One of the fundamental problems in the philosophy of psychology is to determine the relation between personal and subpersonal explanations of human behavior. The problem of determining the relation between the personal and subpersonal levels is called the “interface problem”. This paper has two goals. The first is to introduce the domestic reader to the interface problem from the perspective of the philosophy of psychology. The second goal is to show that insufficient focus on the interface problem and its potential (...) solutions can lead to uncritical and fallacious reasoning that can have significant consequences for particular debates in philosophy of medicine and philosophy of law. (shrink)

The purpose of this essay is to examine some of the ethical concerns raised regarding the use of neuroenhancers. Authors such as Fukuyama and Sandel argue that medical intervention should be limited to treatment of disease, and that enhancement should be outside of the scope of medicine. This commentary will examine the distinction between treatment and enhancement. I shall conclude that it is not a well-drawn distinction and should not be used to provide guidance with regards to the use (...) of psychopharmacological agents for the purpose of cognitive enhancement. I shall further examine whether concepts such as disability and normality could provide a criterion for determining whether enhancement is a permissible use of medical intervention. I conclude that as those concepts are contextually defined, they cannot be used to make principled arguments against enhancement. Finally, I shall review the charge that medicalization of cognitive performance enhancers is not morally permissible. I shall argue that medicalization might have both negative and positive consequences, and decisions about the moral permissibility of medicalization should be made on a case-by-case basis. (shrink)

In the modern culture, the phenomenon of the 'disabled' body is a intersection place of its ableist ideology, power relations and pseudoscientific explanations, and they are urged by the neo-eugenic project of the perfect world creating. As the prisoner of the biomedical discourse, such a body, deprived of any agensy, loaded with the culture-historicaly constituated non-power, is a particularly suitable field of the mainstream culture for spreading almost archetypically powerful apocaliptic visions of confronting with the enemy's otherness. For that reason, (...) the underlying supposition of the article is that the 'disabled' body, by means of the uniqueness of its morphology and anatomical-physiological structure, says nothing about itself, the basis of that it which would qualify to be a cult victim of the discriminatory gaze, but it is a reflection the culture frustrated by its own failure to produce an apsolutelly controlable order of things. Our ideas of demonic figure of the 'disabled' body conceal the century-old negentropic struggle of the Western civilization, conceptualy supplied with the criteria, norms and standards of health, normalcy, beauty and the truth, instrumentally supplied with the preventive and rehabilitative provisions of medicine, cosmetology and fashion and institutionally supplied with asylums, to provide itself with kingdom of peace and serenity through pouring out any otherness, first of all the cultural one, intentionally reduced to the pure biological. Fenomen 'ometenog' tela predstavlja u savremenoj kulturi tacku ukrstanja njene 'neometenisticke' ideologije, odnosa moci i pseudonaucnih objasnjenja motivisanih skrivenim neoeugenickim projektom stvaranja savrsenog sveta. Kao zarobljenik biomedicinskog diskursa, takvo telo, liseno ma kakve agensnosti, obremenjeno kulturno-istorijski konstruisanom ne-moci, jeste narocito podesan poligon mejnstrim kulture za sirenje skoro arhetipski snaznih apokaliptickih vizija suocavanja sa neprijateljskom drugoscu. Zato je osnovna teza koju clanak nastoji da dokaze, da 'ometeno' telo specificnoscu svoje morfologije i anatomsko-fizioloske strukture ne govori nista o sebi sto bi ga kvalifikovalo da bude kultna zrtva diskriminisuceg pogleda, vec da je refleksija kulture frustrirane vlastitim neuspehom u proizvodnji apsolutno kontrolabilnog poretka stvari. Iza nase predstave demonskog lika 'ometenog' tela skriva se vekovna negentropijska borba zapadne civilizacije, konceptualno opremljene kriterijumima, normama i standardima zdravlja, normalnosti, lepote i istine, instrumentalno prevencijskim i rehabilitacijskim merama medicine, kozmetike i mode a institucionalno azilima, da obezbedi sebi vecno carstvo mira i spokoja u rastakanju svake drugosti, a ponajpre one kulturne koju namerno redukuje na cisto biolosko. (shrink)

Global interests in bioethics have increased drastically since the end of 20th century. The reason for this should be ascribed to a broad application of molecular-genetic methods introduced in human bio-medicine. This has, in turn, produced an involvement and development of numerous inter-disciplines, which have started to apply bioethics as a part of their own subject of interest. This article presents more than a decade of experience of teaching bioethics in our country, particularly under the auspices of the National (...) Com?mittee for Bioethics of UNESCO-commission of Serbia. Globalni interes za bioetiku drasticno se povecao krajem dvadesetog stoleca, sto treba pripisati sirokoj primeni molekularno-genetickih metoda uvedenih u oblasti humane biomedicine. Ovo je dovelo do prikljucenja i razvitka brojnih interdisciplinarnih oblasti koje su bioetiku prihvatile kao deo svog opsega interesa. U ovom se clanku iznosi iskustvo dugo preko deset godina o primeni edukacije bioetike u nasoj zemlji, posebno u organizaciji i pod okriljem Nacionalnog komiteta za bioetiku UNESCO-ve komisije R. Srbije. (shrink)

Development of biopharmaceuticals is a challenging issue in bioethics. Unlike conventional, small molecular weight drugs, biopharmaceuticals are proteins derived from DNA technology and hybrid techniques with complex three dimensional structures. Immunogenicity of biopharmaceuticals should always be tested in clinical settings due to low predictive value of preclinical animal models. However, non-human primates and transgenic mice could be used to address certain aspects of immunogenicity. Substantial efforts have been made to reduce NHP use in biopharmaceutical drug development, e.g. study design improvements (...) and changes in regulatory policy. In addition, several expert groups are active in this field. Despite that, there is an increasing trend of use of NHP in preclinical safety testing of biopharmaceuticals, especially regarding monoclonal antibodies. Other potential bioethical issues related biopharmaceutical drug development are their cost/effectiveness ratio, clinical safety assessment, production of biosimilars, and comparison of their efficacy with placebo in countries without intention to market. Identification of the human genome has opened many new bioethical issues. Development of biopharmaceuticals is an important bioethical issue for several reasons. It connects all aspects of contemporary bioethics: bio?medicine, animal welfare and the most recent ad?vances in biotechnology. In particular, biopharmaceutical drug development is a challenging issue regarding treatment of rare diseases. Razvoj biofarmaceutika predstavlja izazov u bioetici. Za razliku od uobicajenih lekova male molekulske mase, biofarmaceutici su proteini kompleksne trodimenzionalne strukture koji se dobijaju tehnologijom rekombinantne DNK i tehnikom hibridoma. Imunogenost biofarmaceutika treba uvek proveriti u klinickim studijama zbog male prediktivne prednosti pretklinickih animalnih modela. Medjutim, primati i transgeni sojevi miseva mogu se upotrebiti da bi se naznacili neki aspekti imunogenosti. Znacajni napori su ucinjeni u cilju smanjenja upotrebe primata u razvoju biofarmaceutika, npr. poboljsanja dizajna istrazivanja i promene u zakonskoj regulativi. Osim toga, u ovoj oblasti su aktivne i pojedine ekspertske grupe. Uprkos tome, postoji rastuci trend upotrebe primata izuzev coveka u pretklinickom ispitivanju bezbednosti biofarmaceutika, posebno kada su u pitanju monoklonska antitela. Druga bioeticka pitanja koja se mogu dovesti u vezu sa razvojem biofarmaceutika su odnos njihove cene i efikasnosti, procena bezbednosti u klinickim uslovima, proizvodnja bioloski slicnih lekova i uporedjivanje njihove efikasnosti sa placebom u zemljama u kojima ne postoji namera o plasmanu. Upoznavanje humanog genoma otvorilo je mnoga bioeticka pitanja. Razvoj biofarmaceutika je vazno bioeticko pitanje iz vise razloga. Ono povezuje sve aspekte savremene bioetike: biomedicinu, dobrobit zivotinja i najnovija dostignuca u biotehnologiji. Posebno, razvoj biofarmaceutika je izazov kada je u pitanju lecenje retkih bolesti. (shrink)

This article challenges a key tacit assumption underpinning legal and ethical instruments in health care, namely, that people are ideally bounded, independent, and often also strategically rational individuals. Such an understanding of personhood has been criticized within feminist and other critical scholarship as being unfit to capture the deeply relational nature of human beings. In the field of medicine, however, it also causes tangible problems. I propose that a solidarity-based perspective entails a relational approach and as such helps to (...) formulate new solutions to complex ethical and regulatory questions, ranging from caring for people at the end of their lives to improving policies for organ donation and better governance of health data. It also underscores the importance of universal health care. Although a solidarity-based perspective does not require health to be seen as an individually enforceable right, it does influence our understanding of individual rights: it draws attention to how their meaning is shaped by shared social practices. I conclude by arguing that, in light of current pressures for medicine to become more personalized, using a relational understanding of personhood to shape policies and practices is a much needed endeavor. (shrink)

What is conscientious objection? -- Should conscientious objectors be accommodated? -- Assessing objectors' beliefs and reasons -- Accommodation and conscientious provision.

Public investments in genomic and precision medicine have begun to yield clinically useful interventions, most recently, for example, two new, FDA-approved gene therapies for sickle cell disease (F...

Society has historically not taken a benign view of genetic disease. The laws permitting sterilization of the mentally re tarded~ and those proscribing consanguineous marriages are but two examples. Indeed as far back as the 5th-10th centuries, B.C.E., consanguineous unions were outlawed (Leviticus XVIII, 6). Case law has traditionally tended toward the conservative. It is reactive rather than directive, exerting its influence only after an individual or group has sustained injury and brought suit. In contrast, state legislatures have not been (...) inhibited in enacting statutes. Many of their products can be characterized as hasty, unnecessary, ill-conceived, and based on the heart rather than the head. Moreover the lack of expert consultation sought has also been remarkable. One state legislature, for example, has advocated immunization for sickle cell anemia! Many others have enacted laws for the screening of inborn errors of metabolism, e.g., phenylketon uria, but have poorly defined the lines of responsibility to secure compliance. A spate of specific disease-related bills has emerged in the u.S. Congress, each seeking recognition and appropriations. Sickle cell anemia, hemophilia, Cooley's anemia and Tay-Sachs disease have been among the front-runners for support. Finally, in 1975, Congress has begun to examine an omnibus bill concerning all forms of genetic disease. The bill, termed the National Genetic Diseases Act is, however, still far from being enacted. (shrink)

Medical mistrust has a well‐documented harmful impact on a range of patients’ health behaviors and outcomes. It can have such egregious downstream effects on so many aspects of medicine—from clinical trial participation to health care use, timely screening, organ donation, and treatment adherence—that it is sometimes described as one of the social determinants of health. In the article “Trust, Risk, and Race in American Medicine,” Laura Specker Sullivan makes the compelling case that trust is essential to building a (...) therapeutic alliance in which effective, high‐quality health care can be delivered and received. As a complement to her suggestion that health care providers take an active role in mitigating mistrust by demonstrating “not only their capacity to be honest and forthright but also their ability to respond to the potential truster's needs,” we recommend that key health care professionals commit to five actions. (shrink)

This perspective article explores the use of digital twins (DTs) in medicine, highlighting its capacity to simulate risks and personalize treatments while examining the emerging bioethical concerns. Central concerns include power dynamics, exclusion, and misrepresentation. We propose adopting a relational bioethical approach that advocates for a comprehensive assessment of DTs in medicine, extending beyond individual interactions to consider broader structural relations and varying levels of access to power. This can be achieved through two key relational recommendations: acknowledging the (...) impact of uneven relational structures on access to medical care and promoting social justice by evaluating resource allocation. While DTs in medicine offer promising advancements, a relational bioethical lens may provide a nuanced understanding, fostering equitable, inclusive and responsible integration of DTs into medical practice. (shrink)

Dr. Galasso’s (2024) insightful article expands the ongoing debate on the utility and equity of precision medicine in public and population health. The initiatives mentioned, Genomics England and t...

The concept of disease remains hotly contested. In light of problems with existing accounts, some theorists argue that the disease concept ought to be eliminated. We answer this skeptical challenge by reframing the discussion in terms of the role that the disease concept plays in the complex network of health-care institutions in which it is deployed. We argue that while prevailing accounts do not suffer from the particular defects that critics have identified, they do suffer from other deficits, and this (...) leads us to propose a new account that satisfies the desiderata for a concept of disease in human medicine. (shrink)

A collection of original comics engaging fundamental issues in medical ethics, including patient autonomy, informed consent, unconscious bias, mandated reporting of suspected abuse, confidentiality, medical mistakes, surrogate decision-making, and futility.

ABSTRACT This article analyzes the politics of nostalgia’s history as a fatal disease between the seventeenth and nineteenth centuries, especially as it was applied to slaves in late eighteenth-century Cuba. I trace nostalgia’s medical history beginning with its inauguration in Swiss medicine in 1688, and then describe the contours of its transformation into a military disease primarily affecting white soldiers in France and the United States. Finally, I translate and analyze key elements of Francisco Barrera y Domingo’s work on (...) nostalgia as experienced by slaves in sugar mills in Havana. I show that Barrera uses his analysis of nostalgia and its treatment to describe the slaves’ harrowing conditions and homesickness. Nevertheless, in denying slaves the ability to return home and in failing to propose the abolition of the slave system in the wake of the Haitian Revolution, I argue, Barrera in fact deploys the diagnosis of nostalgia in order to medicalize and pathologize the slaves’ reactions and resistance to their captivity. Thus, despite his sympathy to the slaves, I conclude that for Barrera, nostalgia functions as a tool to better manage the slaves as laborers and as property. (shrink)

The development of gene expression profiling and next-generation sequencing technologies have steered oncogenomics to the forefront of precision medicine. This created a need for harmonious cooperation between clinicians and researchers to increase access to precision oncology, despite multiple implementation challenges being encountered. The aim is to apply personalised treatment strategies early in cancer management, targeting tumour subtypes and actionable gene variants within the individual’s broader clinical risk profile and wellbeing. A knowledge-generating database linked to the South African Medical Research (...) Council’s Genomic Centre has been created for the application of personalised medicine, using an integrated service and research approach. Insights gained from patient experiences related to tumour heterogeneity, access to targeted therapies and incidental findings of pathogenic germline variants in tumour DNA, provided practice-changing evidence for the implementation of a cost-minimisation pathology-supported genetic testing strategy. Integrating clinical care with genomic research through data sharing advances personalised medicine and maximises precision oncology benefits. (shrink)

In their target article, Galasso (2024) highlights the limitations of upstream inclusion in precision medicine research to produce downstream benefits to participants and proposes precision public...

In their article, Sahan and colleagues have presented ethical dilemmas faced by clinical scientists working in genomics.1 This is a welcome development since thus far little has been published on the ethical issues faced by clinical scientists in general. In their article, the authors present the three themes which emerged from discussions with clinical scientists in respect to three case studies: ‘(1) the redistribution of labour and responsibilities resulting from the practice of genomic medicine; (2) the interpretation and certainty (...) of results and (3) the proposal that better standardisation and consistency of ethical approaches (for example, more guidelines and policy) could resolve some of the challenges arising’.1 One theme which appeared not to emerge is that of ethics education received by clinical scientists during their training, and this is the theme on which this commentary will focus. As noted elsewhere, ‘Clinical Scientists receive some lectures on clinical and research ethics as part of their training, but it amounts to only to a couple of hours of lectures (references omitted)’.2 The usual route to becoming a clinical scientist involves undertaking the 3-year postgraduate Scientist Training Programme (STP), though the ‘equivalence’ route is quite commonly taken by clinical scientists working in …. (shrink)

This book is a collection of original, interdisciplinary essays on the topic of medical error. Given the complexities of understanding, preventing, and responding to medical error in ethically responsible ways, the scope of the book is fairly broad. The contributors include top scholars and practitioners working in bioethics, communication, law, medicine and philosophy. Their contributions examine preventable causes of medical error, disproportionate impacts of errors on vulnerable populations, disclosure and apology after discovering medical errors, and ethical issues arising in (...) specific medical contexts, such as radiation oncology, psychopathy, and palliative care. They also offer practical recommendations for respecting autonomy, distributing burdens and benefits justly, and minimizing injury to patients and other stakeholders. Ethics and Error in Medicine will be of interest to a wide range of researchers, students, and practitioners in bioethics, philosophy, communication studies, law, and medicine who are interested in the ethics of medical error. (shrink)

In Sahan et al ’s article,1 they present the ethical challenges faced by clinical laboratory scientists in genetic medicine, including labour allocation and responsibility, interpretation and accuracy of results with new technologies, and the need for better standardisation and ethical consistency. At the same time, they also propose a potential solution to the aforementioned challenges: ethical preparedness(EP). Along with their vivid case discussions and insightful analysis, I would like to propose two more points that are worth further examination and (...) discussion to aid stakeholders in better comprehending the ethical issues that clinical laboratory scientists face in the practice of genetic medicine. The case 1 reported by Sahan et al raises concerns about who should be responsible for tracking families or individuals with genetic results, particularly in the absence of mainstream services to track future risks. However, this should not be a factor influencing the decision to inform gene carriers. If there is a clear division of responsibilities in current practice, clinical laboratory scientists can report detected gene carriers without psychological burden. However, the decision to report gene carriers should be based on who is being served when clinical laboratory scientists face genetic problems in clinical practice and who is being considered when …. (shrink)

Patient preference predictors take us from known demographic descriptors to unknown facts about patients’ preferences over treatment options. However, the use of PPPs to make treatment decisions on behalf of incapacitated patients faces an apparent normative problem: their use in certain contexts appears to involve treating patients paternalistically. In this paper, I consider whether PPPs can find a home in the context of military medicine. On the assumptions that military organizations sometimes permissibly treat their members paternalistically, I identify the (...) specific circumstances in which PPPs can play a role in making treatment decisions on behalf of patients. I show that these circumstances are not only the natural home of PPPs, PPPs – or something very much like them – are precisely the sort of device required for it to be permissible to paternalistically override a patient’s expressed preferences. (shrink)

In this paper, we discuss the largely neglected topic of semantics in medicine and the associated ethical issues. We analyse several key medical terms from the informed perspective of the healthcare professional, the lay perspective of the patient and the patient’s family, and the descriptive perspective of what the term actually signifies objectively. The choice of a particular medical term may deliver different meanings when viewed from these differing perspectives. Consequently, several ethical issues may arise. Technical terms that are (...) not commonly understood by lay people may be used by physicians, consciously or not, and may obscure the understanding of the situation by lay people. The choice of particular medical terms may be accidental use of jargon, an attempt to ease the communication of psychologically difficult information, or an attempt to justify a preferred course of action and/or to manipulate the decision-making process. (shrink)

McCarthy and Howard (2023) present a “Non-Domination” approach to supported decision-making, specially to help intellectually and developmentally disabled (IDD) patients rather than “Mental Prosthe...

The speed and scale of the COVID‐19 pandemic has highlighted the limits of current health systems and the potential promise of non‐establishment research such as “DIY” research. We consider one example of how DIY research is responding to the pandemic, discuss the challenges faced by DIY research more generally, and suggest that a “trust architecture” should be developed now to contribute to successful future DIY efforts.

Because we tend to study fight books in isolation, we often forget how difficult it is to understand the precise place they occupy in the sociocultural and historical fabric of their time, and spill the many clues they inevitably contain on their owner, their local society, their precise purpose. In order to unlock that information, we need to study them in their broader sociocultural and historical context. This requires a background and research skills that are not always easily accessible to (...) everyone. To illustrate the point, in this paper I show in some detail what is required to make sense of the claim that Aristotelian philosophy and science influenced the medieval fight books in relevant ways, and that understanding this influence helps us to better understand the fight books per se. I give an outline of the general historical framework, and apply it to a testcase: Talhoffer’s Thott 290 2° Ms., with some interesting results. My hope is that this framework may be of some use to other researchers in HEMA Studies who want to dig deeper in sources of interest to them. (shrink)

As disenchantment began to be recognized as a recurring, never-ending process in recent scholarship, “When Jupiter Meets Saturn” argues that Aby Warburg and Karl Sudhoff’s debate on Reformation astrological medicine provided a new theory of the emergence of modern science and rationality. Drawing on their encounter and divergence in interwar Germany, especially their curatorial collaboration for the 1911 Internationale Hygiene-Ausstellung, the article shows that Warburg and Sudhoff generated completely opposite historical evaluations of astrological medicine using the very same (...) materials. Approaching history as healers, they developed different ways of seeing from medical epistemologies and brought out entangled temporalities from images. (shrink)

In 2022, the Camden Coalition Medical-Legal Partnership began providing civil and criminal legal services to substance use disorder patients at Cooper University Health Care’s Center for Healing. This paper discusses early findings from the program’s first year on the efficacy of the provision of criminal-legal representation, which is uncommon among MLPs and critical for this patient population. The paper concludes with takeaways for other programs providing legal services in an addiction medicine setting.

‘四象醫學’으로 象徵되는 동무 이제마(1837~1900)의 四象說은 이제 학적체계를 구축한 하나의 학문으로서 정립되어, 그 학문적 위상은 매우 높다고 할 수 있다. 하지만 그의 사상설에는 기초적인 이론적 토대에 관한 논의에 있어서조차 아직 해결하지 못한 뜨거운 쟁점 또한 존재한다.BR 크게 보면 두 가지 정도인데, 그중 하나가 ‘사상의학은 한의학의 기초 이론인 오행론을 수용하는가?’의 與否문제이며, 또 다른 하나는 “동무 자신의 醫論에 (본래 ‘四象’이라는 용어의 출처인) 『주역』의 ‘易理’를 적용했을까?”라는 문제이다.BR 이에 대한 견해는 현재 학자에 따라 긍정 혹은 부정으로 크게 갈린다. 동무의 주요 저작으로는 철학서인 『格致藁』(1880~1893)와 의학적 내용을 (...) 담고 있는 『東醫壽世保元』(1894)이 있고, 이외에도 易理로 『東醫壽世保元』을 풀이한 『東武遺稿』(시기 미상), 五行에 관한 서술이 들어 있는 『東醫壽世保元草本卷』(1882~1883?) 등이 있으나, 후자의 문헌들은 典據로서의 신뢰를 얻지 못하고 있다. ‘四象’의 주역설을 옹호하는 이들은 주로 『東武遺稿』를 전거로 제시하지만, 반론을 제기하는 이들은 필사본 초고 형태로 발견된 이미상의 문집이 동무의 직접적인 저작물이 아닐 수 있다는 의구심을 품는다.BR 본고에서는 『東醫壽世保元』을 역리로 해석한 斗庵韓東錫(1911~1968)의 『東醫壽世保元註釋』(1967)을 통해 『東醫壽世保元』 ｢性命論｣서두에 나오는 개념들의 敍述方式을 분석하였다. 이 서술 방식을 相異한 방식으로 서술한 다른 문장들과 비교해 보면, ‘四象’의 導出이 易理에 근거하고 있음을 추론해 보는 것이 가능하다. 즉 『동의수세보원』 ｢性命論｣과 『東武遺稿』에 나타난 四象에 관한 서술 순서[방식]는 易理[天機]의 관점과 인간주체적[四象人] 관점을 병행했을 때라야 비로소 이해 가능하다. 다시 말해 본고에서는 ‘四象’의 도출 과정에 관한 중요한 단서를 동무가 직접 저술한 문헌들을 통해 얻고자 하였다. (shrink)

The research is developed with the use of deductive and descriptive analytical methods used to obtain information on doctrine and jurisprudence and to establish and describe specific situations in the field of Ecuadorian Medical Law respectively. The main objective is to provide scientific and doctrinal tools to understand guilt in cases of omissive conduct in Ecuadorian medical practice, as well as its comparison with other countries such as Colombia, Mexico, Cuba and Argentina, the results of the research show that the (...) doctrine in the relationship to the categories of Omission, Guilt, Guarantor Position and Permitted Risk is broad and is based on scientific-doctrinal advances of the Normative Conception of Guilt comprised between 1995 and 2022. To establish useful criteria and conclusions, the discussion focuses on defining what is considered “guilty” in the context of Medical Law, highlighting the importance of elements such as the objective duty, the harmful result and the analysis of the concomitant circumstances, emphasizing the importance of considering the context and development of the facts in cases of omissive conduct in medicine and not only the result. In relation to omissions in criminal law, a distinction is made between proper and improper and finally, it concludes by suggesting the modification of article 146 of the Organic Integral Criminal Code to guarantee due process and a effective judicial protection in matters related to health in Ecuador, specifically with regard to causality in cases of omissive conduct. (shrink)

The book starts with the assumption that vagueness is a fundamental property of this world. From a philosophical account of vagueness via the presentation of alternative mathematics of vagueness, the subsequent chapters explore how vagueness manifests itself in the various exact sciences: physics, chemistry, biology, medicine, computer science, and engineering.

1. At least since W.F. Edwards’ pioneering articles on medieval and renaissance interpretations of the prologue to Galen's Art of Medicine,1 it has often been maintained that Latin scholastics inte...

Die rasanten technischen Fortschritte in der Genomforschung ermöglichen heute schon die Sequenzierung des einzelnen menschlichen Genoms in wenigen Tagen und zu vertretbaren Kosten. In der Krebsforschung ermöglicht die genetische Sequenzanalyse, zunehmend die Defekte zu identifizieren, die für das Tumorwachstum bei jedem einzelnen Patienten verantwortlich sind. Auf dieser Basis können zielgerichteter Therapien entwickelt werden. Diese Forschung wirft jedoch auch neue, ethische Fragen auf. Diesen normativen Fragen widmet sich in Heidelberg das interdisziplinäre EURAT Projekt mit dem Ziel, ethisch und rechtlich informierte Lösungen (...) zu formulieren und zu etablieren.Dieser Beitrag gibt zum einen einen Überblick über die ethischen und klinischen Fragen, die für den Aufklärungs- und Einwilligungsprozess in die biobankbasierte Genomforschung relevant sind. Zum anderen wird als organisationsethische Antwort auf die Frage, wie eine Forschungsinstitution den verantwortungsvollen Umgang mit genetischen Informationen in Biobanken über die verschiedenen Berufsgruppen und beteiligten Institute hinweg sichern kann, ein Verhaltenskodex vorgestellt. Eine gut begründete, informierte Zustimmung und ein Verhaltenskodex sind beides Elemente einer „Best Practice Leitlinie“ und sollen den verantwortlichen Umgang aller beteiligten Mitarbeiter mit sensiblen genetischen Daten prägen. (shrink)

Evidence based medicine has had an increasing impact on primary care over the last few years. In the UK it has influenced the development of guidelines and quality standards for clinical practice and the allocation of resources for drug treatments and other interventions. It has informed the thinking around patient involvement in decision making with the concept of evidence based patient choice. There are, however, concerns among primary care clinicians that evidence based medicine is not always relevant to (...) primary care and that undue emphasis placed on it can lead to conflict with a clinician’s duty of care and respect for patient autonomy. In this paper we consider the impact of evidence based medicine on primary care, and the ethical implications of its increasing prominence for clinicians and managers in primary care. (shrink)

The United States has pursued policies of urban upheaval that have undermined social organization, dispersed people, particularly African Americans, and increased rates of disease and disorder. Healthcare institutions have been, and can be, a part of this problem or a part of the solution. This essay addresses two tools that healthcare providers can use to repair the urban ecosystem—perspective and solidarity. Perspective addresses both our ability to envision solutions and our ability to see in the space in which we move. (...) Solidarity is our ability to appreciate our fellowship with other people, a mindset that is at the heart of medical practice. These two tools lay the foundation for structurally competent healthcare providers to act in a restorative manner to create a health-giving built environment. (shrink)