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)

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)

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)

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)

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)

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)

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)

Benito Feijoo (1676-1764) fue uno de los divulgadores de las ideas científicas y filosóficas más importantes del siglo XVIII español. Lúcido crítico de todo tipo de ideas y miembro de la República de las Letras, se tenía a sí mismo por escéptico. En un primer momento, se alineó con el médico Martín Martínez, famoso por su crítica al aristotelismo médico, que tambíen se autodenominó escéptico. Tras defender contra sus adversarios la medicina escéptica de Martínez, Feijoo abandona el término, tal vez (...) porque intuyó que podría ser entendido en algunos ámbitos como una defensa del materialismo ateo y una forma de socavar las ideas de la Iglesia católica. Asimismo, investigó con detalle qué podía querer significar ser escéptico en medicina, aunque evitó usar el término en asuntos filosóficos y teológicos. (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)

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)

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)

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)

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)

Zusammenfassung Die enge Widerspruchslösung in Österreich erlaubt eine postmortale Organspende bei fehlendem Widerspruch zu Lebzeiten, da von einer mutmaßlichen Zustimmung ausgegangen wird. Liegt kein Eintrag im Widerspruchsregister vor, wird die Familie zum mutmaßlichen Willen der verstorbenen Person befragt. Um die praktische Umsetzung der Widerspruchslösung in Österreich zu beschreiben, sollen relevante Aspekte der Angehörigengespräche und die Rolle der Familie im Entscheidungsprozess zur postmortalen Organspende identifiziert werden. Es wurden insgesamt zehn leitfadengestützte Expert:inneninterviews mit Ärzt:innen und Pflegepersonen an einer österreichischen Krankenanstalt durchgeführt, die (...) mithilfe der qualitativen Inhaltsanalyse nach Mayring unter Anwendung von MAXQDA ausgewertet wurden. Herausforderungen beim Ermitteln des mutmaßlichen Patient:innenwillens im Angehörigengespräch können aufgrund von unterschiedlichen Kulturen/Religionen, Uneinigkeit und Entscheidungsunfähigkeit in der Familie aufgrund von Trauer und der Schwierigkeit der Angehörigen, das Hirntodkonzept zu begreifen, entstehen. Daher ist eine gute Vorbereitung, ausreichend Zeit, interdisziplinäre Zusammenarbeit, das Schaffen von Vertrauen und professionelle Gesprächsführung sowie das Eingehen auf Fragen und Bedürfnisse von Angehörigen durch Ärzt:innen und Pflegepersonen in einem geeigneten Setting notwendig. Die Kommunikation mit Angehörigen bezüglich einer postmortalen Organspende ist sowohl für das Gesundheitspersonal als auch die Familie belastend. Anhand der Ergebnisse wird die Anwendung des Kommunikationsleitfadens der Gesundheit Österreich mit Erweiterung um die Information zur Gesetzeslage sowie regelmäßige Kommunikationsschulungen des Gesundheitspersonals empfohlen. Zudem wird eine flächendeckende Information der Bevölkerung zur Förderung der intrafamiliären Diskussion gefordert. (shrink)

In contrast to standardized guidelines, personalized medicine and person centered care are two notions that have recently developed and are aspiring for more individualized health care for each single patient. While having a similar drive toward individualized care, their sources are markedly different. While personalized medicine stems from a biomedical framework, person centered care originates from a caring perspective, and a wish for a more holistic view of patients. It is unclear to what extent these two concepts can (...) be combined or if they conflict at fundamental or pragmatic levels. This paper reviews existing literature in both medicine and related philosophy to analyze closer the meaning of the two notions, and to explore the extent to which they overlap or oppose each other, in theory or in practice, in particular regarding ethical assumptions and their respective practical implications. (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)

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

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)

The principles of biomedical ethics – autonomy, non-maleficence, beneficence, and justice – are of paradigmatic importance for framing ethical problems in medicine and for teaching ethics to medical students and professionals. In order to underline this significance, Tom L. Beauchamp and James F. Childress base the principles in the common morality, i.e. they claim that the principles represent basic moral values shared by all persons committed to morality and are thus grounded in human moral psychology. We empirically investigated the (...) relationship of the principles to other moral and non-moral values that provide orientations in medicine. By way of comparison, we performed a similar analysis for the business & finance domain. (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)

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)

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)

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)

We invite systematic consideration of the metaphors of cycles and circulation as a long-term theme in the history of the life and environmental sciences and medicine. Ubiquitous in ancient religious and philosophical traditions, especially in representing the seasons and the motions of celestial bodies, circles once symbolized perfection. Over the centuries cyclic images in western medicine, natural philosophy, natural history and eventually biology gained independence from cosmology and theology and came to depend less on strictly circular forms. As (...) potent ‘canonical icons’, cycles also interacted with representations of linear and irreversible change, including arrows, arcs, scales, series and trees, as in theories of the Earth and of evolution. In modern times life cycles and reproductive cycles have often been held to characterize life, in some cases especially female life, while human efforts selectively to foster and disrupt these cycles have harnessed their productivity in medicine and agriculture. But strong cyclic metaphors have continued to link physiology and climatology, medicine and economics, and biology and manufacturing, notably through the relations between land, food and population. From the grand nineteenth-century transformations of matter to systems ecology, the circulation of molecules through organic and inorganic compartments has posed the problem of maintaining identity in the face of flux and highlights the seductive ability of cyclic schemes to imply closure where no original state was in fact restored. More concerted attention to cycles and circulation will enrich analyses of the power of metaphors to naturalize understandings of life and their shaping by practical interests and political imaginations. (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)

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)

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)

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)

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)

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)

The article by Dupras and Bunnik. makes a fundamental contribution in the context of the current boom in personalized medicine. We propose an additional crit...

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)

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 General Data Protection Regulation imposes, at European level, a need to seek express or explicit consent for the processing of health data. In the framework of biomedical research, some favor the use of express ‘broad’ consent, whereas other maintain, or wish to maintain the use of presumed or implicit consent, often referred to as ‘non-opposition’ in conditions in which such consent is still authorized. In our view, broad consent and presumed consent are likely to prove to be easy solutions (...) in the short term but much less relevant in the long term, for both hospital and patients, if the bioethical objective remains the improvement of patient quality of life and/or survival, regardless of the disease considered. Dynamic consent could be the best way to achieve this objective because only this type of consent could improve hospital transparency and increase patient confidence by allaying certain fears. (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)

Is it a requirement of justice to democratize private companies? This question has received renewed attention in the wake of the financial crisis, as part of a larger debate about the role of companies in society. In this article, we discuss three principled arguments for workplace democracy and show that these arguments fail to establish that all workplaces ought to be democratized. We do, however, argue that republican-minded workers must have a fair opportunity to work in a democratic company. Under (...) current conditions, this means that a liberal order must actively promote workplace democracy. (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)

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?