This article tries to present a broad view on the values and ethicalissues that are at stake in efforts to rationalize health policy on thebasis of economic evaluations (like cost-effectiveness analysis) andrandomly controlled clinical trials. Though such a rationalization isgenerally seen as an objective and `value free' process, moral valuesoften play a hidden role, not only in the production of `evidence', butalso in the way this evidence is used in policy making. For example, thedefinition of effectiveness of medical treatment or (...) health care serviceis heavily dependent on dominant individual or social views about thegoals of the particular treatment or service. There is also a concernthat a reliance on EBM in health policy will occur at the expense ofwidely shared social values like equity and solidarity. Moreover, thereis a concern that when economic considerations and rational proceduresbecome more influential, various `outside' groups third parties likeinsurance companies and policy makers will get a stronger influence onmedical practice which may lead to a change in the patient-providerrelationship. The authors conclude that social values and patientpreference should be explicitly addressed when health policy making isbased on economic and other scientific evidence. (shrink)

Nikola Biller-Andorno ist eine deutsche Bioethikerin und lehrt seit über zehn Jahren an der Universität Zürich. Zuvor war sie an der Universität Göttingen, der Weltgesundheitsorganisation in Genf sowie der Charité in Berlin tätig. Ihr Zugang zu ethischen Fragen in Medizin und Biotechnologie ist geprägt von einer empirisch gut informierten Analyse praktisch relevanter Fragen, welche wenn immer möglich auch die Wahrnehmungen beteiligter Akteure berücksichtigt.

Artificial intelligence has found its way into many areas of human life, serving a range of purposes. Sometimes AI tools are designed to help humans eliminate high-volume, tedious, routine tas...

Comments and reports on synthetic biology often focus on the idea that this field may lead to synthetic life or life forms. Such claims attract general attention because “life” is a basic concept that is understood, interpreted and explained in multiple ways. While these different understandings of life may influence the ethical assessment of synthetic biology by experts and the public, this field might, in turn, influence how academics or the public view life. We suggest in this paper that synthetic (...) biology provides an opportunity to discuss and compare different views and explanations of the world, starting from the concept of life. We argue that a narrow focus on just one interpretation of this concept may be harmful and that people will benefit from being aware of a diversity of understandings of life because they provide answers to different questions. Moreover, the confrontation among views is important for the development of reasoning abilities, and a nuanced view on our world will be useful for integrating scientific findings and their implications into a wider context. At the same time, we should not only consider other understandings of life for our own benefit but also because a moral attitude of respect for and toleration toward others implies permission to express and maintain their views. For these reasons, we suggest that a diversity of views on life should be included in public education and in public engagement events on synthetic biology. Moreover, they should be on the research agenda of technology assessment studies within the ELSA or RRI frameworks. (shrink)

In response to the COVID-19 pandemic, countries around the world developed ICU triaging guidelines. One important point of convergence was an explicit commitment to...

Artificial intelligence (AI) systems are increasingly being used in healthcare, thanks to the high level of performance that these systems have proven to deliver. So far, clinical applications have focused on diagnosis and on prediction of outcomes. It is less clear in what way AI can or should support complex clinical decisions that crucially depend on patient preferences. In this paper, we focus on the ethical questions arising from the design, development and deployment of AI systems to support decision-making around (...) cardiopulmonary resuscitation and the determination of a patient’s Do Not Attempt to Resuscitate status (also known as code status). The COVID-19 pandemic has made us keenly aware of the difficulties physicians encounter when they have to act quickly in stressful situations without knowing what their patient would have wanted. We discuss the results of an interview study conducted with healthcare professionals in a university hospital aimed at understanding the status quo of resuscitation decision processes while exploring a potential role for AI systems in decision-making around code status. Our data suggest that (1) current practices are fraught with challenges such as insufficient knowledge regarding patient preferences, time pressure and personal bias guiding care considerations and (2) there is considerable openness among clinicians to consider the use of AI-based decision support. We suggest a model for how AI can contribute to improve decision-making around resuscitation and propose a set of ethically relevant preconditions—conceptual, methodological and procedural—that need to be considered in further development and implementation efforts. (shrink)

BackgroundThe need for an ethical debate about the use of coercion in intensive care units (ICU) may not be as obvious as in other areas of medicine, such as psychiatry. Coercive measures are often necessary to treat critically ill patients in the ICU. It is nevertheless important to keep these measures to a minimum in order to respect the dignity of patients and the cohesion of the clinical team. A deeper understanding of what patients and their relatives perceive during their (...) ICU stay will shed different light on intensive care management. Patients' experiences of loss of control, dependency and abandonment may lead to a new approach towards a broader approach to the concept of coercion in intensive care. The aim of our research is to explore the experiences of patients and relatives in the ICU and to determine when it might be possible to reduce feelings and memories of coercion.MethodsWe conducted and analysed 29 semi-structured interviews with patients and relatives who had been in the ICU a few months previously. Following a coding and categorisation process in MAXQDA™, a rigorous qualitative methodology was used to identify themes relevant to our research.ResultsFive main themes emerged: memory issues; interviewees’ experiences of restricting measures and coercive treatment; patients’ negative perception of situational and relational dependency with the risk of informal coercion; patients’ perceptions of good care in a context of perceived dependency; progression from perception of coercion and dependency to respect for the person. All patients were grateful to have survived. However, coercion in the form of restraint, restriction of movement, and coercive treatment in the ICU was also acknowledged by patients and relatives. These included elements of informal coercion beyond restraints, such as a perceived negative sense of dependence, surrender, and asymmetrical interaction between the patient and health providers.ConclusionsTo capture the full range of patients' experiences of coercion, it is necessary to expand the concept of coercion to include less obvious forms of informal coercion that may occur in dependency situations. This will help identify solutions to avoid or reduce negative recollections that may persist long after discharge and negatively affect the patients' quality of life. (shrink)

The future of medicine will be predictive, preventive, personalized, and participatory. Recent technological advancements bolster the realization of this vision, particularly through innovations in...

Name der Zeitschrift: Deutsche Zeitschrift für Philosophie Jahrgang: 64 Heft: 6 Seiten: 951-977.

Definition of the problem: The ELSI (Ethical, Legal, and Social Issues) program of the Human Genome Project is the biggest bioethical research project to date. However, it has met with fairly critical reception. Arguments: ELSI is nevertheless an important element in current bioethics. We can learn not just from the results and methodology of the numerous studies that received ELSI funding, but also by looking at the pros and cons of its close institutional integration into the Human Genome Project. Finally, (...) excellent didactic resources have been developed, providing helpful tools for the improvement of medical ethics teaching. Conclusion: A critical analysis of the ELSI program can be instrumental in developing new perspectives in medical ethics. (shrink)

Bd. 1. Absenz-Darstellung -- Bd. 2. Dekadent-Grotesk -- Bd. 3. Harmonie-Material -- Bd. 4. Medien-Popular -- Bd. 5. Postmoderne-Synästhesie -- Bd. 6. Tanz-Zeitalter/Epoche -- Bd. 7. Register und Supplemente.

Liberalism is a big word in bioethics. It smacks of freedom—the freedom of patients from unwanted therapeutic interventions, the freedom of physicians to practice according to what they consider the state of the art, the freedom of society from unwanted regulation, everyone's freedom to form and pursue an individual idea of a good life. So far so good. Yet sometimes ‘liberal’ positions are strikingly simplistic: using enhancers is ok as long as competent individuals consent to it; selling your organs is (...) ok if that is what you want, and women wearing a burka and having their hymen repaired after premarital intercourse are just expressing their autonomy. You do not have to be a sociologist to sense a part of the picture might be missing here. Usually we consider people from a certain age as competent to make decisions, unless there are good reasons to doubt that. Still, this does not mean there is nothing else to consider. Autonomy is an ideal that is constantly being compromised in everyday life. We do not have quite the information we would need to make a …. (shrink)

Transplanting organs from emotionally related donors has become a fairly routine procedure in many countries. However, donors have to be chosen carefully in order to avoid not just medically, but also morally, questionable outcomes. This paper draws attention to vulnerabilities that may affect the voluntariness of the donor's decision. Suggestions are made as to how to approach the evaluation and selection of potential donors.

Living organ donation has developed into an important therapeutic option in transplantation medicine. However, there are some medico-ethical problems that come along with the increasing reliance on this organ source. One of these concerns is based on the observation that many more women than men function as living organ donors. Whereas discrimination and differential access have been extensively discussed in the context of cadaveric transplantation and other areas of health care, the issue of gender imbalance in living organ donation has (...) received less attention. This paper presents relevant data from the Eurotransplant and UNOS transplantation systems and discusses possible explanations for the documented gender discrepancies. The conclusion calls for are view of existing practice guidelines in order to secure effective protection of particularly vulnerable potential donors and an equitable donor-recipient-ratio in living organ donation. (shrink)

Extended Reality (XR) systems, such as Virtual Reality (VR) and Augmented Reality (AR), provide a digital simulation either of a complete environment, or of particular objects within the real world. Today, XR is used in a wide variety of settings, including gaming, design, engineering, and the military. In addition, XR has been introduced into psychology, cognitive sciences and biomedicine for both basic research as well as diagnosing or treating neurological and psychiatric disorders. In the context of XR, the simulated ‘reality’ (...) can be controlled and people may safely learn to cope with their feelings and behavior. XR also enables to simulate environments that cannot easily be accessed or created otherwise. Therefore, Extended Reality systems are thought to be a promising tool in the resocialization of criminal offenders, more specifically for purposes of risk assessment and treatment of forensic patients. Employing XR in forensic settings raises ethical and legal intricacies which are not raised in case of most other healthcare applications. Whereas a variety of normative issues of XR have been discussed in the context of medicine and consumer usage, the debate on XR in forensic settings is, as yet, straggling. By discussing two general arguments in favor of employing XR in criminal justice, and two arguments calling for caution in this regard, the present paper aims to broaden the current ethical and legal debate on XR applications to their use in the resocialization of criminal offenders, mainly focusing on forensic patients. (shrink)

Living organ donation is developing increasingly into an important therapeutic option in transplantation medicine. In spite of the existence of a normative-legal frame, medico-ethical questions remain open. Among these are in particular 1) who should be taken into consideration as a donor, 2) how information concerning the possibility of living organ donation should be passed on, and 3) what an adequate medical-psychosocial evaluation of potential donors should look like. The paper presents the results of a survey based on questionnaires, which (...) addresses the current practice in German transplantation centers as well as the opinions of clinical practioners regarding these three topics. The empirical data form the context for the formulation of medico-ethical ideas and suggestions concerning living organ donation in Germany. (shrink)

This chapter stages an ongoing conversation between Arthur Danto and the author. In a series of encounters from 1985 till 2012 (in New York City and elsewhere) the problem of defining art is explored from different angles. Eventually, two kinds of definition are distinguished. On the one hand, a definition may aspire to identify peculiar characteristics of the things that are commonly regarded members of the noble class of artworks. On the other hand, a definition might also name criteria for (...) deciding whether an object may become a member of this class in the first place. Danto focused on the first task because he felt, quite rightly, that the second would require competences that philosophy does not dispose of. (shrink)

In order to understand why analytic aesthetics has lost a lot of its former intellectual stature it is necessary to combine historical reconstruction with systematic consideration. In the middle of the twentieth century analytic philosophers came to the conclusion that essentialist theories of the “nature” of art are no longer tenable. As a consequence they felt compelled to move to the meta-level of conceptual analysis. Then they tried to show how a purely classificatory concept of art is used. The presupposition, (...) however, that there actually is such a concept can only appear plausible at first sight. Upon closer inspection it turns out to be utterly misguided. (shrink)

Artificial intelligence (AI) systems are quickly gaining ground in healthcare and clinical decision-making. However, it is still unclear in what way AI can or should support decision-making that is based on incapacitated patients’ values and goals of care, which often requires input from clinicians and loved ones. Although the use of algorithms to predict patients’ most likely preferred treatment has been discussed in the medical ethics literature, no example has been realised in clinical practice. This is due, arguably, to the (...) lack of a structured approach to the epistemological, ethical and pragmatic challenges arising from the design and use of such algorithms. The present paper offers a new perspective on the problem by suggesting that preference predicting AIs be viewed as sociotechnical systems with distinctive life-cycles. We explore how both known and novel challenges map onto the different stages of development, highlighting interdisciplinary strategies for their resolution. (shrink)

In our recent article ‘The Ethics of the Algorithmic Prediction of Goal of Care Preferences: From Theory to Practice’1, we aimed to ignite a critical discussion on why and how to design artificial intelligence (AI) systems assisting clinicians and next-of-kin by predicting goal of care preferences for incapacitated patients. Here, we would like to thank the commentators for their valuable responses to our work. We identified three core themes in their commentaries: (1) the risks of AI paternalism, (2) worries about (...) attacks to our humanity stemming from the use of AI and (3) the possibility of designing AI systems for more relevant use cases than the one we consider in our work. We shall focus on these themes, leaving aside some other interesting suggestions, given the limited space available for our response. Diaz Milian and Bhattacharyya discuss the risks of AI paternalism highlighting how the use of an AI to predict goal of care preferences may incentivise clinicians and surrogates to shift the burden of decision making to the machine.2 In particular, ‘[i]f the AI-generated response is given priority above the other agents’2 and the AI makes decisions autonomously, then ‘AI paternalism’ would emerge.2 Against this possibility, the authors suggest four safeguards to be implemented in the AI life-cycle.2 These are procedures that may improve the trustworthiness of the AI and human control over it.3 We agree that it is important …. (shrink)