Background The German Diagnosis-Related Groups (G-DRG) system has led to a revenue-orientated hospital financing system. This article examines the ethical implications and consequences of this system using the example of reconstructive measures (defect care) in patients with oral cavity carcinoma. At the same time, the interplay between the G‑DRG system and guideline development must also be scrutinized. This is preceded by introductory information on oral cavity carcinoma and the existing treatment options: conventional reconstruction techniques versus cost-intensive high-end surgery. Methods The (...) case scenario “treatment of medium-sized defects after tumor resection” forms the methodological basis and argumentative reference point of the study. Results and discussion The G‑DRG system and the economic incentives lead to far-reaching ethical implications concerning the demand-orientated treatment of patients and lead to multidimensional interactions. The existing tendency towards high-end surgery harbors the risk of overuse and misuse and, therefore, runs counter to the principles of beneficence and nonmaleficence. The one-sided indication in favor of high-end surgery also suggests that patient information is given in a directive manner (violation of respect for patient autonomy). Moreover, costly high-end procedures counteract the principle of economic efficiency and, thus, touch on issues of distributive justice. Finally, the clinical favoring of high-end procedures also affects logic within medicine, namely the publication landscape (publication bias), the design of the relevant guidelines, and surgical expertise. Conclusions There is a need to raise the awareness of all those working in the field of surgery (surgeons, guideline experts, reviewers). (shrink)

Problem Self-tracking—and of course also health-related self-tracking—has an influence on those who use it. This influence can (but does not necessarily have to) pose a threat to the autonomy of people tracking themselves. Argumentation Self-tracking can easily come into conflict with one of the three conditions for autonomy defined by Beauchamp, Faden, and Childress: voluntariness. Based on a distinction between different forms of manipulative influence—mildly controlling and substantially controlling—I will argue that health-related self-tracking often has a mildly controlling influence but (...) that it can also turn into a substantially controlling manipulative influence and even become coercive. Conclusion Substantially manipulative self-tracking and self-tracking that involves coercion is a violation of the condition of voluntariness set for autonomy. This risk of violating autonomy must be taken into account when assessing health-related self-tracking. (shrink)

Definition of the problem In Germany, there is currently a significant gap in the care of persons affected by obesity due to the absence of a standardized therapy path, regional variations in health services, and case-by-case decisions for approval. This situation prompts the discussion of integrating digital obesity applications into the existing care framework. Arguments The analysis presents an ethical reflection on the use of digital health applications for obesity treatment, examining their suitability for this complex chronic condition, which has (...) multifactorial causes and a heterogeneous patient group. We evaluate the social, advisory, and organizational aspects required to meet the diverse needs of those affected. The study highlights key ethical challenges such as avoiding stigmatization and discrimination, acknowledging the diversity of patient groups, and integrating holistic therapeutic approaches. The article also emphasizes the importance of participatory research methods to incorporate the perspectives and experiences of patients systematically. Conclusion Digital health applications hold potential to significantly improve obesity care in Germany, especially in regions with limited access to traditional therapy options. Successful implementation, however, requires careful ethical reflection and empirical research. It is crucial that these applications address the diversity and complexity of the patient population and their specific needs, which will contribute to a reduction of the care gap. (shrink)