zu begründen, erweist sich als naturalistischer Fehlschluss. Die Rechtfertigung der künstlichen Nahrungs- und Flüssigkeitszufuhr setzt vielmehr—wie die jeder anderen medizinischen Maßnahme—voraus, dass ihre Durchführung medizinisch begründet und vom Patienten gewollt ist. Dies trifft grundsätzlich auch auf den nicht mehr einwilligungsfähigen (...) Patienten zu; bei diesem kommt es auf den früher erklärten oder mutmaßlichen Willen an. (shrink)

ZusammenfassungDer Beitrag untersucht mögliche Kriterien für die normative Bewertung der künstlichen Ernährung bei nichteinwilligungsfähigen Patienten. Der in der aktuellen Diskussion immer wieder unternommene Versuch, den verpflichtenden Charakter bestimmter Formen der Ernährung aufgrund ihrer Zuordnung zu den Kategorien „Basisbetreuung“ oder „Remedia ordinaria“ zu begründen, erweist sich als naturalistischer Fehlschluss. Die Rechtfertigung der künstlichen Nahrungs- und Flüssigkeitszufuhr setzt vielmehr—wie die jeder anderen medizinischen Maßnahme—voraus, dass ihre Durchführung medizinisch begründet und vom Patienten gewollt ist. Dies trifft grundsätzlich auch auf den nicht mehr einwilligungsfähigen (...) Patienten zu; bei diesem kommt es auf den früher erklärten oder mutmaßlichen Willen an. (shrink)

Rights to life for unborn humans and to abortion with impunity are incompatible. This observation by the German legal philosopher Norbert Hoerster contains a fundamental criticism of the state regulation on abortion in Germany. The regulation regards abortion as unlawful, but declines to prosecute if the abortion is conducted within the first three months of pregnancy and the pregnant woman received counseling at least three days prior to terminating the pregnancy. In contrast to the German legislature, Hoerster is in favor (...) of setting the beginning of a right to life at birth. With this suggestion and the consequent demand for a general legalization of abortion, Hoerster himself has become the target of harsh criticism. The following article analyzes Hoerster's position and that of his opponents against the background of the current abortion debate in Germany. The consequences for dealing with the handicaps of Hoerster's suggested regulations will also be addressed. (shrink)

ZusammenfassungDer Beitrag untersucht mögliche Kriterien für die normative Bewertung der künstlichen Ernährung bei nichteinwilligungsfähigen Patienten. Der in der aktuellen Diskussion immer wieder unternommene Versuch, den verpflichtenden Charakter bestimmter Formen der Ernährung aufgrund ihrer Zuordnung zu den Kategorien „Basisbetreuung“ oder „Remedia ordinaria“ zu begründen, erweist sich als naturalistischer Fehlschluss. Die Rechtfertigung der künstlichen Nahrungs- und Flüssigkeitszufuhr setzt vielmehr—wie die jeder anderen medizinischen Maßnahme—voraus, dass ihre Durchführung medizinisch begründet und vom Patienten gewollt ist. Dies trifft grundsätzlich auch auf den nicht mehr einwilligungsfähigen (...) Patienten zu; bei diesem kommt es auf den früher erklärten oder mutmaßlichen Willen an. (shrink)

Name der Zeitschrift: Jahrbuch für Wissenschaft und Ethik Jahrgang: 22 Heft: 1 Seiten: 205-220.

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)

Culture creates the context within which individuals experience life and comprehend moral meaning of illness, suffering and death. The ways the patient, family and the physician communicate and make decisions in the end-of-life care are profoundly influenced by culture. What is considered as right or wrong in the healthcare setting may depend on the socio-cultural context. The present article is intended to delve into the cross-cultural perspectives in ethical decision making in the end-of-life scenario. We attempt to address the dynamics (...) of the roles of patient, family and physician therein across two countries from East and West, namely, India and Germany. In India, where illness is more a shared family affair than an individual incident, a physician is likely to respect the family’s wishes and may withhold the ‹naked truth’ about the diagnosis of a fatal disease to the patient. In Germany, a physician is legally required to inform the patient about the disease. In India, advance directive being virtually non-existent, the family acts as the locus of the decision-making process, taking into account the economic cost of available medical care. In Germany, advance directive is regarded as mandatory and healthcare is covered by insurance. Family and the physician appear to play larger roles in ethical decision making for patients in India than for those in Germany, who place greater emphasis on autonomy of the individual patient. Our study explicates how culture matters in ethical decision-making and why the bioethical discourse is necessary in the concrete realities of the socio-cultural context. To explore the possibility of finding a common ground of morality across different cultures while acknowledging and respecting cultural diversity, thus remains a formidable challenge for the bioethicists. (shrink)

This study explores the attitude of German psychiatrists in leading positions towards joint crisis plans and psychiatric advance directives. This topic was examined by contacting 473 medical directors of German psychiatric hospitals and departments. They were asked to complete a questionnaire developed by us. That form contained questions about the incidence and acceptance of joint crisis plans and psychiatric advance directives and previous experiences with them. 108 medical directors of psychiatric hospitals and departments responded . Their answers demonstrate that in (...) their hospitals these documents are rarely used. Among the respondents, joint crisis plans are more accepted than psychiatric advance directives. There is a certain uncertainty when dealing with these instruments. Our main conclusion is that German psychiatry needs an intensified discussion on the use of instruments for patients to constitute procedures for future critical psychiatric events. For this purpose it will be helpful to collect more empirical data. Furthermore, the proposal of joint crisis plans in psychiatric hospitals and departments should be discussed as well as the possibility of consulting an expert during the preparation of a psychiatric advance directive. (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)

Excerpt from La France au Point de Vue Morale Depuis douze ans que ce livre fut ecrit, de notables changements se sont produits dans notre pays, sur lesquels nous avons insiste dans notre recent ouvrage: la Democratie politique et sociale en France. Le plus important peut-etre de ces changements a ete la separation des Eglises et de l'Etat, evenement plein de consequences morales et sociales. Cette separation etait inevitable, et la logique de notre histoire, depuis la Revolution francaise, devait tot (...) ou tard l'amener. C'est dans l'enseignement scolaire que les premiers effets de la separation se sont fait deja sentir et se feront sentir de plus en plus. Les programmes elabores il y a trente ans par Jules Simon, Paul Janet et divers philosophes spiritualistes contenaient des notions, d'ailleurs vagues, de religion naturelle, en dehors de toute religion revelee. Ces notions furent assez mal accueillies du clerge catholique, qui y voyait une sorte d'invitation pour les enfants a se contenter de la religion naturelle et de la morale laique. On pretendit, malgre tous les programmes de Jules Simon, que l'Etat avait institue l'ecole sans Dieu, l'ecole contre Dieu. Le clerge catholique soutint que tout enseignement theiste ou deiste, donne en dehors des dogmes, etait une usurpation de l'Etat sur te role du pretre et une occasion fournie aux instituteurs de miner plus ou moins sourdement la foi positive aux religions revelees. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works.". (shrink)

A book review of Michael A. Simon's Understanding Human Action: Social Explanation of the Vision of Social Science.

Today the economic diagram is employed universally in teaching and research by professional economists. Yet the history of its construction shows that much that has been regarded as distinctive of twentieth-century visual culture was prefigured in the nineteenth. This paper will place the construction of the first economic diagrams by Alfred Marshall in the context both of contemporary visual technologies developed in other moral sciences, and of his wider theory of industrial production. The paper will argue that an understanding (...) of the background to the historical graphs, constructed by the Cambridge political economist from the late 1860s onwards, will necessitate a revision of the narrative of modern visual reasoning, as recently advanced by Lev Manovich. (shrink)

Mobility has become a central topic of contemporary social research with the mobility turn initiated in the 2000s. In order to grasp the complexity of the global order, its authors have attempted to decenter the importance of human subjectivity and to envisage a “sociology beyond societies”. The present paper considers this interpretive context to demonstrate the contemporary relevance of Alfred Schutz’s theory of action, and to propose a notion of mobility intrinsically linked to the performance of subjectivity. By revisiting (...) the distinction between action as a thing produced and as an ongoing process, the notion of mobility is detailed in relation to movement in space and to the subjective flow of time. The specific type of action Schutz calls “locomotion” in his later work enables us to understand how action involves bodily operations in configuring a common space of sociality and communication. I conclude by going beyond the explanation of action in terms of its starting point and end point, and by assessing how action unfolds through the experiential life of the subject, with its new meanings and unexpected changes. (shrink)

Long debated has been whether or not the “objectivistic” epistemologies, quantitative methods and causal explanations, developed by the natural sciences for the study of physical objects, their actions and interactions, might also be applied to the study of human subjects, their experiences, actions and social interactions. Pointing out that such supposedly objective approaches would be singularly inappropriate to the study of the significance or meanings, qualitative values and freedom of choice, widely regarded as essential aspects of human subjects, their experiences, (...) actions, and social interactions, and drawing attention, a la Alfred Schutz, to the two meanings of the term “subjective” it is first argued that many of the claims of the natural sciences themselves are “empirically” unverifiable, in the Positivistic sense of that term. Moreover, and most crucially, it is further argued that the “objectivity” of an experience cannot be empirically established on the basis of its supposed correspondence to some “objective” world—for, as precisely appearance or experience transcending, the existence of such a world, much less its nature, is clearly empirically unverifiable—and must therefore rest upon inter-subjective coherence, which in turn must, as Schutz has pointed out, depend precisely upon the very subjective experiences which those who would council such an “objective” approach, had ipso facto, sought to avoid as unverifiable. Thus, paradoxically, the criterion of objective verification cannot itself be objectively verified, but rests upon appeals to “subjective” experiences. (shrink)

This article concerns two of the last great metaphysical thinkers: Austin Farrer and Alfred North Whitehead. It also concerns a fundamental cosmological question: does the world point inexorably to God? Often, attempts to formulate and answer this question still stand firm on the Aristotelian categories of scholastic theology. Confronting these head-on, Farrer and Whitehead offered an antidote to Aristotle’s outdated metaphysics. They re-conceived being in active terms. This deployment of action-concepts was designed to overcome the logical and ontological inertia (...) of divine Ipseity and so heal the breach between God and Creation. By exploring the ways Farrer and Whitehead addressed these matters, I hope to remind readers of a fertile alternative to realist/anti-realist conflicts currently dominating philosophical theology. (shrink)