This study aims to characterize the different types of certification in the Brazilian citriculture as well as analyze the major changes in the market. The paper also has the objective to discuss how social and environmental factors influence the demand for food certifications and the sustainability and ethics aspects in the field. Therefore, a literature review on the subject was carried out as well as a qualitative research using interviews with certifiers, governmental institutions, farmers, cooperatives and producer associations. The certification (...) is becoming mandatory for those working in foreign markets and for those working nationally; it can be a competitive differential. The organic certification in citriculture shows the highest number of growers. Companies with large areas of citrus and the orange juice processing industry are adhering to this certification in order to maintain themselves competitive in the market. There is an enormous potential of Brazilian citriculture certification, because the certified area is still less than 6 % of the total area. Certification reduces the asymmetry of information and consists of an important step towards sustainability although incapable of solely guaranteeing it. (shrink)

BackgroundValue sensitivity – the ability to recognize value-related issues when they arise in practice – is an indispensable competence for medical practitioners to enter decision-making processes related to ethical questions. However, the psychological competence of value sensitivity is seldom an explicit subject in the training of medical professionals. In this contribution, we outline the traditional concept of moral sensitivity in medicine and its revised form conceptualized as value sensitivity and we propose an instrument that measures value sensitivity.MethodsWe developed an (...) instrument for assessing the sensitivity for three value groups in a four step procedure: 1) value identification ; 2) value representation ; 3) vignette construction and quality evaluation ; and 4) instrument validation by comparing nursing professionals with hospital managers.ResultsWe find that nursing professionals recognize and ascribe importance to principle-related issues more than professionals from hospital management. The latter are more likely to recognize and ascribe importance to strategy-related issues.ConclusionsThese hypothesis-driven results demonstrate the discriminatory power of our newly developed instrument, which makes it useful not only for health care professionals in practice but for students and people working in the clinical context as well. (shrink)

In this article, I will argue in favor of both the ethical and epistemological utility of explanations in artificial intelligence -based medical technology. I will build on the notion of “explicability” due to Floridi, which considers both the intelligibility and accountability of AI systems to be important for truly delivering AI-powered services that strengthen autonomy, beneficence, and fairness. I maintain that explicable algorithms do, in fact, strengthen these ethical principles in medicine, e.g., in terms of direct patient–physician contact, as (...) well as on a longer-term epistemological level by facilitating scientific progress that is informed through practice. With this article, I will therefore attempt to counter arguments against demands for explicable AI in medicine that are based on a notion of “whatever heals is right.” I will elucidate my elaboration on the positive aspects of explicable AI in medicine as well as by pointing out risks of non-explicable AI. (shrink)

There is no cure or vaccine for HIV/AIDS. The only life-prolonging treatment available is antiretroviral (ARV) therapy. WHO estimates, however, that less than 5 percent of those who require treatment in developing countries currently enjoy access to these medicines. In Africa fewer than 50,000 people–less than 2 percent of the people in need–currently receive ARV therapy. These facts have elicited strongly divergent reactions, and views about the appropriate response to this crisis have varied widely.The intensity of the debate concerning access (...) to life-prolonging medicines for the treatment of HIV/AIDS, and the heated rhetoric with which they are often conducted, suggest that these disagreements may be rooted in deeper disagreements of value. It is not obvious, however, what disagreements of value are at stake in this debate. By analyzing the statements of scholars, public officials, activist organizations, and private sector representatives, each of whom may endorse very different policy recommendations on access to HIV/AIDS drugs, we have identified and created a typology of the different sources of disagreement in the debate. We conclude that the central disagreements concerning access to medicines arise from competing understandings of how responsibilities for bringing remedy to hardships should be allocated to different agents and institutions. A central lesson that emerges from our analysis is that thinking about “health equity” must extend beyond the explanation and justification of goals, values, and ideals, and engage more honestly with the difficult question of how responsibilities for bringing remedy to health crises should be allocated in complex social contexts. (shrink)

The practice and development of modern medicine requires large amounts of data, particularly in the domain of cancer. The future of personalized medicine lies neither with “genomic medicine” nor with “precision medicine”, but with “data medicine”. The establishment of this DM has required far-reaching changes, to establish four essential elements connecting patients and doctors: biobanks, databases, bioinformatic platforms and genomic platforms. The “transformation” of scientific research areas, such as genetics, bioinformatics and biostatistics, into clinical specialties (...) has generated a new vision of care. Molecular tumor boards are one response to these changes and are now providing better access to next-generation sequencing and new cancer treatments to patients with inoperable or metastatic cancers, and those for whom the usual treatment has failed. However, MTB face a crucial ethical challenge: maintaining and improving the trust of patients, clinicians, researchers and industry in academic medical centers supported by private or public funding rather than providing genetic data directly to private companies. We believe that, in this era of DM, appropriate modern digital communication networks will be required to maintain this trust and to improve the organization and effectiveness of the system. There is, therefore, a need to reconsider the form and content of informed consent documents at all academic medical centers and to introduce dynamic and electronic informed consent. (shrink)

ZusammenfassungTrotz seiner großen Verbreitung in den Lebenswissenschaften wurde dem Aquarium bisher wenig wissenschafts- und technikhistorische Aufmerksamkeit zuteil. Dies ist nicht zuletzt durch den Umstand begründet, dass das Aquarium und seine Geschichte bisher größtenteils als außerwissenschaftlich aufgefasst wurden. Dabei spielen so unterschiedliche Kontexte wie Akklimatisierung, Amateurnaturkunde und bürgerliche Populärkultur eine wichtige Rolle. Gleichzeitig ist die Entwicklung des Aquariums aber auch eng mit der Geschichte der Lebenswissenschaften verbunden. Mit Blick auf die zweite Hälfte des 19. Jahrhunderts verstehe ich das Aquarium als techno-natural (...) assemblage, in der Technologie, Kultur und Natur zu einem künstlichen Naturraum verbunden sind. Seine Geschichte beginnt in der britischen Amateurnaturkunde und der französischen Akklimatisierungsbewegung. Im Deutschland des späten 19. Jahrhunderts entwickelte sich das Aquarium zu einem Massenphänomen. Gleichzeitig hielt es Einzug in die Lebenswissenschaften, wo es als Einfallstor, Instrument und Umwelt Verwendung fand. Wie sich zeigt, ist das Aquarium eine hochgradig konstruierte Technologie, die sich aus einer Verbindung unterschiedlicher Traditionen herausgebildet und das Leben in die Lebenswissenschaften gebracht hat. (shrink)

In the climate ethics debate, scholars largely agree that individuals should promote institutions that ensure the reduction of greenhouse gas emissions. This paper aims to establish that there are individual duties beyond compliance with and promotion of institutions. Duties of individuals to reduce their emissions are often objected to by arguing that an individual’s emissions do not make a morally relevant difference. We challenge this argument from inconsequentialism in two ways. We first show why the argument also seems to undermine (...) the case for duties to promote institutions that the arguments’ proponents endorse. Second, we argue that individuals ought to cut emissions if they exceed their fair share of emissions entitlements and, by emitting, contribute to climate-related harm. In response to inconsequentialism, we specify the notion of ‘contribution’ via the so-called NESS theory, according to which an act is causally relevant for and contributes to an outcome if it is a Necessary Element of a Set of conditions that is Sufficient for the outcome. After refuting two objections to our approach, we conclude by discussing how to deal with possible conflicts between duties to promote institutions and to reduce one’s emissions. (shrink)

The use of evidence in medicine is something we should continuously seek to improve. This book seeks to develop our understanding of evidence of mechanism in evaluating evidence in medicine, public health, and social care; and also offers tools to help implement improved assessment of evidence of mechanism in practice. In this way, the book offers a bridge between more theoretical and conceptual insights and worries about evidence of mechanism and practical means to fit the results into evidence (...) assessment procedures. (shrink)

The focus of this special issue is on moral psychology and the goals of moral education. My focus will be considerably narrower in addressing the following question: In light of the situationist movement in psychology and philosophy, what should be the goal(s) of character education? The main conclusion will be that the central goal of character education should be modified in a certain way to make it more empirically informed. But not to worry, as this modification should be amenable to (...) most contemporary supporters of character education. (shrink)

Nanomedicine plays a prominent role among emerging technologies. The spectrum of potential applications is as broad as it is promising. It includes the use of nanoparticles and nanodevices for diagnostics, targeted drug delivery in the human body, the production of new therapeutic materials as well as nanorobots or nanoprotheses. Funding agencies are investing large sums in the development of this area, among them the European Commission, which has launched a large network for life-sciences related nanotechnology. At the same time government (...) agencies as well as the private sector are putting forward reports of working groups that have looked into the promises and risks of these developments. This paper will begin with an introduction to the central ethical themes as identified by selected reports from Europe and beyond. In a next step, it will analyse the most frequently invoked ethical concerns–risk assessment and management, the issues of human identity and enhancement, possible implications for civil liberties (e.g. nanodevices that might be used for covert surveillance), and concerns about equity and fair access. Although it seems that the main ethical issues are not unique to nanotechnologies, the conclusion will argue against shrugging them off as non-specific items that have been considered before in the context of other biomedical technologies, such as gene therapy or xenotransplantation. Rather, the paper will call on ethicists to help foster a rational, fair and participatory discourse on the different potential applications of nanotechnologies in medicine, which can form the basis for informed and responsible societal and political decisions. (shrink)

While other parts of medicine and health care seems traditionally to be primarily directed at preventing losses of bodily functions, repairing said functions in the case of such losses, or at least to provide ailment for unpleasant symptoms, sports medicine has allready from the beginning been involved with the project of enhancing bodily functions with regard to sports performance. First, when sports medicine involve itself in the traditional health care activity of prevention, therapy and ailment, the aim (...) is often very different from ordinary medical activities in that it tries to secure bodily functions far beyond what is required to reach what would normally be seen as a non-pathological state of a person. Second, sports medicine actively involves itself in the project of extending and enhancing human performance capacities through medical knowledge and technology. This raises several issues both with regard to medical ethics and the ethics of sports. For example, how should the goals of sports medicine be viewed from the perspective of rationing scarce health care resources? Should sports medicine be restricted by rules from the sports community as to which performance enhancing activities are tolerated in that sector? Or should sports medicine rather direct what is to be accepted within the world of sports? Both lines of reasoning are to be found in debates about, e.g., doping, controversial training methods and the potential use of gene technology in sports. The paper will address these issues and analyse them from a philosophical point of view. (shrink)

American society has a history of turning to physicians during times of extreme need, from plagues in the past to recent outbreaks of communicable diseases. This public instinct comes from a deep seated trust in physician duty that has been earned over the centuries through dedicated and selfless care, often in the face of personal risks. As dangers facing our communities include terroristic events physicians must be adequately prepared to respond, both medically and ethically. While the ethical principles that govern (...) physician behavior—beneficence, nonmaleficence, autonomy, and social justice—are unchanging, fundamental doctrines must change with the new risks inherent to terroristic events. Responding to mass casualty disasters caused by terrorists, natural calamities, and combat continue to be challenging frontiers in medicine. Preparing physicians to deal with the consequences of a terroristic disease must include understanding the ethical challenges that can occur. (shrink)

While in medicine, comparison of the data supplied by a clinical syndrome with the data supplied by the biological system is used to arrive at the most accurate diagnosis, the same cannot be said of financial economics: the accumulation of statistical results that contradict the Brownian hypothesis used in risk modelling, combined with serious empirical problems in the practical implementation of the Black-Scholes-Merton model, the benchmark theory of mathematical finance founded on the Brownian hypothesis, has failed to change the (...) Brownian representation, which has endured for more than fifty years despite the extent of its invalidation by experience. Without any statistical foundations, one mathematical representation has become the established approach, acting in the minds of practitioners as a “prenotion” in the sense the word is used by Durkheim, i.e. a “schematic, summary representation” which has produced a kind of spontaneous epistemology. The question arises of the persistence of this mathematical representation, which has been the basis for every financial risk modelling approach: how can its long life be explained? How was this spontaneous epistemology formed, and why did it prove to be so persistent? To address this question and offer an answer, I will test the various dynamics of scientific knowledge used with reference to financial modelling. All these dynamics are specific ways of describing the relationship between knowledge of a phenomenon and the phenomenon itself. Observing that it is impossible for the positivist approach to solve the financial puzzle, I turn to the three principal postpositivist dynamics, developed by Kuhn, Lakatos and Quine. I shall try to make to speak these representations of science for financial research, in order to reflect on the dominance of the Brownian representation in finance. We shall see that none of the epistemologies examined can explain why the Brownian representation continues to be used in mathematical finance research. I shall then propose an alternative hypothesis, concerning a significant pervading mental model that has irrigated both academics and practitioners in the financial sector: the “principle of continuity” introduced into economics by Marshall in. I consider that this principle of continuity has become a “persistent idea” in the form of a viral approach to representations, and I give this persistent idea the metaphorical name of the “Brownian virus”. Then, to explain the spread of this Brownian virus through the financial sector, the contamination of financial practices by this mental representation founded on the principle of continuity, I introduce the concept of the “financial Logos”, a discourse that structures practices and organisations, calculations, prudential regulations and accounting standards, leading to a general financialisation of society from the 1980s onwards. (shrink)

Many studies have emphasized the importance of medical, insurance, and workplace systems treating individuals fairly in work disability prevention and return-to-work. However, ethical theories and perspectives from these different systems are rarely discussed in relation to each other, even though in practice these systems constantly interact. This paper explores ethical theories and perspectives that may apply to the WDP–RTW field, and discusses these in relation to perspectives attributed to dominant stakeholders in this field, and to potential differences in different jurisdictional (...) contexts. Literature was sought primarily in biomedical ethics, business ethics, and public administration ethics. In biomedical ethics, four ethical principles are dominant: autonomy, beneficence, nonmalevolence, and justice. Business ethics involve theories on Corporate Social Responsibility, social contracts, and organizational justice. Public administration ethics focus on constitutional theory, citizenship, social equity, virtue, and public interest. Several concepts were identified as relevant for ethical analyses in the WDP–RTW field, including justice; individual autonomy; nonmalevolence; economic and social responsibility; and social contracts. These concepts provide a vocabulary that may be used to analyze stakeholders’ actions and interactions in RTW processes. It was also noted how the power balance between stakeholders will influence which ethical perspectives will influence RTW. Jurisdictional differences that influence RTW processes with regard to stakeholder responsibilities were identified, as well as varying beliefs as to who is the client in different compensation systems. A social contractual approach may inform an analysis of cultural and legal differences. (shrink)

The job of veterinarians is often described as morally challenging. This online survey (n = 123) investigated how farm veterinarians in Germany perceive these challenges. Most participants described their job in accordance with the literature: as a profession that regularly has to deal with morally difficult decisions. The majority assumed that their moral challenges were greater than the ones of small animal practitioners. The results indicate that the typical moral challenges are (a) situations in which the farm veterinarians are convinced (...) to know what is morally right, however, specific external obstacles prevent them from implementing their convictions. Therefore, the central moral problem from the veterinarians’ point of view can be described with the following words: “I would like to, but I can’t.” Other ideal types of moral challenges like (b) open ethical questions, (c) ethical dilemmas or (d) “duty vs. inclination” conflicts play a less prominent role. With regard to dealing with these challenges, the study shows that farm veterinarians are looking for exchange, for example with colleagues. Most participants see the current social debate about livestock farming as something that stresses them, arguing that their university’s curriculum did not adequately prepare them to participate in these controversies. (shrink)

In this book, Christiane L. Joost-Gaugier offers the first systematic study of Pythagoras and his influence on mathematics, astronomy, philosophy, religion, medicine, music, the occult, and social life-as well as on architecture and art-in the late medieval and early modern eras. Following the threads of admiration for this ancient Greek sage from the fourteenth century to Kepler and Galileo in the seventeenth, this book demonstrates that Pythagoras's influence in intellectual circles-Christian, Jewish, and Arab-was more widespread than has previously been (...) acknowledged. Joost-Gaugier shows that during this period Pythagoras was respected by many intellectuals in different areas of Europe. She also shows how this admiration was reflected in ideas that were applied to the visual arts by a number of well known architects and artists who sought, through the use of a visual language inspired by the memory of Pythagoras, to obtain perfect harmony in their creations. Among these were Alberti, Bramante, Leonardo da Vinci, Michelangelo, and Raphael. Thus did, she suggests, some of the greatest art works in the Western world owe their modernity to an inspirational force that, paradoxically, had been conceived in the distant past. (shrink)

This book involves an in-depth analysis of the ethical, political and philosophical issues related to health-oriented screening programs.

The fact that Ludwik Fleck drew his inspiration from medicine has been largely overlooked, with the exception of a few scholars. Although Fleck considered his ideas applicable to all sciences, he always insisted on the specificity of medicine. To illustrate the usefulness of Fleck’s concepts for the history of medicine, three main ideas developed by Fleck are applied to the historical study of diabetes mellitus : first, that different and often divergent pictures of disease coexist within a (...) given culture; second, that scientific ideas circulate between ‘esoteric’ and ‘exoteric’ circles; and third, that scientific concepts are often incommensurable. The author also suggests that Fleck’s epistemology, like other scholars’, is loaded with ethical and political consequences. However, the link between an ‘open’ epistemology and political or ethical questions is more explicit in Georges Canguilhem’s pioneering work on the normal and the pathological . Indeed, Canguilhem and Fleck’s conceptions of disease have much in common, so that we can use Canguilhem’s work to bring out the hidden ethical and political issues in Fleck’s work. (shrink)

Military physicians are often perceived to be in a position of ‘dual loyalty’ because they have responsibilities towards their patients but also towards their employer, the military institution. Further, they have to ascribe to and are bound by two distinct codes of ethics, each with its own set of values and duties, that could at first glance be considered to be very different or even incompatible. How, then, can military physicians reconcile these two codes of ethics and their distinct professional/institutional (...) values, and assume their responsibilities towards both their patients and the military institution? To clarify this situation, and to show how such a reconciliation might be possible, we compared the history and content of two national professional codes of ethics: the Defence Ethics of the Canadian Armed Forces and the Code of Ethics of the Canadian Medical Association. Interestingly, even if the medical code is more focused on duties and responsibility while the military code is more focused on core values and is supported by a comprehensive ethical training program, they also have many elements in common. Further, both are based on the same core values of loyalty and integrity, and they are broad in scope but are relatively flexible in application. While there are still important sources of tension between and limits within these two codes of ethics, there are fewer differences than may appear at first glance because the core values and principles of military and medical ethics are not so different. (shrink)

Two essential periods may be identified in the early stages of the history of vitamin D-resistant rickets. The first was the period during which a very well known deficiency disease, rickets, acquired a scientific status: this required the development of unifying principles to confer upon the newly developing science of pathology a doctrine without which it would have been condemned to remain a collection of unrelated facts with very little practical application. One first such unifying principle was provided by the (...) notion of hygiene; while the blanket explanations provided by this notion alone were much too general to enable rickets to achieve scientific status, it did point out the need to look for specific external causes for the disease and to examine the life-style and dietary habits of the patients. The second phase of the conceptualization of the disease was the assumption of a specific cause — that is, using concepts developed in the area of infectious diseases. This was made possible by fundamental similarities between deficiency and infectious diseases, in spite of their apparent differences. Both types of illness have some of the characteristics of what Georges Canguilhem calls the ontological representation of disease as opposed to dysharmonic representations, which primarily concern the endocrine diseases. It is precisely this shift from one to the other manner of perceiving ill health that enabled the identification of the vitamin D-resistant rickets. Conceptualization of the notion of vitamin D resistancy required that the conditions causing the disease be looked for within the organism rather than outside it; this was thus the first time that endocrine concepts were applied to studying the physiology of vitamin D.The history of resistant rickets therefore represents an interesting model for understanding the growth of biomedical knowledge. It allows the development of a number of more general ideas on the question of the relationship between biology and medicine and on the thorny problem of specificity in medical thinking. As far as this topic is concerned it can be seen that there was an ongoing exchange between medical and biological thinking during the initial period up until 1937, and that one could deny any such specificity in medical thinking during this same period. Albright, for example, used human diseases as spontaneously produced models for experimental biology. It was also more feasible for an experimental biologist to administer toxic doses than for a clinician to do so.What, then, if any, is the place of the specificity of medical thinking in this history? The fact that medicine is characterized not only by it ccognitive content78 but also by its final aim, which is to restore health, makes it necessary to take factors other than objective knowledge into consideration. This is particularly evident in two aspects of medicine, therapeutics and nosology, and in approaching the notion of pathological individuality.Therapeutic activity has a largely empirical approach. Many drugs, such as cod-liver oil, were discovered empirically. Treatment often in the past, and still now, has proceeded by trial and error, upon no established theoretical basis. At this level the relationship between biology and medicine is roughly comparable to that between science and technology79 \3- that is, it is impossible to reduce either therapeutics or technical activities to the simple application of basic science. In this sense, the application of vitamin D to vitamin-resistant rickets is quite typical. Further-more, in the case studied here, the therapeutic activity heralds a definite breaking away from the medicatrix naturae of conventional medicine dating back to ancient times, and it embodies a new concept of the organism and of disease: no longer can the diseased organism be thought of as merely having a perturbed equilibrium requiring restoration by means of a natural style of medicine. On the contrary, vitamin D resistance is an obstacle that indicates profound biological dysfunction, to be rectified only by means of an extremely aggressive and therefore dangerous therapy. The therapy thus serves to reveal the severity of the dysfunction, thereby leading inevitably to conceptual innovation. This sheds light on the theoretical innovations of which the therapeutic activity is capable.Therapeutic activity is also influenced by notions of health and illness, normal and pathological states, none of which may be determined entirely objectively. For example, the term healing as used by Albright in the case of resistant rickets that he described may be discussed in this light.Nosology, or the classification of diseases, depends largely on the description of clinical syndromes, which are themselves mainly based on subjective elements (discomfort, disability, or the extent of a patient's suffering). The advent of pathological anatomy at the beginning of the nineteenth century disrupted classification by introducing the concept of localized anatomical lesions81-and, hence, an element of material objectivity \3- into nosology. Radiological examination further complicated matters by enabling the equivalent of an autopsy on living matter. Lastly, biological examination complicated nosology by showing that biological anomalies may exist in human beings without necessarily leading to a pathological condition. Medical thinking can choose to combine all these elements to describe a disease, but can also separate them and retain only a few, or a single one, according to requirements - as did Albright.The notion of biological and pathological individuality is fundamental to the development of medical thinking. Whatever its theoretical origin, medical thinking has since ancient times incorporated the idea that each individual reacts differently to the same treatment and his own specific pathological tendencies. I mentioned earlier that in the history of vitamin D-resistant rickets the notion of rachitic tendency reflected this type of thinking. After 1937, this history progressed by successively separating new individual entities, affecting smaller and smaller groups of individuals in each case. In other words, the need to understand and to define individual illness more closely required the development of new concepts and the construction of new individual categories of disease linking these concepts to older clinical, radiological, and biochemical elements. (shrink)

This volume addresses the interdependencies between visual technologies and epistemology with regard to our perception of the medical body. It explores the relationships between the imagination, the body, and concrete forms of visual representations: Ranging from the Renaissance paradigm of anatomy, to Foucault's "birth of the clinic" and the institutionalised construction of a "medical gaze"; from "visual" archives of madness, psychiatric art collections, the politicisation and economisation of the body, to the post-human in mass media representations. Contributions to this volume (...) investigate medical bodies as historical, technological, and political constructs, constituted where knowledge formation and visual cultures intersect. Contributors are: Axel Fliethmann, Michael Hau, Birgit Lang, Carolyn Lau, Heikki Lempa, Stefanie Lenk, Joanna Madloch, Barry Murnane, Jill Redner, Claudia Stein, Elizabeth Stephens, Corinna Wagner, and Christiane Weller. (shrink)

Advanced AI systems are rapidly making their way into medical research and practice, and, arguably, it is only a matter of time before they will surpass human practitioners in terms of accuracy, reliability, and knowledge. If this is true, practitioners will have a prima facie epistemic and professional obligation to align their medical verdicts with those of advanced AI systems. However, in light of their complexity, these AI systems will often function as black boxes: the details of their contents, calculations, (...) and procedures cannot be meaningfully understood by human practitioners. When AI systems reach this level of complexity, we can also speak of black-box medicine. In this paper, we want to argue that black-box medicine conflicts with core ideals of patient-centered medicine. In particular, we claim, black-box medicine is not conducive for supporting informed decision-making based on shared information, shared deliberation, and shared mind between practitioner and patient. (shrink)

Genetic predispositions often concern not only individual persons, but also other family members. Advances in the development of genetic tests lead to a growing number of genetic diagnoses in medical practice and to an increasing importance of genetic counseling. In the present article, a number of ethical foundations and preconditions for this issue are discussed. Four different models for the handling of genetic information are presented and analyzed including a discussion of practical implications. The different models’ ranges of content reach (...) from a strictly autonomous position over self-governed arrangements in the practice of genetic counseling up to the involvement of official bodies and committees. The different models show a number of elements which seem to be very useful for the handling of genetic data in families from an ethical perspective. In contrast, the limitations of the standard medical attempt regarding confidentiality and personal autonomy in the context of genetic information in the family are described. Finally, recommendations for further ethical research and the development of genetic counseling in families are given. (shrink)

ZusammenfassungDie Zeitgeschichte der Prävention hat Konjunktur. An ihr lässt sich nämlich exemplarisch der Wandel von Konzepten, Organisation und Praxis des biopolitischen Regierens von Bevölkerung anhand des vorbeugenden gesellschaftlichen Umgangs mit Gesundheit und Krankheit beleuchten. Eine entscheidende Technologie ist hierbei die Gesundheitsaufklärung. Diese ist jedoch nach wie vor gerade im Hinblick auf ihre methodologischen Wandlungsprozesse sowie auf die Relationen zwischen internationalen Entwicklungen und nationalen Implementationen wenig erforscht. Auf Grundlage einer quantitativen sowie qualitativen Analyse dreier englischsprachiger Zeitschriften wird diese Lücke im Folgenden (...) ein Stück weit geschlossen. Es wird gezeigt, wie sich in den 1950er Jahren ein internationaler Fachdiskurs der Gesundheitserziehung etablierte und in diesem sich ein verwissenschaftlichendes Berufsfeld konstituierte. Darin wurde die Forderung deutlich, vom deutschen Modell einer anschaulichen Vermittlung medizinischen Wissens vor allem durch Ausstellungen abzukommen und sich auf die Integration sozialwissenschaftlicher Erkenntnisse und Methoden zu fokussieren. Aus der Perspektive der behavioural sciences wurden das Handeln und die Möglichkeit seiner Beeinflussung in Netze wechselseitiger Einflussfaktoren eingefügt: Nur Umfrageforschung zu Gesundheitseinstellungen und -motivationen sowie zur Wirkung der eigenen Aktivitäten schien es zu ermöglichen, den in der Gesundheitserziehung priorisierten Zweck zu erfüllen, Verhalten zu ändern. Über solch eine Zweck‑, Mittel- und Wissensbestimmung, die – gleichwohl unterschiedlich – sowohl in der Bundesrepublik als auch in der DDR rezipiert und institutionalisiert wurde, vergewisserten sich die Akteure im Diskurs, einer internationalen Profession der healtheducators anzugehören. Doch die Hoffnungen, „Rezepte für die Lenkung der Menschen“ zu finden, erfüllten sich auch mit mehr Forschung und der Implementation ihrer Ergebnisse nicht. (shrink)

While the 1970's have been called the environmental years, the 1990's could be seen as the genome years. As the challenge to map and to sequence the human genome mobilized the scientific community, risks and benefits of information and uses that would derive from this project have also raised ethical issues at the international level. The particular interest of the 1997 UNESCO Declaration relies on the fact that it emphasizes both the scientific importance of genetics and the appropriate reinforcement of (...) human rights in this area. It considers the human genome, at least symbolically, as the common heritage of humanity. (shrink)

Wolfgang Huber recently reflected on current frontiers in medicine and exemplified the need for ethical boundaries especially in the case of the brain death definition, which appears to him to meet rather medical interests than the needs of human dignity. In contrast, this article describes the complex interdependence of medical innovation and ethical thinking in the development of the brain death definition in the USA. In this case, human dignity seems to be mediated with the individual life interest at (...) specifice intermediate Ievels, which are lying between the basic philosophical and the specific medical sphere. This may have helped to avoid disagreements caused by the various approaches of medical and ethical professionals and laymen. (shrink)

The debate in philosophy of science in the twentieth century over the theory-laden-ness of observation showed both that there are many ways in which scientific observation depends on theory, and also highlighted some ways in which it is blind to theoretical assumptions. Debates in the philosophy of medicine have shown how concepts and theories of illness are value-laden, especially in psychiatry. Kious in his helpful and stimulating target article argues that the mainstream approach to autonomy depends on assumptions about (...) value, and this conclusion is surely correct. However, his focus on the concept of non-voluntariness is problematic, as I argue, and we are better off not seeing it as laden with. (shrink)

ABSTRACT Numerous benefits for patients have been predicted if prescribing decisions were routinely accompanied by pharmacogenetic testing. So far, little attention has been paid to the possibility that the routine application of this new technology could result in considerable harm to patients. This article emphasises that pharmacogenetic testing shares both the opportunities and the pitfalls with ‘conventional’ disease‐genetic testing. It demonstrates that performing pharmacogenetic tests as well as interpreting the results are extraordinarily complex issues requiring a high level of expertise. (...) It further argues that pharmacogenetic testing can have a huge impact on clinical decisions and may influence the therapeutic strategy as well as the clinical monitoring of a patient. This view challenges the predominant paradigm that pharmacogenetic testing will predict patients’ responses to medicines, but that it will not provide any other significant disease‐specific predictive information about the patient or family members. The article also questions published proposals to reduce the consent procedure for pharmacogenetic testing to a simple statement that the physician wishes to test a sample of the patient's DNA to see if a drug will be safe or whether it will work, and presents an alternative model that is better suited to protect patients’ interests and to obtain meaningful informed consent. The paper concludes by outlining conditions for the application of pharmacogenetic testing in clinical practice in a way that can make full use of its potential benefits while minimising possible harm to patients and their families. (shrink)

In this paper, we challenge the usual argument which says that competition is a fair mechanism because it ranks individuals according to their relative preferences between effort and leisure. This argument, we claim, is very insufficient as a justification of fairness in competition, and we show that it does not stand up to scrutiny once various dynamic aspects of competition are taken into account. Once the sequential unfolding of competition is taken into account, competition turns out to be unfair even (...) if the usual fairness argument is upheld. We distinguish between two notions of fairness, which we call U-fairness, where ‘U’ stands for the ‘usual’ fairness notion, and S-fairness, where ‘S’ stands for the ‘sequential’ aspect of competition. The sequential unfairness of competition, we argue, comprises two usually neglected aspects connected with losses of freedom: first of all, there is an ‘eclipse’ of preferences in the sense that even perfectly calculating competitors do not carry out a trade-off between effort and ranking; and second, competitive dynamics leads to single-mindedness because the constraints on the competitors’ choices always operate in the sense of increased competitiveness and, therefore, in the direction of an increased effort requirements. We argue (1) that competition is S-unfair even if it is U-fair, (2) that as S-unfairness increases, the ethical relevance of U-fairness itself vanishes, so that (3) by focusing as they usually do on U-fairness alone, economists neglect a deeper aspect of unfairness. (shrink)

History is full of references to dancing plague, dance mania, ecstatic dance, collective effervescence, choreo mania, collective psychosis, and Tarantism. In each of these cases, groups of people come together in joint activity (typically dance) and reach a prolonged ecstatic state in which they cannot stop the movement. To this day, academic literature in medicine, psychology, history, and cognitive science has not been able to answer the question; why does ecstatic dance lead to a loss of executive control? I (...) here focus on the case of group dance and provide an enactive embodied account of the loss of executive control. I argue that dancing crowds are scaffolded, self-organizing, self-perpetuating, dynamical systems. Within such systems, the majority of affordances provided to the individual agent lead to the perpetuation of the system, leading to more dancing. The embodied impact of the crowd, as an emergent entity, on the individual also leads to change in the sense of agency. Dancers experience being “unable to stop” because the sense of “who” is initiating the movements changes within crowd dance interaction. If it is unclear who is moving, then the interaction is experienced as outside individual control. (shrink)

Perceptions are often merely regarded as the basic elements of knowledge. They have, however, a complex structure of their own and are far from being elementary. My paper will analyze two basic patterns of perception and some of the resulting medical implications. Most basically, all object perception is characterized by a mixture of knowledge and ignorance (Husserl). Perception essentially perceives with inner and outer horizons, brought about by the kinesthetic activity of the perceiving subject (Sartre). This first layer of perceptual (...) reality, the world of open perceptions, is the inescapable background for every rationality, every value, every existence (Merleau-Ponty). On an epistemological level a characteristic change of perceptual patterns in medicine was introduced by pathological anatomy (Foucault). The reference of medical perception to the dead body created the new possibility of absolute perception, allowing for more precise medical interventions, but at the same time coming into conflict with the open structures of ordinary, non-scientific perception patterns in everyday life. On the basis of these distinctions, an analysis of the different perceptual patterns in medicine becomes possible. Such an analysis would be the task of a sub-field in medical philosophy that could be called medical aesthetics having as its goal an art of perception understood as a technique of adequately applying different perceptual patterns in medical practice. (shrink)

Questions concerning the parent/ patient’s autonomy are seen as one of the most important reasons for requesting Ethics Consultations. Respecting parent/ patient’s autonomy also means respecting the patient’s wishes. But those wishes may be controversial and sometimes even go beyond legal requirements. The objective of this case series of 32 ECs was to illustrate ethically challenging parent / patients’ wishes during the first stages of life and how the principle of patient’s autonomy was handled. The case series has a qualitative (...) retrospective approach. A documentary sheet was designed de novo and information was gained from EC minutes and medical charts. The cases originate from the following specialties: reproductive medicine, obstetrics and neonatology as well as two interdisciplinary cases. Through the structured EC minutes aspects of patient / parents’ wishes could be identified explicitly. Overall the patient / parents’ wishes were not supported in 61% of the cases. Central reasons for rejection of patient / parent wishes were mainly the protection of the best interest of the unborn / new-born child as well as the rejection of clinical approaches that were regarded as being substandard treatment. The study shows that treatment decisions in reproductive medicine, obstetrics and neonatology raise substantial ethical questions leading to the request for ethics consultation. The systematic case series presented here gives insight into the ethical reflection carried out to support the clinicians in their decision-making and counselling. It shows that clinicians, after using ethics consultation, make deliberate decisions that do not “automatically” fulfil the treatment requests of the patients and parents. (shrink)

reminds us that reproductive medicine has become part of our social reality and as such justifies the intervention of public authorities. The Instruction suggests relevant principles which should guide appropriate legislation. This essay analyzes how far the French government has taken these fundamental principles into account. Keywords: IVF-ET, Donum Vitae , civil law, France CiteULike Connotea Del.icio.us What's this?

Medical genetic interventions can be performed in two ways. First, genetic defects may be repaired (gene therapy). Secondly, a possible future individual (an embryo or a possible combination of gametes) may be preselected because of its favourable genetic make-up (by using genetic diagnostic methods and procedures from reproductive medicine so called Preimplantation Genetic Diagnosis). The first kind of intervention means that someone gets medical treatment in the normal sense, however, the second kind does not. Rather, in that case, the (...) potential patient is exchanged for another individual who is in no need of treatment. The paper explores to what extent arguments for and against these kinds of genetic intervention apply equally to all of them. For example, may the benefits that can be achieved through gene therapy be equally well achieved through genetic preselection? Are fears of a resurrection of eugenic practices through gene technology more warranted regarding therapeutic interventions than regarding preselective ones (or vice versa)? Since genetic preselection is an intervention at the germ-line level and is presently clinically applied: How is it possible to motivate that clinical application of germ-line gene therapy is not similarily permitted? (shrink)

Standard versions of the requirement of informed consent state that patients who are offered to enter a clinical trial of a medical procedure should be informed about risks and possible benefits of this procedure (compared to available alternatives) in order to facilitate a rational decision whether or not to participate. However, in many real cases where new medical procedures are to be clinically tested for the first time the information available for such communication to prospective patients is very scarce, vague (...) and/or uncertain. This phenomenon is illustrated by the clinical introduction of new procedures in reproductive medicine, such as preimplantation genetic diagnosis (PGD). Regarding such procedures, it has ben argued that, in such cases, the quality of the available information may be too low for the obtaining of informed consent to be possible, even if it is successfully communicated. Others, instead, holds that informed consent may always be obtained regardless of the quality of the available information. Unfortunately, the standard litterature on informed consent give no clue as to which of these interpretations is correct. This issue is explored by connecting the concept of informed consent to ethical ideas of respect for autonomy and ideas of rational decision making. It is argued, first, that low quality of available information regarding the risks and possible benefits of a medical procedure may indeed make the obtaining of informed consent from patients to undergo this procedure impossible even in theory. However, it is also argued that whether or not this is the case must be relativized to the actual needs and deires of individual patients. Thus, regarding one and the same procedure, informed consent may be impossible to obtain from some patients due to the low quality of the available information regarding this procedure, but still be possible to obtain from other patients. (shrink)

Codes are a well known and popular but weak form of ethical regulation in medical practice. There is, however, a lack of research on the relations between moral judgments and ethical Codes, or on the possibility of morally justifying these Codes. Our analysis begins by showing, given the Nuremberg Code, how a typical reference to natural law has historically served as moral justification. We then indicate, following the analyses of H. T. Engelhardt, Jr., and A. MacIntyre, why such general moral (...) justifications of codes must necessarily fail in a society of ‘’moral strangers’ Going beyond Engelhardt we argue, that after the genealogical suspicion in morals raised by Nietzsche, not even Engelhardt's "principle of permission" can be rationally justified in a strong sense – a problem of transcendental argumentation in morals already realized by I. Kant. Therefore, we propose to abandon the project of providing general justifications for moral judgements and to replace it with a hermeneutical analysis of ethical meanings in real-world situations, starting with the archetypal ethical situation, the encounter with the Other (E. Levinas). (shrink)

Unser Beitrag stellt ein interaktives Ethik-Konzept vor, das in Zusammenarbeit der BruderhausDiakonie Reutlingen und der Universität Tübingen entwickelt wurde, um den Eigenheiten und Bedarfen einer komplexen Organisationsstruktur gerecht zu werden, die mehrere Geschäftsfelder und Standorte unter sich vereint. Wir skizzieren die Grundzüge des interaktiven Nijmegener Modells, in dem die Kooperation eines auf Leitungsebene angesiedelten Komitees und situationsbezogener Fallbesprechungen ein fruchtbares Zusammenspiel zweier unverzichtbarer Reflexionsweisen bewirken soll. Wir zeigen auf, welche Herausforderungen sich bei der Implementierung dieses Modells in die konkrete Aufbauorganisation (...) der BruderhausDiakonie ergaben, und mit welchen konzeptionellen oder „implementationstechnischen“ Mitteln ihnen begegnet wurde. Im Zentrum steht dabei die Erweiterung des Nijmegener Modells um ein Verbindungselement, welches die Zusammenarbeit zwischen zentralem Ausschuss und dezentralen Fallbesprechungen koordiniert und das interaktive Moment des Modells erst ermöglicht. (shrink)

Definition of the problemMedical and nursing care often takes place within complex organizational structures that comprise numerous facilities at numerous locations. We introduce an interactive ethical concept, designed in cooperation with the diaconal foundation BruderhausDiakonie Reutlingen and the International Centre for Ethics in Science, University of Tübingen, to address the particular needs of such organizations.ArgumentsTherefore we portray the interactive Nijmegen Model which combines an ethics committee located at the management level and situational ethical case deliberations on the ward in order (...) to bring together two indispensable ways of ethical reflection in organizations: “top-down”/“bottom-up”. We illustrate the challenges of implementing the said model into the organizational construction of the BruderhausDiakonie and how to address these by means of conception and implementation.ConclusionConsidering the implementational challenges that we encountered, the Nijmegen Model needs to be enhanced by introducing a link between the committee and the case deliberations. We delineate the basic elements and the requirements for such a position while reporting our initial practical experience with this model. (shrink)

In an increasingly data-driven age of medicine, do companies that offer genetic testing directly to patients represent an important part of personalising care, or a dangerous threat to privacy? Should we celebrate this new mechanism of patient involvement, or fear its implications?The Universities of Oxford and Cambridge addressed these issues in the 10th annual Medical Ethics Varsity Debate, through the motion: “This House Regrets the Rise of Direct-to-Consumer Genetic Testing”. This article summarises and extends key arguments made in the (...) debate, exploring the impacts of such genetic testing on both the individual patient and broader society, with special consideration as to whether companies can ever truly guarantee anonymity of genetic data. (shrink)

In an increasingly data-driven age of medicine, do companies that offer genetic testing directly to patients represent an important part of personalising care, or a dangerous threat to privacy? Should we celebrate this new mechanism of patient involvement, or fear its implications?The Universities of Oxford and Cambridge addressed these issues in the 10th annual Medical Ethics Varsity Debate, through the motion: “This House Regrets the Rise of Direct-to-Consumer Genetic Testing”. This article summarises and extends key arguments made in the (...) debate, exploring the impacts of such genetic testing on both the individual patient and broader society, with special consideration as to whether companies can ever truly guarantee anonymity of genetic data. (shrink)

This research presents the results of a survey regarding scientific misconduct and questionable research practices elicited from a sample of 1215 management researchers. We find that misconduct is not encountered often by reviewers nor editors. Yet, there is a strong prevalence of misrepresentations. When it comes to potential methodological improvements, those that are skeptical about the empirical body of work being published see merit in replication studies. Yet, a sizeable majority of editors and authors eschew open data policies, which points (...) to hidden costs and limited incentives for data sharing in management research. (shrink)

For the first time in history, genetics will enable science to completely identify each human as genetically unique. Will this knowledge reinforce the trend for more individual liberties or will it create a ‘brave new world’? A law policy approach to the problems raised by the human genome project shows how far our democratic institutions are from being the proper forum to discuss such issues. Because of the fears and anxiety raised in the population, and also because of its wide (...) implications on the everyday life, the human genome analysis more than any other project needs to succeed in setting up such a social assessment. Keywords: human genome project, judiciary law policy, legislative activity, new ethics institutions, methodology in law reform, public debate, social consensus CiteULike Connotea Del.icio.us What's this? (shrink)