Zur patientenorientierten Behandlung bei nichteinwilligungsfähigen Patienten werden aktuell der Einbezug oder auch die Entscheidung durch ein Ethikkonsil oder klinisches Ethikkomitee (KEK) gefordert. Damit die Entscheidung des Entscheidungsträgers durch das KEK unterstützt werden kann, müssen Zuständigkeiten, Besetzung und Arbeitsweise des Gremiums klar umschrieben sein.

Discussions in Germany regarding appropriate end-of-life decision-making have been heavily influenced by the liberalization of access to physician-assisted suicide and voluntary active euthanasia in the Netherlands and Belgium. These discussions disclose conflicting moral views regarding the propriety of physician-assisted suicide and euthanasia, threatening conflicts within not only the medical profession, but also the mainline churches in Germany, whose membership now entertains views regarding end-of-life decision-making at odds with traditional Christian doctrine. On the surface, there appears to be a broad consensus (...) supporting the hospice movement and condemning physician-assisted suicide and euthanasia. The German Supreme Court has held that treatment decisions should, in absence of known patients’ wishes, be made in light of commonly shared values, unless these violate the principle of “in dubio pro vita”. The Roman Catholic church and the Evangelical Lutheran church in Germany have developed an advance directive for treatment choices at the end of life, while condemning physician-assisted suicide and euthanasia. This stance is in tension with the strong emerging support for physician-assisted suicide and euthanasia, a development that promises to open up foundational disagreements within mainline German Christianity regarding the appropriate approach to intentionally terminating human life. (shrink)

Modern medicine, based on enormous progress in science and its applications, has lost dimensions of individualized treatment and compassion which traditionally were an essential part of physician’s service over the millennia in Eastern and Western cultures. Today diseases and symptoms, rather than persons, are treated, based on objective quality norms and inflexible payment schemes rather than the rather than persons. We present a checklist model for personalized health care, which has been successful in teaching and practice to reclaim lost territory (...) in treating patients as persons. (shrink)

Zur patientenorientierten Behandlung bei nichteinwilligungsfähigen Patienten werden aktuell der Einbezug oder auch die Entscheidung durch ein Ethikkonsil oder klinisches Ethikkomitee (KEK) gefordert. Damit die Entscheidung des Entscheidungsträgers durch das KEK unterstützt werden kann, müssen Zuständigkeiten, Besetzung und Arbeitsweise des Gremiums klar umschrieben sein.

In den letzten Jahren hat sich eine Vielfalt unterschiedlicher Gremien zur Ethikberatung entwickelt: vom Konsil mit einem einzelnen Berater bis zum Ethikkomitee. In dem Band werden die Ethikberatung, ihre Entwicklung und Anwendung, sowie die Gründung von Gremien in Krankenhäusern, Pflegeeinrichtungen, Hospizen und von niedergelassenen Ärzten anhand von Fallbeispielen erläutert. Dabei schlagen die Autoren eine Brücke zwischen traditioneller philosophischer Ethik und anwendungsbezogener klinischer Ethik. Auch rechtliche Fragen werden erörtert.

In matters such as affirmative action or home schooling, rights of ethnic and other minority groups often come into conflict with those of society in a culturally diverse population such as ours. But before considering the dilemmas posed by these issues, we must first ask such basic but important questions as what group rights are and how they intersect with the principles of democracy. This new collection brings together some of today's leading thinkers from the cutting edge of these debates, (...) taking in a broad range of issues confronting philosophers, sociologists, and political scientists. Contributors such as Carl Wellman, Carol Gould, and Rex Martin examine the nature of groups and the conflict between group rights and democracy and also consider case studies depicting current issues in cultural, ethnic, and religious rights. The first section, on the nature of groups, examines some of the perplexing alternatives in the formulation of a theory of group rights. These articles investigate the kinds of rights minorities might claim and ask when groups can be held responsible for the acts of some of their members. The second section addresses the treatment of groups in a democracy and the precarious balance between indifference toward minorities and capitulation to their demands. Here the contributors examine five principles for the sensitive treatment of minority and disadvantaged groups in a democratic society. A final section explores specific conflicts between subgroup and societal claims through case studies dealing with affirmative action, religious practice and the education of children, and the land rights of indigenous peoples. By drawing on the legal and political dilemmas related to these cases, the authors confront issues of core versus peripheral interests, of individual member versus subgroup rights, and of the possibilities for social openness raised in the preceding sections Written from varied perspectives, Groups and Group Rights offers stimulating reading for both students and professionals as it takes on some of the most pressing dilemmas confronting our society. (shrink)

The research described here contributes to the extant empirical research on business ethics education by examining outcomes drawn from the literature on positive organizational scholarship (POS). The general research question explored is whether a course on ethical decision-making in business could positively influence students’ confidence in their abilities to handle ethical problems at work (i.e., moral efficacy), boost the relative importance of ethics in their work lives (i.e., moral meaningfulness), and encourage them to be more courageous in raising ethical problems (...) at work even if it is unpopular (i.e., moral courage). Specifically, the study used a rigorous quasi-experimental pretest–posttest research design with a treatment (N = 30) and control group (N = 30) to investigate whether a graduate-level course in business ethics could influence students’ levels of moral efficacy, meaningfulness, and courage. Findings revealed that participants in the business ethics treatment course experienced significant positive increases in each of the three outcome variables as compared to the control group. The largest increase was in moral efficacy, followed by moral courage, and finally, moral meaningfulness. These findings are discussed in the context of the current research on business ethics education and POS. Implications for future research are discussed. (shrink)

Ethical conduct is the hallmark of excellence in engineering and scientific research, design, and practice. While undergraduate and graduate programs in these areas routinely emphasize ethical conduct, few receive formal ethics training as part of their curricula. The first purpose of this research study was to assess the relative effectiveness of ethics education in enhancing individuals’ general knowledge of the responsible conduct of research practices and their level of moral reasoning. Secondly, we examined the effects of ethics education on the (...) positive psychological outcomes of perspective-taking, moral efficacy, moral courage, and moral meaningfulness. To examine our research hypotheses, we utilized a pretest–posttest quasi-experimental design consisting of three ethics education groups (control, embedded modules, and stand-alone courses). Findings revealed that both embedded and stand alone courses were effective in enhancing participants’ perspective-taking, moral efficacy, and moral courage. Moral meaningfulness was marginally enhanced for the embedded module condition. Moral judgment and knowledge of responsible conduct of research practices were not influenced by either ethics education condition. Contrary to expectations, stand alone courses were not superior to embedded modules in influencing the positive psychological outcomes investigated. Implications of these findings for future research and practice are discussed. (shrink)

A medical centre is an institution established for a specific purpose: to facilitate the health and health-related welfare of the medical centre's patients. Within this institution, there are a variety of professionals who act and interact to serve this purpose. Of particular interest is the interaction between physician and nurse. Generally, the nurse is thought to be under a certain obligation to implement a physician's orders unless there is good reason not to do so. This qualifier places a conflicting obligation (...) upon the nurse not to implement some physician orders. How should a judgement about which orders there is 'good reason' not to implement be made? I propose to approach this question through an analysis of the obligation the nurse has to implement the order of a physician, and the conditions under which the order does not pose such obligations. This analysis will consist of an examination of the obligation in terms of the purposive authority of the physician. For example, in the context of the medical centre, the physician's medical training qualifies her as best able to make determinations of what treatment would promote the patient's health. However, this purpose not only serves as the basis of the physician's authority, but also serves as a limitation upon the physician's authority (for example, an order which would harm the patient would not reflect the purpose for which the physician has been given authority). Thus, a philosophical investigation into the nature of the obligation to implement a physician's orders can help to clarify those occasions when a nurse should not implement an order. (shrink)

This paper develops a model of the nurse/physician authority relationship presented in an earlier issue of this journal, and responds to criticisms raised against that model in commentaries on that article. Specifically, I examine the discrepancy which exists between medical knowledge and nursing education, and show this discrepancy to be a difference in type, not quality. The implication is that improvements in nursing education will not affect the authority relationship between physician and nurse. To affect this relationship the nature of (...) nursing education must change. (shrink)

Excerpt from Das Ethische System des Helvetius Beobachtung gegründeten Principien irgend einer Kunst oder Wissenschaft. Gehe der Philosoph nicht bei der Erfahrung in. 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)

Whereas present theories of transformative learning tend to focus on the rational and reflective actor, in this article it is suggested that spontaneous action may play a decisive role in transformative learning too. In the spontaneity of action, novelty finds its way into life, gains momentum, is respected by others and reflected by the actor. Such transformation processes are investigated both with the means of theoretical reflection and of empirical inquiry. Based on nine narrative interviews typical phases of transformative learning (...) processes are identified. Owing to the comparative nature of the study, it was also possible to develop an age‐related typology that overlaps certain phases of the transformation process. These empirical findings constitute the background against which the nexus of spontaneous action and transformative learning is reflected theoretically. Theories drawn upon include John Dewey's Pragmatism and George Herbert Mead's Social Pragmatism. Both scholars provide rich theoretical concepts for reflecting on the nature of that what so often eludes from the control of both educators and learners: the spontaneity of the beginning. (shrink)

ZusammenfassungDie Diskussionen um Sterbehilfe und Patientenverfügung sowie der Ruf nach einer Stärkung der Palliativmedizin nehmen viel Platz in der deutschen Presselandschaft ein. Da Zeitungen einerseits Meinungen und Wissen der Bevölkerung abbilden, andererseits auch zu deren Meinungsbildung und Information beitragen, wurde eine Analyse der Darstellung der Sterbehilfedebatte und der Palliativmedizin durchgeführt. Als empirisches Material dienten 433 Artikel aus den Jahren 2006 und 2007, die mithilfe einer Suche nach den Schlagworten „Palliativmedizin“, „Hospiz“, „Sterbebegleitung“, „Patientenverfügung“, „Patientenautonomie“ und „Sterbehilfe“ in den Print-Archiven verschiedener deutscher (...) Zeitungen identifiziert wurden. Diese Artikel wurden einer qualitativen Inhaltsanalyse unterzogen. Mit Würde, Selbstbestimmung, Unterversorgung und Unsicherheit zeigten sich vier Hauptargumente innerhalb der Sterbehilfedebatte. Würde wird dabei als Argument sowohl für wie gegen aktive Sterbehilfe benutzt. Eine Unsicherheit zeigt sich in der Terminologie der Sterbehilfe. Das Bild der Palliativmedizin ist gekennzeichnet von der Hoffnung, dass sie eine Alternative zur Sterbehilfe bieten kann, sofern sie weiter ausgebaut und besser finanziert wird. Die Ergebnisse bestätigen die in verschiedenen Studien aufgezeigte Bedeutung der Begriffe Würde und Selbstbestimmung für die Einstellung der Bevölkerung zu Sterbehilfe, Suizidbeihilfe und Patientenverfügungen. Das Potential und die noch zu gering ausgebauten Strukturen der Palliativmedizin werden zunehmend erkannt. Demgegenüber erschwert das mangelnde Wissen um die Sterbehilfe-Terminologie und die rechtlichen Grundlagen der Therapiebegrenzung und Patientenverfügungen eine Diskussion um die Sterbehilfe auch auf fachlicher Ebene. (shrink)

Economic principles and instruments have been introduced into the German welfare system. The European Union wants to realize an open market economy with free competition for the social services. In this situation Christian welfare organisations get in conflict with their churches and the ethics of Christianity. The concepts of »entrepreneurship diakonia« and »advocatory diakonia« are completed and criticized by the new concept of a »public diakonia of citizenship and community« on the basis of the ethical principles of charity, justice and (...) man’s dignity. According to that new concept »diaconics« and economics may learn from each other in a dialogue of reciprocity. (shrink)

The international political economy for higher education is marked by an increasing globalisation and regionalisation of activities. In this context an emphasis on the roles of universities as engines of economic growth and sub-national economic and social development can be seen. However, the de-contextualised nature of dominant neo-liberal global pressures gives rise to particular sets of issues for universities and a “missing middle” between contexts of knowledge production and application. This article explores these issues in comparative context, drawing on empirical (...) work undertaken on regional science policies in Europe and considering the implications for African universities as they seek to fulfil a diverse range of scientific and civic roles. It is structured in three sections. First, it examines the global pressures that are leading to a rethinking and rescaling of science. Second, it analyses changing discourses around excellence, relevance and context and in so doing identifies a convergence in models of national science policy. Finally, it examines the implications for the global university order, including issues of stratification and diversification and a resulting tension that emerges between the expectations of higher education and their capacities to deliver. It is this missing middle that needs consideration if expectations and capacity are to be more realistically matched for greater benefit. (shrink)

Die Diskussionen um Sterbehilfe und Patientenverfügung sowie der Ruf nach einer Stärkung der Palliativmedizin nehmen viel Platz in der deutschen Presselandschaft ein. Da Zeitungen einerseits Meinungen und Wissen der Bevölkerung abbilden, andererseits auch zu deren Meinungsbildung und Information beitragen, wurde eine Analyse der Darstellung der Sterbehilfedebatte und der Palliativmedizin durchgeführt. Als empirisches Material dienten 433 Artikel aus den Jahren 2006 und 2007, die mithilfe einer Suche nach den Schlagworten „Palliativmedizin“, „Hospiz“, „Sterbebegleitung“, „Patientenverfügung“, „Patientenautonomie“ und „Sterbehilfe“ in den Print-Archiven verschiedener deutscher (...) Zeitungen identifiziert wurden. Diese Artikel wurden einer qualitativen Inhaltsanalyse unterzogen. Mit Würde, Selbstbestimmung, Unterversorgung und Unsicherheit zeigten sich vier Hauptargumente innerhalb der Sterbehilfedebatte. Würde wird dabei als Argument sowohl für wie gegen aktive Sterbehilfe benutzt. Eine Unsicherheit zeigt sich in der Terminologie der Sterbehilfe. Das Bild der Palliativmedizin ist gekennzeichnet von der Hoffnung, dass sie eine Alternative zur Sterbehilfe bieten kann, sofern sie weiter ausgebaut und besser finanziert wird. Die Ergebnisse bestätigen die in verschiedenen Studien aufgezeigte Bedeutung der Begriffe Würde und Selbstbestimmung für die Einstellung der Bevölkerung zu Sterbehilfe, Suizidbeihilfe und Patientenverfügungen. Das Potential und die noch zu gering ausgebauten Strukturen der Palliativmedizin werden zunehmend erkannt. Demgegenüber erschwert das mangelnde Wissen um die Sterbehilfe-Terminologie und die rechtlichen Grundlagen der Therapiebegrenzung und Patientenverfügungen eine Diskussion um die Sterbehilfe auch auf fachlicher Ebene. (shrink)

This article is the lead piece in a special report that presents the results of a bioethical investigation into chimeric research, which involves the insertion of human cells into nonhuman animals and nonhuman animal embryos, including into their brains. Rapid scientific developments in this field may advance knowledge and could lead to new therapies for humans. They also reveal the conceptual, ethical, and procedural limitations of existing ethics guidance for human‐nonhuman chimeric research. Led by bioethics researchers working closely with an (...) interdisciplinary work group, the investigation focused on generating conceptual clarity and identifying improvements to governance approaches, with the goal of helping scholars, funders, scientists, institutional leaders, and oversight bodies (embryonic stem cell research oversight [ESCRO] committees and institutional animal care and use committees [IACUCs]) deliver principled and trustworthy oversight of this area of science. The article, which focuses on human‐nonhuman animal chimeric research that is stem cell based, identifies key ethical issues in and offers ten recommendations regarding the ethics and oversight of this research. Turning from bioethics’ previous focus on human‐centered questions about the ethics of “humanization” and this research's potential impact on concepts like human dignity, this article emphasizes the importance of nonhuman animal welfare concerns in chimeric research and argues for less‐siloed governance and oversight and more‐comprehensive public communication. (shrink)

Kit Fine (2000) breaks with tradition, arguing that, pace Russell (e.g., 1903: 228), relations have neither directions nor converses. He considers two ways to conceive of these new "neutral" relations, positionalism and anti-positionalism, and argues that the latter should be preferred to the former. Cody Gilmore (2013) argues for a generalization of positionalism, slot theory, the view that a property or relation is n-adic if and only if there are exactly n slots in it, and (very roughly) that each slot (...) may be occupied by at most one entity. Slot theory (and with it, positionalism) bears the full brunt of Fine's (2000) symmetric completions and conflicting adicities problems. I fully develop an alternative, plural slot theory (or pocket theory), which avoids these problems, key elements of which are first considered by Yi (1999: 168 ff.). Like the slot theorist, the pocket theorist posits entities (pockets) in properties and relations that can be occupied. But unlike the slot theorist, the pocket theorist denies that at most one entity can occupy any one of them. As a result, she must also deny that the adicity of a property or relation is equal to the number of occupiable entities in it. By abandoning these theses, however, the pocket theorist is able to avoid Fine's problems, resulting in a stronger theory about the internal structure of properties and relations. Pocket theory also avoids a serious drawback of anti-positionalism. (shrink)