Martin Woesler, Hans-Martin Sass (Hrsg) (2020) Medizin und Ethik in Zeiten von Corona

<jats:title>Zusammenfassung</jats:title><jats:p>Kaum ein Begriff der ethischen Debatten der letzten Jahre hat eine solche Konjunktur erlebt wie der Begriff der Diskriminierung. Eine vergleichende Erörterung des Konzepts einschließlich seiner begrifflichen Nuancen und seiner ethischen Bedeutung für das Gesundheitswesen fehlte jedoch bislang. Ziel dieses Beitrags ist die Entwicklung eines differenzierten Verständnisses von Diskriminierung auf der Basis der philosophischen und soziologischen Literatur vor dem Hintergrund ethisch relevanter medizinischer und pflegerischer Szenarios. Anhand von praktischen Beispielen aus dem Gesundheitswesen erörtern wir die Besonderheiten direkter, indirekter und statistischer Diskriminierung, wir untersuchen die Bedeutung von Absichten und die Rolle von kollektiven Akteuren. Zudem diskutieren wir, welche sozialen Gruppen diskriminiert werden können und welche Rolle Formen epistemischer Ungerechtigkeit dabei spielen. Argumentiert wird, dass das Konzept trotz seiner Komplexität einen signifikanten Mehrwert bietet, weil es erlaubt, Formen der Benachteiligung aufzuzeigen, die über die Verletzung einzelner spezifischer Rechte oder Interessen hinausgehen. Als wissensbasiertes System von großem gesellschaftlichen Einfluss weist das Gesundheitswesen einige Eigenschaften auf, die Diskriminierung begünstigen können. Dies zu erkennen ist unerlässlich, um Diskriminierung wirksam entgegentreten zu können.</jats:p&gt

Ethik in der ambulanten Pflege: Eine integrative Analyse unter Berücksichtigung medizin- und pflegeethischer sowie medizintheoretischer Aspekte.

Hintergrund Immer mehr pflegebedürftige Menschen werden in der Häuslichkeit durch informell Pflegende zusammen mit ambulanten Pflegediensten versorgt. Die drei Konzepte „Pflegebedürftigkeit“, „Gesundheit“ und „Krankheit“ spielen in diesem Kontext eine besondere Rolle. Über keines dieser Konzepte besteht definitorische Einigkeit; die Termini werden je nach Kontext bzw. Zweck unterschiedlich verstanden. Empirische Sozialforschung, Medizintheorie sowie Medizin- und Pflegeethik beschäftigen sich intensiv – jedoch getrennt voneinander – mit ihren Inhalten und ethischen Implikationen. Den drei Konzepten ist gemeinsam, dass deren subjektives Verständnis und normative Implikationen in der ambulanten Pflege bisher nur unzureichend analysiert wurde. Methoden In einem dreigliedrigen Projekt bestand der erste Schritt in einer Literaturrecherche mit Analyseschwerpunkt zu medizin- und pflegeethischen sowie medizintheoretischen Konzepten im wissenschaftlichen Diskurs zu Gesundheits- und Krankheitsvorstellungen. Ausgehend davon wurden die Forschungsfrage und - methode festgelegt. In einem zweiten Schritt erfolgte die empirische Exploration subjektiver Perspektiven professionell Pflegender, Pflegebedürftiger und informell Pflegender auf Pflegebedürftigkeit, Gesundheit und Krankheit in häuslichen Langzeitpflegearrangements mit Hilfe qualitativer Leitfadeninterviews. Die Auswertung der Transkripte wurde mittels qualitativer Inhaltsanalyse vorgenommen. Um Implikationen für die empirische Sozialforschung, Medizintheorie sowie Medizin- und Pflegeethik entwickeln zu können, führte ein dritter Schritt die empirischen und normativen Perspektiven zusammen. Ergebnisse Die Studie liefert empirische Ergebnisse zu den subjektiven Vorstellungen und Wahrnehmungen professionell Pflegender, Pflegebedürftiger und informell Pflegender hinsichtlich der Angemessenheit der Versorgung (1), den Vorstellungen von Gesundheit (2) und den Belastungen, die aus der häuslichen Pflegesituation resultieren (3). Zudem werden die Ergebnisse der empirisch-ethischen Analyse zu Spannungsfeldern zwischen subjektivem Krankheitsgefühl („Illness“) und anhand objektiver Kriterien festgestellter Krankheit („Disease“) geschildert und die Grenzen der moralischen Verpflichtungen zur Pflegeübernahme in der ambulanten Pflege abgesteckt. Diskussion Ein Vergleich der empirischen Ergebnisse mit existierenden normativen Leitfäden offenbart eine Diskrepanz zwischen Ist- und Sollzustand. Es wird die Bedeutung für die Praxis der empirischen Sozialforschung sowie der Medizintheorie und Medizin- und Pflegeethik abgeleitet.Background An increasing proportion of individuals in need of care are being cared for at home by informal caregivers together with home nursing services. The three concepts “care dependency”, “health” and “disease” are of outstanding importance in this context. There is no consensus on the definition of any of these concepts; the terms are interpreted differently depending on the context or purpose. Empirical social research, medical theory, and medical and nursing ethics are intensively – but independently of each other – concerned with their content and ethical implications. The three concepts have in common that their subjective understanding and normative implications in home care have been insufficiently analysed so far. Methods In a tripartite project, the first step consisted of a literature review with a focus on used within the scientific discourse on “care dependency”, “health” and “disease”in nursing ethics as well as of medical theory. On this basis, the research question, methodology and method were defined. In a second step, an empirical exploration of subjective perspectives of professional caregivers, care recipients, and informal caregivers on care dependency, health, and disease in home-based long-term care arrangements was conducted using qualitative semi-structured interviews. Qualitative content analysis according to Mayring was used to analyse the transcripts. To develop implications for empirical social research, medical theory, and medical and nursing ethics, a third step integrated the empirical and normative perspectives. Results The study provides empirical results on the subjective perceptions of professional caregivers, care recipients, and informal caregivers regarding the adequacy of care (1), the concepts of health (2), and the burdens resulting from the home care situation (3). In addition, the results of an empirical-ethical analysis of tensions fields between the concepts of “illness” (subjective experience of a loss of health) and disease (determined on the basis of objective criteria) are described. Furthermore, the limits of moral obligations to provide care in long-term home nursing arrangements are delineated. Discussion A comparison of the empirical results with existing normative guidelines reveals a discrepancy between the current situation (“is”) and the target state (“ought”). The significance for the practice of empirical social research as well as medical theory and medical and nursing ethics is demonstrated and implications for practice are drawn

Illness and disease: an empirical-ethical viewpoint

Abstract Background The concepts of disease, illness and sickness capture fundamentally different aspects of phenomena related to human ailments and healthcare. The philosophy and theory of medicine are making manifold efforts to capture the essence and normative implications of these concepts. In parallel, socio-empirical studies on patients’ understanding of their situation have yielded a comprehensive body of knowledge regarding subjective perspectives on health-related statuses. Although both scientific fields provide varied valuable insights, they have not been strongly linked to each other. Therefore, the article aims to scrutinise the normative-ethical implications of patient perspectives in building a bridge to the empirical ethics debates. Main text Three potential fields of tension between the illness and the disease perspective are presented. Consequently, findings from empirical research examining patient perspectives on illness are displayed and the practical implications and associated ethical issues which arise are discussed. This leads to the conclusion that an explicit and elaborate empirical-ethical methodology is needed to deal appropriately with the complex interaction between patients’ views and the medico-professional view of disease. Kon’s four-stage model of normative-empirical collaboration is then applied against the background of empirical data on patient perceptions. Starting from this exemplary approach, the article suggests employing empirical-ethical frameworks for further research on the conceptual and normative issues, as they help to integrate perspectives from the philosophy of medicine with socio-empirical research. Conclusion The combination of theoretical and empirical perspectives suggested contributes to a more nuanced discussion of the normative impact of patients’ actual understanding of illness. Further empirical research in this area would profit from explicitly considering potential ethical issues to avoid naturalistic fallacies or crypto-normative conclusions that may compromise healthcare practice. Vice versa, medico-theoretical debates could be enriched by integrating subjective views of those people who are immediately affected

Intensivpflege in Zeiten der COVID-19 Pandemie: Zur Frage des Verhältnisses von Fürsorge und Selbstsorge

Definition of the problem!#!The COVID-19 pandemic poses a considerable challenge to the capacity and functionality of intensive care. This concerns not only resources but, above all, the physical and psychological boundaries of nursing professionals. The question of how care for others and self-care of nurses in intensive care units are related to each other in the context of the COVID-19 pandemic has not been addressed in public and scientific discourse so far.!##!Arguments!#!The present contribution reflects this relationship with reference to the Code of Ethics of the International Council of Nurses, particularly considering principlism and the Care Ethics according to Joan Tronto. As a result, it shows a corridor of ethically justifiable care with several borders, above all: (1) self-care must not be given up completely for the benefit of care for others, and (2) a categorical subordination of care for others to self-care is ethically not justifiable.!##!Conclusion!#!The article makes an important contribution to a differentiated ethical consideration of the rights and responsibilities of intensive care nurses as moral actors within the pandemic in Germany. It, thus, provides a first starting point for a broad social and political discourse which is urgently needed not only during but also after the pandemic in order to improve the situation of intensive care nurses and those who are cared for

Healthcare professionals experiences of death: Meaning and impact

Experiences of healthcare professionals are distinct and relevant because they are frequently reminded of death and consequently of their own mortality. Healthcare professionals go through diverse and sometimes very difficult emotions when a patient dies, because their perspective is characterized by the proximity to the dying person and his or her relatives. They feel involved and bring their own ideas of and attitudes towards death in. These attitudes can be influenced by cultural, social, philosophical and religious belief systems and previous experiences and affect the care for dying individuals and their families. Repeated death confrontation is part of the professional role and it follows that these individuals must have at the least an implicit knowledge and understanding of what “death of the other” means to them. This "meaning making" is colsely interwoven with the potential risks of death confrontation such as burnout, compassion fatigue and poor quality of care. However, most of the scientific discourse focusses on questions of a "good death" and "good dying" and there is a lack of knowledge on what death itself means to the professionals involved

Adequacy of care provision in long‐term home nursing arrangements: A triangulation of three perspectives

Abstract Background A growing proportion of older people in Germany receive long‐term care from informal and professional caregivers at home. Their personal assessment of the individual care situation is scarcely considered. Aim This study aimed to explore the subjective views of care recipients, informal and professional caregivers on the adequacy of care provision in long‐term home care arrangements. Design and Methods Qualitative semi‐structured face‐to‐face interviews were conducted with ten care recipients, ten professional caregivers and eight informal caregivers to capture their perspectives on the adequacy of the care received and delivered. Qualitative content analysis was applied using MAXQDA software. Results All groups highlighted that they perceive an underprovision of care, even though their explanations differed. The underprovision was mainly described regarding the quality rather than quantity of services. It occurs especially in interpersonal relationships and social inclusion, where the gap between the self‐perceived current situation and the desires of those affected is most prominent. The ambivalent impact of home care on social participation becomes apparent. Perceptions of an overprovision of care range from the view that it appears mainly with respect to informal care to the statement that it is currently non‐existent or generally impossible. Misprovision of care is experienced as serious whenever the interviewees face the challenge of preserving existing abilities or regaining certain skills

Ethics and (Inter-)Professionalism in Health Care at the End of Life:A Position Paper

This position paper summarizes key results from the workshop “Professional Ethics at the End of Life” held from 27 May to 1 June 2019 in Greifswald (Germany). An international group of 13 young scholars from six countries and various healthcare-related disciplines (e.g. nursing, medicine, philosophy, theology, gerontology, psychology) met to discuss ethical issues in patient care at the end of life. A special focus of the workshop was on international comparisons and the roles and moral obligations of health-care professionals. The need for interprofessional dialogue and family involvement emerged as key factors for patient-centred, holistic care at the end of life. Further main results were collected from the participants subsequent to the workshop, arranged regarding content and further circulated and revised within the group. The position paper, therefore, represents the views of young health-care researchers and practitioners with respect to the current status and further perspectives of professionalism and interprofessional care at the end of life. It can serve as a starting point for scientific and political debates on moral obligations, professional practice and health-care structures

[Children visiting intensive care units and emergency departments : Kids are welcome!].

In this white paper, key recommendations for visitation by children in intensive care units (ICU; both pediatric and adult), intermediate care units and emergency departments (ED) are presented. In ICUs and EDs in German-speaking countries, the visiting policies for children and adolescents are regulated very heterogeneously: sometimes they are allowed to visit patients without restrictions in age and time duration, sometimes this is only possible from the age of teenager on, and only for a short duration. A request from children to visit often triggers different, sometimes restrictive reactions among the staff. Management is encouraged to reflect on this attitude together with their employees and to develop a culture of family-centered care. Despite limited evidence, there are more advantages for than against a visit, also in hygienic, psychosocial, ethical, religious, and cultural aspects. No general recommendation can be made for or against visits. The decisions for a visit are complex and require careful consideration