In der Medizinethik sind der Respekt vor der Patientenselbstbestimmung, das Nichtschadensgebot, das Handeln zum Wohl des Kranken und das Gerechtigkeitsgebot praxisrelevante Prinzipien. Anhand des Beispiels der Frühintervention und Akutbehandlung schizophrener Störungen wird aufgezeigt, dass es in der psychiatrischen Praxis zu einer Kollision dieser Prinzipien kommen kann. Der frühe Krankheitsbeginn und der häufig chronische Verlauf schizophrener Störungen führen zu großem Leid der Betroffenen und ihrer Angehörigen sowie zur ökonomischen Belastung der Solidargemeinschaft. Die negativen Folgen einer verzögerten Intervention stehen den Risiken der (...) Stigmatisierung sowie den möglichen Nebenwirkungen durch die psychotherapeutische oder psychopharmakologische Behandlung gegenüber. Es wird für eine an der konkreten Situation orientierte, lebensnahe und dynamische Ethik plädiert, die vom konkreten Fall aus diskutiert und verschiedene Perspektiven berücksichtigt – mit dem Ziel von einer Arztethik und Patientenethik zu einer Verantwortungspartnerschaft zu gelangen. (shrink)

I Norge er ikke surrogati tillatt, og myndighetene fraråder norske statsborgere å benytte seg av surrogati i utlandet. I denne artikkelen fokuserer vi på kommersiell gestational surrogati og stiller spørsmålet: Bør man tillate at norske statsborgere benytter seg av surrogati i India? De etiske problemstillingene rundt surrogati er mange og sammensatte og blir spesielt utfordrende når tjenesten tilbys i et land med store kulturelle og økonomiske forskjeller både internt og i forhold til Norge. Vi baserer analysen og drøftingen av dette (...) etisk utfordrende spørsmålet på Beauchamps og Childress sin veletablerte metodiske tilnærming innen biomedisinsk etikk. Vi anvender de fire allmennmoralske prinsipper: respekt for autonomi, velgjørenhet, ikke-skade og rettferdighet på sakskomplekset for å synliggjøre spenningene involvert i dette etiske dilemmaet. Med full bevissthet om at det ikke finnes noen lettvinte og omkostningsfrie løsninger på dilemmaer generelt og dette spesielt, konkluderer vi med at interessene til de berørte parter, og spesielt surrogatmødrenes, kan bli bedre ivaretatt om surrogati tillates under omfattende reguleringer. Dersom man velger å gjøre praksisen illegal, vil man også miste mulighetene til å påvirke prosessen og sikre rettighetene til de involverte partene.Nøkkelord: surrogati, Norge–India, utnyttelse, autonomi, regulering av prosessenEnglish summary: Should Norwegian citizens be permitted to use surrogacy in India?Surrogacy is not permitted in Norway, and the government strongly advises against Norwegian citizens travelling abroad to have children through the use of the surrogacy industry. In this article, we focus on commercial gestational surrogacy and debate the question: Should Norwegian citizens be permitted to use surrogacy in India? The ethical concerns regarding surrogacy are complex and are especially challenging when the service is offered in a country with big cultural and economic differences both internal and in comparison to Norway. We base our analysis of this ethical, challenging question on Beauchamp’s and Childress’s well-established approach within biomedical ethics. We apply the four principles of respect for autonomy, beneficence, nonmaleficence and justice to shed light on the conflicts of interests in this ethical dilemma. With full awareness that there are no simple and correct solutions to dilemmas in general and on this issue, especially, our conclusion is that the interests of the involved parties, and especially those of the surrogate mothers, might be better attended to if surrogacy is allowed with extensive regulations. If this practice is made illegal, the opportunity to influence the process and secure the rights of the involved parties is lost. (shrink)

Die demografische Entwicklung und der medizinische Fortschritt werden die Problematik der Ressourcenknappheit im Gesundheitswesen in Zukunft weiter verschärfen. Auch Deutschland steht eine Prioritätensetzung im Gesundheitswesen bevor. Diese sollte in möglichst transparenter Weise nach klaren Kriterien erfolgen. Ein nur selten in diesem Kontext besprochenes Kriterium der Verteilung von Mitteln in der Gesundheitsversorgung ist die marginale Wirksamkeit medizinischer Leistungen. Im vorliegenden Beitrag wird dieses Kriterium vorgestellt und auf seine Fairness hin untersucht. Nach der kritischen Diskussion einiger Argumente gegen den offenen Einsatz von (...) Rationierungskriterien und einer Definition von marginaler Wirksamkeit in zwei unterschiedlichen Dimensionen werden verschiedene Vorzüge und eventuelle Nachteile des Kriteriums beleuchtet. (shrink)

Omfanget av helsepersonells reservasjonsrett har nylig vært gjenstand for debatt i Norge. Vi spør om leger bør ha reservasjonsrett ved utførelse og henvisning til assistert befruktning, og drøfter argumenter for og imot ved hjelp av et rammeverk med sju kriterier for vurdering av reservasjon. Reservasjonsrettens grunnleggende dilemma er hvordan to viktige hensyn, henholdsvis pasientens rett til behandling og hensynet til helsepersonellets moralske integritet, best kan ivaretas. Det argumenteres for at leger bør ha rett til å reservere seg mot å utføre, (...) assistere ved og henvise til assistert befruktning generelt hvis begrunnelsen er hensynet til befruktede eggs moralske verdi. Videre finner vi at leger også kan ha en moralsk rett til reservasjon mot å utføre, assistere ved og henvise til assistert befruktning for likekjønnede, men da på nærmere spesifiserte vilkår.Nøkkelord: reservasjonsrett, assistert befruktning, samvittighet, moralsk integritetEnglish summary: Should physicians have the right to conscientiously object to assisted reproduction?The extent of the healthcare worker's right to conscientious objection has recently been debated in Norway. This article asks whether physicians should have a right to conscientious objection to the performance of, and referral for, assisted reproduction, and discusses arguments for and against the same, utilizing a framework of seven criteria for the evaluation of conscientious objection. The fundamental dilemma of conscientious objection is how two important considerations can be reconciled: the patient's right to treatment, and the protection of the healthcare worker's moral integrity. It is argued that physicians should have the right to object to performing, assisting with, and referring for assisted reproduction generally when the objection is grounded in the moral value of the embryo. Furthermore, physicians may also have a moral right to object to performing, assisting with, and referring for assisted reproduction for same-sex couples, but only on conditions that are further specified. (shrink)

This is the first new edition of the Meno with English commentary and annotation since Thompson's in 1901. Dr. Bluck brings to bear more recent scholarship in his commentary and notes, which are judicious and thorough; and his new collations help to make the text the best available. Any account of the Meno's truth and meaning should begin with the careful textual, philological, logical, and historical considerations of the commentary and introduction of this new edition.--R. S. B.

Moderne teknologi gir fantastiske muligheter for menneskelig formering. Mange som tidligere ikke kunne få barn, eller som fikk syke barn, kan nå hjelpes. Samtidig reiser mulighetene en rekke vanskelige moralske spørsmål, som ikke har enkle svar – ofte fordi de bunner i grunnleggende etiske motsetninger. Denne artikkelen gir en kort oversikt over de mulighetene som tre typer teknologier gir: assisterende, seleksjonsfremmende og egenskapsendrende teknologier. Deretter peker den på noen av de viktige moralske spørsmålene som disse teknologiene reiser i betydningen «Hvordan (...) bør teknologiene brukes»? Så stilles spørsmålet: Hvordan skal vi begrunne bruken? Dette spørsmålet peker på en rekke grunnleggende etiske utfordringer. Det er disse utfordringene som gjør at de moralske spørsmålene sjelden finner solide og stabile svar, men til stadighet blusser opp i til dels heftige offentlige debatter. I tillegg løfter artikkelen frem flere moralske spørsmål som er glemt eller gjemt. Spørsmålene som vi ikke stiller kan ofte fortelle oss like mye om oss selv og våre verdier, som de spørsmålene som drøftes eksplisitt. De moralske spørsmålene – samt de underliggende etiske utfordringene og de glemte spørsmålene – kan forklare hvorfor debattene ofte står på stedet hvil, og hva vi må jobbe med for å komme videre i drøftingene av moderne reproduksjonsteknologi. Vi synes å være teknologiske helter som er fremragende på teknikk, men elendige på etikk. Målet er å forhindre at vi blir tragiske helter som går til grunne på våre beste egenskaper. Nøkkelord: reproduksjonsteknologi, assistert reproduksjon, invitro-fertilisering, fosterdiagnostikk, genredigering, sortering, abortEnglish summary: Ethical challenges with newer reproductive technology Modern technologies provide fascinating opportunities for human reproduction. Many persons previously infertile, or who risked having diseased children, can now have healthy children. At the same time, these technological opportunities also raise a wide range of moral questions, which rarely have easy answers. One reason for this is that they are based on profound ethical challenges. This article sets out to give a short overview of three types of technologies: assisting, selective, and characteristic-changing technologies. It goes on to highlight some of the important moral questions raised by these technologies. The third part addresses the basic ethical challenges lurking behind the moral questions and debates. The fourth part addresses some forgotten or hidden questions, arguing that these are telling and important. The article ends with arguing that many of the basic ethical challenges and the unaddressed questions can explain why debates on reproductive technologies are so heated and static. We appear to have become technological giants, but ethical infants. Accordingly, we should try to avoid becoming tragic heroes succumbing to our very best abilities. (shrink)

Dr. B.R. Ambedkar is one of the names who advocated to change social order of the age-old tradition of suppression and humiliation. He was an intellectual, scholar, statesman and contributed greatly in the nation building. He led a number of movements to emancipate the downtrodden masses and to secure human rights to millions of depressed classes. He has left an indelible imprint through his immense contribution in framing the modern Constitution of free India. He stands as a symbol of struggle (...) for achieving the Social Justice. We can assign several roles to this great personality due to his life full dedication towards his mission of eradicating evils from Indian society. The social evils of Indian society, also neglected this great personality even in intellectual sphere too. The so-called intellectuals of India not honestly discussed his contribution to Indian intellectual heritage, rather what they discussed, also smells their biases towards a Dalit literate and underestimated his great personality. This paper will attempt to discuss important facts about life and a short description of the literature written by Dr. B.R. Ambedkar. This is followed by discussion his philosophy in the five major sections i.e. Feminism and women empowerment, philosophy of education, ideas on social justice and equality, philosophy of politics and economics and philosophy of religion. (shrink)

Dr. B. R. Ambedkar is one of the most eminent intellectual figures of modern India. The present year is being celebrated as 125th Birth Anniversary of Dr. B. R. Ambedkar. Educationist and humanist from all over the world are celebrating 125th Birth Anniversary of Dr. B. R. Ambedkar by organizing various events and programmes. In this regard the Centre for Positive Philosophy and Interdiscipinary Studies (CPPIS) Pehowa (Kurukshetra) took an initiative to be a part of this mega event by organizing (...) an national level esssay competition for students, publication of books, posters and research journals on Dr. B.R. Ambedkar. Dr. B.R. Ambedkar’s ideas, writings and outlook could well be characterized as belonging to that trend of thought called Social Humanism. He developed a socio-ethical philosophy and steadfastly stood for human dignity and freedom, socio-economic justice, material prosperity and spiritual discipline. He showed the enlightening path for Indian society via his ideals of freedom, equality and fraternity and made India a democratic country. The complete works of Dr. B.R. Ambedkar published by the Governemtn of Maharastra and it has taken about 25 years to complete this initiative in 21 Volumes with the name, “Dr. Babasaheb Ambedkar: Writing and Speeches” and covers 14000 pages. In the words of Trilochan Sing, “Above all, Dr. Ambedkar is a philosopher. Those who read his books cannot be failed to be impressed with steadffastness with which he pursues truth; and only those who have dispassionately read his books can frame true estimate of the greatness of the man”. These 21 Volumes includes books published by Dr. B.R. Ambedkar himself and unpublished writings and speaches too. The present volume entitled “Dr. B.R. Ambedkar: The Maker of Modern India” contains 12 research papers on the different aspects of philosophy of Dr. B.R. Ambedkar written by academicians from different branches of knowledge. You can find a variety of dialogues and concen about the theme of the book here. We are not defending this book as a highly an intellectual work but a smaller step to know the various aspects of this great personality and is a start to study his vast wisdom. You suggestions and comments are welcome to its first hand review version. (shrink)

Seventy six papers collected together to honor Dr. S. Radhakrishnan, the philosopher-statesman of India. The selection of papers reflects Radhakrishnan's life long task of encouraging a genuine encounter between the thought of the east and the west.—R. J. B.

Variations in levels of apolipoprotein E have been tied to the risk and progression of Alzheimer's disease . Our group has previously compared and contrasted the promoters of the mouse and human ApoE gene promoter sequences and found notable similarities and significant differences that suggest the importance of the APOE promoter's role in the human disease. We examine here three specific single-nucleotide polymorphisms within the human APOE promoter region, specifically at -491 , -427 , and at -219 upstream from the (...) +1 transcription start site. The -219 and -491 polymorphic variations have significant association with instance of AD, and -491AA has significant risk even when stratified for the APOEepsilon4 allele. We also show significant effects on reporter gene expression in neuronal cell cultures, and, notably, these effects are modified by species origin of the cells. The -491 and -219 polymorphisms may have an interactive effect in addition to any independent activity. DNA-protein interactions differ between each polymorphic state. We propose SP1 and GATA as candidates for regulatory control of the -491 and -219 polymorphic sites. This work's significance lies in drawing connection among APOE promoter polymorphisms' associations with AD to functional promoter activity differences and specific changes in DNA-protein interactions in cell culture-based assays. Taken together, these results suggest that APOE expression levels are a risk factor for AD irrespective of APOEepsilon4 allele status. (shrink)

"Nothing Better Than Death" is a comprehensive analysis of the near-death experiences profiled on my website at www.near-death.com. This book provides complete NDE testimonials, summaries of various NDEs, NDE research conclusions, a question and answer section, an analysis of NDEs and Christian doctrines, famous quotations about life and death, a NDE bibliography, book notes, a list of NDE resources on the Internet, and a list of NDE support groups associated with IANDS.org - the International Association for Near-Death Studies. -/- The (...) unusual title of this book, "Nothing Better Than Death," was inspired by NDE experiencer Dr. Dianne Morrissey who once said, "If I lived a billion years more, in my body or yours, there's not a single experience on Earth that could ever be as good as being dead. Nothing." -/- Having read every NDE book I could get my hands on, I didn't want to create just another NDE book. My motivation was to give readers a large variety of information about NDEs challenging both the seasoned NDE enthusiast as well as the novice. This book gives readers the means to understand the NDE phenomenon from the perspective of a large number of some of the most profound NDEs ever documented. My hope is that you will enjoy this book, my labor of love, and that you will be truly blessed by the heavenly insights within it. (shrink)

I dette bogkapitel skrevet sammen med Ingeborg Ilkjær fremlægges tre etiske positioner herunder dydsetik, pligtetik og konsekvensetik. Disse teorier er sammen med eksempler på etiske principper og værdier det grundlag, som sygeplejersker kan benytte sig af i arbejdet med patientinvolvering og etiske dilemma, hvor der skal foretages et valg, der har betydning for patienter, pårørrende og de klinisk involverede. -/- For at kunne træffe valg af denne art er det vigtigt at kunne gøre det på et oplyst grundlag samt at (...) kunne påtage sig et klinisk lederskab. Derfor er det nødvendigt at benytte sig af en etisk refleksionsmodel. Dette arbejde kan være med til at skabe klarhed over en given situation, der rummer vanskelige etiske dilemmaer. -/- Bogkapitlet findes i bogen Sygepleje & Patientinvolvering Bind 3 redigeret af Steen Hundborg og udgivet på FADL’s Forlag I 2019. (shrink)

Values are an important part of human existence, his society and human relations. All social, economic, political, and religious problems are in one sense is reflection of this special abstraction of human knowledge. We are living in a globalized village and thinking much about values rather than practice of it. If we define religion and spirituality we can say that religion is a set of beliefs and rituals that claim to get a person in a right relationship with God, and (...) spirituality is a focus on spiritual things and the spiritual world instead of physical/earthly things. If we think rationally we can find the major evils related to religion exiting in present society are due to lack of proper understanding of religion and spirituality. If we really know our own religions and values associated with it, we can create a beautiful world, full or love and respect for each and every human being. The proper knowledge and practice of any religion’s values can make an integrated man. In the book, The Buddha and His Dhamma, Dr. Ambedkar elucidated the significance and importance of Dhamma in human life. The Dhamma maintained purity of life, which meant abstains from lustful, evil practices. The Dhamma is a perfection of life and giving up craving. Dhamma’s righteousness means right relation of man to man in all sphere of life. The basic idea underlying religion is to create an atmosphere for the spiritual development of the individual. He said that Knowing the proper ways and means is more important than knowing the ideal. The major objective of this paper is to the study the religious philosophy of Dr. B.R. Ambedkar and to study how he established that religious and spiritual values enables religious people in particular and humanity at large to solve contemporary problems. (shrink)

To follow the legacy of Dr. B.R. Ambedkar, a RUSA Sponsored One-Day Facutly Development Programme on “Dr. B.R. Ambedkar, Indian Constitution and Indian Society” organised by the Department of Philosophy and P.G. Department of Public Administation held on 20th January, 2016 was a creative and fruitful effort to bring together the scholars and academicians from several disciplines to participate in the deliberations related to the conceptual understanding and insights of the philosophy of Dr. B.R. Ambedkar.

Children's cognitive and imaginative development is greatly enhanced by creative projects, which establish the groundwork for critical thinking, problem-solving, and flexibility. By evaluating improvements in creativity, memory, and problem-solving abilities, this study seeks to determine how creative activities affect children’s imaginative and cognitive growth. The dataset includes performance measures from 894 children between the ages of seven and ten who participated in eight weeks of either traditional or creative learning activities. Split the data into two groups, such as Group A (...) (experimental group) and Group B (control group). A normal curriculum was followed by Group B (n=212), while Group A (n=481) participated in a variety of creative activities like music, art, and storytelling. Cognitive and imaginative assessments were administered pre- and post-intervention, covering four key indicators: fluency, originality in narrative creativity, flexibility and graphic abilities in drawing creativity. The results showed that the Group A had performed better than Group B in terms of originality. In conclusion, creative activities help children to develop specific cognitive and imaginative skills; this means that including them in curriculums is important for their overall development. (shrink)

Artikkelen ønsker å gi et konstruktivt bidrag til forståelsen og anvendelsen av fair play i en kroppsøvingsfaglig kontekst. Dette er et tema som er blitt aktualisert i og med at fair play er kommet inn som et sentralt element i kroppsøvingsfagets nye reviderte læreplan. Fair play omhandler regler, normer og verdier som skal gjelde ved idrettsutøvelse, og det er et etablert verdikonsept innenfor organisert idrettsliv og idrettsetisk forskning. I skolen, derimot, er fair play mindre kjent. Kroppsøvingsplanen hevder fair play omfatter (...) aspekter ved idrettsspillet som å overholde regler, vise hverandre respekt og gjøre hverandre gode. Hva betyr så dette? Hva vil det si å gjøre hverandre gode? Rommer det bare en teknisk eller også en sosialetisk kvalitet? Dersom det siste er tilfelle, bør det diskuteres hvilke danningskvaliteter det så ligger i det å gjøre hverandre gode i faget, og om disse har noen tilknytningspunkt til Aristoteles' klassiske dyder om rettferdighet, måtehold, mot og klokskap. Dette er de sentrale spørsmålene artikkelen reiser og prøver å gi noen svar på. Artikkelen ser først på fair play i kroppsøvingsfagets planer, for deretter å gi begrepet en nærmere etymologisk og ideologisk-historisk avklaring, med utgangspunkt i begrepene «fair» og «play». Videre drøftes fair play i lys av de aristoteliske dydene, relatert til kroppsøvingsfaglig kontekst og diskurs.Nøkkelord: kroppsøving, fair play, idrett, lek og danningEnglish summary: Fair play in Physical Education in the light of Aristotelian virtue ethicsThe aim of this article is to give a constructive contribution to the understanding and the application of the concept of fair play in the Physical Education context. This is a topic that has come into focus since fair play has been introduced as a central element in the newest revision of the subject curriculum. Fair play concerns the rules, norms, and values that apply to sports activities, and constitutes an established value concept within organized sports and research related to sports ethics. In schools, however, fair play is less known. The Physical Education curriculum states that fair play concerns aspects of sports and games such as adhering to rules, showing each other respect, and helping each other achieve. What, then, does this mean? What does it mean to help each other achieve? Does it entail purely technical, or also socio-ethical qualities? If the latter is the case, a discussion is needed as to what ethical formation qualities are involved in helping each other achieve in the subject and whether these have any connection to Aristotle's classical virtues of justice, moderation, courage, and wisdom. These are the central issues the article raises and attempts to shed some light on. The article takes a closer look at fair play in the curricula of Physical Education, moving on to an etymological and ideological-historical clarification of the concept, taking the concepts of fair and play as starting points. Further, it discusses fair play in the light of Aristotelian virtues, related to a Physical Education context and discourse. (shrink)

I denne teksten blir følgende spørsmål tatt opp til drøfting: Er det å ta medisinsk teknologi i bruk for å selektere et døvt barn mer etisk problematisk enn det motsatte; å bruke teknologien for å sikre seg et hørende barn? På bakgrunn av fire premisser konkluderer jeg med at både seleksjon for døvhet og for hørsel er tilnærmet like etisk problematisk. De fire premissene er 1) at seleksjonskriteriet sykdom eller skade bør erstattes av autentisitetsbetraktninger, 2) at døve og hørende har (...) samme potensial for autentisk livsutfoldelse, selv om det ikke kan avvises at døvhet kjennetegnes ved manglende hørsel, 3) at seleksjon innebærer fravalg av liv som har autentisk potensialitet enten som døv eller hørende, og 4) at dette fravalget involverer en etisk kostnad. Konklusjonen har enkelte andre implikasjoner og en restproblematikk som belyses avslutningsvis. (shrink)

As a social issue, violence continues to manifest and remains a current topic of academic research. Scientific studies mostly focus on the individual and societal dimensions of violence; however, studies that address violence in the context of everyday life practices remain limited. This study argues that violence has a masculine character as a result of gender inequality and within the framework of the masculinity-power relationality. On the other hand, this study considers folk dances as a product of social culture and (...) views them as an effective form of non-verbal communication within society. The study is based on the claim that, in folk dances observed in formal or informal ceremonial events, which are part of everyday life and contain elements of violence, violence is legitimized as a spectacle. In this context, local folk dances from different regions of Turkey, performed exclusively by male dancers and portraying themes of heroism, victory, bravery, and courage, have been selected as examples. These include Trabzon Bıçak Horonu, Bursa Kılıç-Kalkan, Manisa Seğmen Sekmesi, Balıkesir Bengi, Erzurum Köroğlu Barı, Giresun Tüfekli Çandır Karşılaması, and Diyarbakır Şur-u Mertal. The violent content of these dances has been analyzed through the method of semiotic analysis. Weapons used in these dances, fast and rhythmic tunes, and rigid movements have been considered as indicators of violence. It has been concluded that these dances, admired and enthusiastically applauded, normalize violence. This study makes a significant contribution by addressing folk dances within the context of violence and aims to fill the gap in the literature in this field. (shrink)

_Etter revisjonen av bioteknologiloven i mai 2020, ble eggdonasjon på norsk et faktum. I kjølvannet av «bioteknologiforliket» – en koalisjon mellom Ap, Frp og SV som sikret stortingsflertall for endringene i loven – skulle kompensasjonsstørrelsen fastsettes for kvinner som ønsker å donere bort egg. Det ble av den grunn holdt en høring om retningslinjene for donasjon av egg, herunder alternativer for hvor mye donor bør kompenseres økonomisk. I denne artikkelen har jeg analysert høringsutkastet, høringssvarene og de endelige retningslinjene for kompensasjon (...) av eggdonasjon. Hensikten med studien var å undersøke de ulike argumentene i den norske debatten om økonomisk kompensasjon for donasjon av egg. Tre gjennomgående temaer ble identifisert i høringsdokumentene: motivasjonens form og innhold, rettferdighet og donorbutikk. Et sentralt funn i høringen var en gjennomgående bekymring for økonomisk motivert donasjon. Samtidig var det bred enighet om at eggdonasjoner skulle være altruistiske. Altruisme ble forstått som et fravær av økonomisk motivasjon hos donoren, men uten at andre ikke-altruistiske motiver ble problematisert eller at forutsetningene for altruisme ble videre diskutert. Analysen viste også hvordan lignende argumenter ble vinklet ulikt for å kunne understøtte både en høyere og lavere kompensasjon. For eksempel endte en vektlegging av kvinners rettigheter i noen høringssvar opp som et forsvar for det høyeste forslaget til kompensasjon, mens i andre høringssvar ble den brukt som argument for et forbud mot enhver kompensasjon. Samlet sett gir denne studien innblikk i mangfoldet av argumenter som er blitt brukt i den norske debatten om økonomisk kompensasjon for eggdonasjon, og den viser viktigheten av å definere begrepene som brukes – som altruisme, frivillighet og økonomisk motivasjon – for å få bedre frem både enighetene og uenighetene mellom partene i debatten._ _Nøkkelord:_ altruisme, bioteknologi, eggcelledonasjon, godtgjørelse, motivasjon _English abstract_ After the revision of the Biotechnology Act in May 2020, egg donation in Norwegian became a fact. In the wake of the "biotechnology agreement" – a coalition between Ap, Frp and SV that secured a parliamentary majority for the changes in the law – the amount of compensation was to be determined for women who wish to donate eggs. A hearing was therefore held on the guidelines for egg donation, including options for how much the donor should be financially compensated. In this article, I have analyzed the consultation draft, the consultation responses and the final guidelines for compensation for egg donation. The purpose of the study was to examine the various arguments in the Norwegian debate about financial compensation for egg donation. Three consistent themes were identified in the consultation documents: the form and content of the motivation, justice and donor shop. A key finding in the consultation was a consistent concern about financially motivated donation. At the same time, there was broad agreement that egg donations should be altruistic. Altruism was understood as an absence of financial motivation on the part of the donor, but without other non-altruistic motives being problematized or the prerequisites for altruism being further discussed. The analysis also showed how similar arguments were angled differently in order to support both higher and lower compensation. For example, an emphasis on women's rights in some consultation responses ended up as a defense for the highest proposal for compensation, while in other consultation responses it was used as an argument for a ban on any compensation. Overall, this study provides an insight into the diversity of arguments that have been used in the Norwegian debate on financial compensation for egg donation, and it shows the importance of defining the terms used _–_ such as altruism, volunteering and financial motivation _–_ in order to better bring out both the agreements and the disagreements between the parties in the debate. _Keywords:_ altruism, biotechnology, egg cell donation, remuneration, motivation. (shrink)

From time to time the figure of Tenes or Tennes, the eponymous hero of Tenedos, intrudes itself into discussions of larger matters connected with Greek religion, usually in order to lend support to some imaginative theory. As one of the latest examples might be instanced Dr. A. B. Cook's Zeus II., pp. 654 sqq. It is as well, however, to be certain as to the precise evidential value which attaches to the stories about Tenes before employing them to buttress further (...) hypotheses. A little intensive study of these traditions will therefore not be unprofitable, even if the result should be almost wholly negative. For in that event wemay be spared the trouble of placing much reliance upon edifices erected upon sand. (shrink)

Throughout the Old Testament, the stories, laws, and songs not only teach a way of life that requires individuals to be moral, but they demonstrate how. In biblical studies, character ethics has been one of the fastest-growing areas of interest. Whereas ethics usually studies rules of behavior, character ethics focuses on how people are formed to be moral agents in the world. This book presents the most up-to-date academic work in Old Testament character ethics, covering topics throughout the Torah, the (...) Prophets, and the Writings, in addition to the use of the Bible in the modern world. In addition to Carroll and Lapsley, contributors are Denise M. Ackermann, Cheryl B. Anderson, Samuel E. Balentine, William P. Brown, Walter Brueggemann, Thomas B. Dozeman, Bob Ekblad, Jose Rafael Escobar R., Theodore Hiebert, Kathleen O'Connor, Dennis T. Olson, J. David Pleins, Luis R. Rivera Rodriguez, J. J. M. Roberts, and Daniel L. Smith-Christopher. (shrink)

This article revisits the intellectual history of inequality in the thinking of Dr Bhimrao Ramji Ambedkar (1891–1956) and Dr Ram Manohar Lohia (1910–1967). Both were pivotal figures in the intellectual history of inequality in colonial and postcolonial India. Yet little work has been done to systematically juxtapose the two and their thinking on inequality. This article offers a first comparison, arguing that their ideas on inequality can be seen as the emergence of a unique, Indian version of what, in this (...) article, we term “organic intersectionality.” We build this argument on four claims. First, both were organic intellectuals whose thinking was molded in the marginalized groups from which they arose, but whose ideas developed in unique and organic ways. Second, both had a unique eye to the intersectional and holistic character of Indian inequality, cutting across caste, class, race, and gender. Third, their thinking grew from a deep engagement with religion, which they saw as both legitimizing and delegitimizing inequality. Fourth, both these figures exemplify postcolonial hybridity and thus stand in contrast both to a diffusionist approach whereby ideas are simply diffused from the West to the East, and to a nationalized, self-contained, or decolonial history of ideas. (shrink)

While writing the foreword for this special edition of the International Journal for the Semiotics of Law, I was informed of Dr. Nelson R. Mandela’s death. While saddened with his passing, I was struck by the fact, he was one of the two men who most influenced my study and practice of Restorative Justice; the other was my father. Both passed away while this edition was compiled and edited.In the mid 1990s, I first read about Restorative Justice as an aspect (...) of the Truth and Reconciliation Commission (“TRC”) established by Dr. Mandela in post-apartheid South Africa. I was fascinated by his forgiveness of his oppressors and how he infused the ideals of reconciliation and forgiveness into a court-like hearing. It was an opportunity for the victim of human rights violations to face the perpetrator and tell the perpetrator the extent of the injuries he or she suffered. After the victim spoke, the perpetrator had an opportunity to admit to the wrongdoing, take full responsibility for the har. (shrink)

Die jüngste höchstrichterliche Rechtsprechung zur Selbstbestimmung der Patienten und zur Normierung medizinischer Handlungen am Lebensende hat eine intensive Debatte ausgelöst. Das Urteil und die akademisch vorgetragene Kritik werden einer grundlegenden medizinethischen Analyse unterworfen. Sie betrifft die objektive Eingrenzung der Zulässigkeit einer Behandlungsbegrenzung und die Subsumtion des Wachkomas als irreversibel tödliches Grundleiden, das ärztliche Ermessen bei der Indikationsstellung, die normative Einordnung einer Ernährungstherapie am Lebensende und die Verbindlichkeit von Patientenverfügungen. Die medizinethische Kritik offenbart eine unzureichende Wahrnehmung medizinischer und medizinethischer professioneller Dokumente (...) und den Rückgriff auf medizinethisch veraltete Konzeptionen der Sterbehilfe durch das Gericht. Die Folge ist eine fehlerhafte Subsumtion der Wachkomapatienten in die Kategorie irreversibel tödlicher Erkrankungen und eine inhaltliche Schwächung der Verbindlichkeit von Patientenverfügungen. Beides bedarf dringend der Korrektur. (shrink)

Die demografische Entwicklung und der medizinische Fortschritt werden die Problematik der Ressourcenknappheit im deutschen Gesundheitswesen in Zukunft weiter verschärfen. Soll nicht nur kurzfristig akuten Sparzwängen ausgewichen werden, steht – wie in verschiedenen Ländern bereits geschehen – auch Deutschland auf Dauer eine Prioritätensetzung im Gesundheitswesen bevor. Diese sollte in möglichst transparenter Weise nach klaren Kriterien erfolgen. Eines der seit einiger Zeit häufig öffentlich zitierten Kriterien der Verteilung von Mitteln in der Gesundheitsversorgung ist die Eigenverantwortung von Patienten. Deren Berücksichtigung in der Allokation (...) von Ressourcen birgt allerdings zahlreiche Probleme. Der vorliegende Beitrag untersucht die gerechtigkeitstheoretischen Grundlagen und die praktischen Probleme bzw. die möglichen Konsequenzen von Eigenverantwortung als Verteilungskriterium im Gesundheitswesen. Auf der Grundlage eines alternativen gerechtigkeitstheoretischen Vorschlags werden drei Möglichkeiten skizziert, Eigenverantwortung von Patienten im deutschen Gesundheitswesen in gerechter Weise stärker zu betonen. (shrink)

In den USA haben sich im Wesentlichen drei verschiedene Organisationsformen klinischer Ethikberatung entwickelt: der einzelne Berater, das große Komitee und das Beratungsteam teilweise mit Rückbindung an ein größeres Komitee. Bislang gibt es jedoch weder empirische Daten noch ein Ergebnis der anfänglichen theoretischen Diskussion, ob es ein favorisiertes Modell für die klinische Ethikberatung geben sollte und welches dieses sei. Dieser Artikel argumentiert, dass die Vorzüge, Nachteile und die Erfolgsfaktoren der verschiedenen Organisationsformen in Abhängigkeit von der Zielsetzung klinischer Ethikdienste (KED) bewertet werden (...) müssen. Diese Zielsetzung kann auf einem Spektrum vom „Patientenanwalt“ bis zum „Gewissen der Institution“ angesiedelt sein. Die Zielsetzung bestimmt dabei Aufgabenschwerpunkte, Zusammensetzung, die favorisierte Organisationsform und wünschenswerte Standards. Die Untersuchung stützt sich zum einen auf die Analyse von Interviews mit fünf Vorsitzenden klinischer Ethikkomitees von Harvard Lehrkrankenhäusern in Boston, die jeweils etwa 20 Jahre Erfahrung in klinischer Ethikberatung mit den drei unterschiedlichen Modellen gemacht haben. Zum anderen basiert sie auf der Rezeption der Literatur und empirischen Studien zu KEDs in den USA und Deutschland. Insgesamt scheint das Konsilteam mit Rückbindung an ein Komitee am besten geeignet, die Behandlung einzelner Patienten und das ethische Bewusstsein einer ganzen Organisation zu verbessern. Es vereint die Vorteile der anderen beiden Modelle auf sich, ohne unter deren Schwächen zu leiden. (shrink)

Im Zuge des „empirical turn“ der Medizin- und Bioethik ist von verschiedenen Autoren in den vergangenen Jahren die Idee einer „evidenzbasierten Ethik“ diskutiert worden. Die Analogie zwischen evidenzbasierter Medizin und „evidenzbasierter Ethik“ soll in diesem Beitrag kritisch diskutiert und dabei gezeigt werden, dass der Ausdruck „evidenzbasierte Ethik“ irreführend ist. Zentraler Ausgangspunkt der Kritik ist die unterschiedliche Bedeutung, die empirische Informationen für das medizinisch-klinische Urteil zum einen und das ethische Urteil in der Medizin zum anderen haben. Im medizinisch-klinischen Urteil können mit (...) Hilfe empirischer Informationen hypothetische Handlungsnormen generiert werden, welche auf den der Medizin inhärenten Zwecksetzungen basieren. Bei Fragen der Ethik in der Medizin hingegen sind die Handlungsziele selbst Gegenstand des Urteils; diese aber können allein aus empirischem Wissen heraus nicht zureichend bestimmt werden. Die Diskussion um die Möglichkeit einer „evidenzbasierten Ethik“ eröffnet weiterhin aufschlussreiche Perspektiven in Bezug auf empirische Forschung und den Umgang mit empirischen Informationen in der Angewandten Ethik und das Aufgabenfeld der Medizinethik. (shrink)

Wenn man davon ausgeht, dass eine der Voraussetzungen für ein gut fundiertes moralisches Urteil im Bereich der Medizin ein adäquates Verständnis der medizinischen Gegebenheiten und Zusammenhänge ist, dann muss diesem Aspekt bei der Beurteilung der künstlichen Ernährung bei fortgeschritten Demenzerkrankten in Zukunft mehr Aufmerksamkeit geschenkt werden. Damit verbunden ist die kritische Auseinandersetzung mit aktuellen empirischen Untersuchungen, anhand derer es gerechtfertigt scheint, die künstliche Ernährung bei dementen Patienten als erfolglos hinsichtlich des Ernährungszustands, der Verbesserung der Lebensqualität und der Überlebenszeit zu bezeichnen. (...) Unsere Arbeit setzt an drei wesentlichen Punkten an: zum einen soll der Zusammenhang zwischen Ernährungssituation und Demenzerkrankung dargestellt werden, andererseits soll ein Modell vorgestellt werden, das bessere Ergebnisse verspricht als sie in den bisherigen empirischen Studien gefunden worden sind, und drittens soll darauf aufmerksam gemacht werden, dass mit dem Erkennen der Möglichkeit der adäquaten Ernährung von fortgeschritten Demenzkranken auch neue Optionen in der normativen Beurteilung von künstlicher Ernährung offen stehen. (shrink)

ZusammenfassungDie von einem multiprofessionellen Behandlungsteam durchgeführte Symptombehandlung bei inkurablen Patienten am Lebensende erweist sich als hoch effektiv und verschafft den meisten Patienten eine ausreichende Linderung. Dennoch verbleibt ein Patientenanteil, bei dem auch unter Berücksichtigung physischer, psychischer, sozialer und spiritueller Bedürfnisse kein erträglicher Zustand erreicht werden kann. In diesen Extremfällen können Sedierungsmaßnahmen zur Linderung eingesetzt werden. Der Begriff und das Angebot der terminalen Sedierung sind in vielerlei Hinsicht umstritten. Eine Kasuistik soll die Problemstellung veranschaulichen und zeigen, wie die terminale Sedierung von (...) erfahrenen Behandlern als ergänzendes Instrument der Symptombehandlung eingesetzt werden kann, auch wenn sie keine perfekte Antwort auf unerträgliches Leiden in der Sterbesituation darstellt. Im Literaturvergleich werden aktuelle medizinische, rechtliche und psychosoziale Fragen diskutiert. (shrink)

Mit der Einführung der Diagnosis Related Groups wurde die Qualitätssicherung für Krankenhäuser verpflichtend. Vor diesem Hintergrund werden im vorliegenden Beitrag die gebräuchlichen Definitionen für Qualität der Gesundheitsversorgung und ihre Umsetzung in Maßnahmen der Qualitätsförderung analysiert. Auswirkungen des Umgangs mit Qualität sind u. a. eine Verbesserung der objektiven Qualität von Gesundheitsleistungen und eine Veränderung der Kultur der Medizin im Sinne einer Zergliederung der Behandlung in messbare Einzelschritte und der Standardisierung von Behandlungsabläufen. Im Kontrast zu diesem objektiven Verständnis von Qualität steht die (...) Forderung nach Patientenorientierung und nach einer subjektiven Qualität, die vor allem auf das Gelingen der therapeutischen Interaktion verweist und darauf, dass erst in der Interaktion der Maßstab für Qualität festgelegt wird. Demzufolge ist es die Aufgabe einer guten Krankenhausorganisation, einen geschützten Raum für die therapeutische Interaktion zu schaffen. (shrink)

Demographischer Wandel und medizinischer Fortschritt haben zur Folge, dass immer mehr Patienten außerstande sind, selbstbestimmt über eine medizinische Behandlung zu entscheiden. Dann sind andere gefordert, unter Berücksichtigung von Wohl und Willen des Patienten stellvertretend zu entscheiden. Dabei bieten sich drei Entscheidungskriterien an: Paternalismus, substitutive Autonomie (mutmaßlicher Wille) und prospektive Autonomie (vorausverfügter Wille). Keines dieser Kriterien garantiert für sich genommen eine optimale Entscheidung. Realistisch ist nur ein integratives Modell, das diese Kriterien pragmatisch verbindet. Je klarer im Einzelfall die Evidenz für den (...) autonomen Patientenwillen ist, desto mehr Gewicht sollte ihm eingeräumt werden. Dabei lassen sich konkrete Schritte benennen, wie die Evidenz für eine autonome Willensbekundung beurteilt werden kann. Obgleich stellvertretende Entscheidungen in der medizinischen Praxis oft von Ärzten, professionellen Betreuern und Richtern getroffen werden, gibt es überzeugende Gründe für die These, dass der nächste Angehörige am besten geeignet ist, prima facie als stellvertretender Entscheidungsträger zu fungieren. (shrink)

Die Behandlung von einwilligungsunfähigen psychisch kranken Menschen mit neuen Therapiemethoden ist insbesondere im Kontext des „individuellen Heilversuchs“, der als Anwendung wenig erprobter Therapieansätze im Rahmen von „ultima ratio“-Entscheidungen charakterisiert ist, mit ethischen Abwägungsproblemen verbunden. Diese bestehen aufgrund von Einschränkungen in der Handlungs- und Entscheidungsautonomie der betroffenen Patienten und, aufgrund eigen- oder fremdgefährdender Symptome der psychischen Krankheit selbst, insbesondere in der praktischen Umsetzung ethisch akzeptierter Modelle stellvertretender Entscheidung sowie in der Wahl des Bezugspunkts der Nutzen-Risiko-Analyse des intendierten Therapieverfahrens. Der Artikel untersucht (...) den ethischen Konflikt zwischen gerechtfertigter Hilfeleistung und Instrumentalisierungsrisiko psychisch kranker Menschen zu Fremdzwecken am historischen Beispiel der „Rindenexcisionen“ des Psychiaters Gottlieb Burckhardt (1836–1907). Als Lösungsmöglichkeit dieses ethischen Konflikts wird das „Konzept des kontrollierten individuellen Heilversuchs“ diskutiert. (shrink)

Die „künstliche Ernährung“ steht in enger Beziehung zu den grundsätzlichen Fragen nach medizinisch sinnvollen und angemessenen Maßnahmen, nach Therapiebegrenzung, Lebensqualität und Sterbehilfe. Im Diskurs müssen die dabei verwendeten Begriffe hinsichtlich der ihnen innewohnenden, oft unbewussten Wertungen zur Diskussion gestellt werden. Einer ethischen Entscheidungsberatung muss eine sorgfältige Abklärung der naturwissenschaftlichen Aspekte, einschließlich einer umfassenden Erhebung der Vorsituation und der gegenwärtigen Befindlichkeit des einzelnen Kranken sowie eine aufrichtige Einschätzung der Zielorientierung vorausgehen. Unter Zugrundelegung der—unter Umständen auch nur ersatzweise wahrgenommenen—Selbstbestimmung des Patienten werden (...) in der ethischen Diskussion mögliche stereotype Vorgehensweisen, latente Entscheidungskonflikte oder eine vermeintliche Vorrangigkeit naturwissenschaftlicher Lösungsansätze zur Sprache kommen. Ziel ist eine gemeinsam erarbeitete individuell angemessene Lösung, die sich—unabhängig vom Ergebnis—heilsam in den Lebenshorizont des Patienten einbetten lässt. (shrink)

Gegenwärtig gibt es eine intensive internationale Diskussion zum Stellenwert der Sedierungsbehandlung am Lebensende. Auch in Deutschland sind der grundsätzliche Status und die medizinethische Bewertung palliativer bzw. terminaler Sedierung noch nicht ausreichend geklärt. Der vorliegende Beitrag stellt anhand der Analyse sechs möglicher klinischer Szenarien differenzierte Beispiele für die Situation von Patienten vor einer Sedierungsbehandlung dar. Dazu wird ein Vergleich mit Standardsituationen der Sterbehilfe vorgenommen. Für die moralische Bewertung werden Aktionen und Intentionen der Sedierungsformen unter besonderer Berücksichtigung von Aufklärung und Autonomie diskutiert. (...) Aus Perspektive einer klinisch orientierten Ethik sind eine differenzierte Entscheidungsanalyse, die Form informierter Zustimmung sowie der Ablauf der Sedierungs- und Ernährungsbehandlung von Bedeutung. Eine kritische Debatte zur moralischen Legitimität der Sedierung am Lebensende ist notwendig für die medizinethische Kultur ärztlicher Praxis. (shrink)