Rationierung von Gesundheitsleistungen aus Altersgründen? Perspektiven theologischer Ethik unter Berücksichtigung intergenerationeller Gerechtigkeit

Die Verteilung knapper bzw. als knapp erachteter Gesundheitsgüter stellt uns vor ethische Herausforderungen: Nach welchen Kriterien sollen Güter zugeteilt werden? Auf der Basis welcher normativer Vorüberlegungen lassen sich solche Kriterien entwickeln? Wie unterscheiden sich diese normativen Vorüberlegungen, wie unterscheiden sich die daraus resultierenden Kriterien der Zuteilung voneinander? Welche Kriterien entwickelt eine theologische Ethik, die ihren Orientierungsmaßstab in der Heiligen Schrift findet? Im vorliegenden Beitrag werden aus dem alttestamentlichen ‚Elterngebot‘ Maßstäbe für eine gegenwärtige theologisch-ethische Beurteilung der Einbeziehung eines Alterskriteriums bei Verteilungsfragen im Gesundheitswesen entwickelt. Die bisweilen einseitige Darstellung des höheren Anteils älterer Menschen an der Gesamtzahl der Versicherten als Grund für die Überlastung der GKV wird dabei ebenso kritisiert wie die Auffassung, Alter sei ein besonders gerechtes Rationierungskriterium, weil diese Lebensphase prinzipiell allen Versicherten bevorstehe. In Auseinandersetzung mit anderen, nicht-theologischen ethischen Grundlagentheorien wird schließlich eine ‚kontextsensible, aber nicht begründungsvergessene‘ theologisch-ethische Perspektive skizziert, die insbesondere vor den Folgen eines konstruierten Generationenkonflikts warnt und demgegenüber einen ‚Generationen integrierenden und differenzierenden Grundsatz der Befähigungsgerechtigkeit‘ in den Mittelpunkt stellt

Privacy revisited? Old ideals, new realities, and their impact on biobank regimes

Biobanks, collecting human specimen, medical records, and lifestyle-related data, face the challenge of having contradictory missions: on the one hand serving the collective welfare through easy access for medical research, on the other hand adhering to restrictive privacy expectations of people in order to maintain their willingness to participate in such research. In this article, ethical frameworks stressing the societal value of low-privacy expectations in order to secure biomedical research are discussed. It will turn out that neither utilitarian nor communitarian or classical libertarian ethics frameworks will help to serve both goals. Instead, John Rawls’ differentiation of the “right” and the “good” is presented in order to illustrate the possibility of “serving two masters”: individual interests of privacy, and societal interests of scientific progress and intergenerational justice. In order to illustrate this counterbalancing concept with an example, the five-pillar concept of the German Ethics Council will be briefly discussed

Primer on an ethics of AI-based decision support systems in the clinic

Making good decisions in extremely complex and difficult processes and situations has always been both a key task as well as a challenge in the clinic and has led to a large amount of clinical, legal and ethical routines, protocols and reflections in order to guarantee fair, participatory and up-to-date pathways for clinical decision-making. Nevertheless, the complexity of processes and physical phenomena, time as well as economic constraints and not least further endeavours as well as achievements in medicine and healthcare continuously raise the need to evaluate and to improve clinical decision-making. This article scrutinises if and how clinical decision-making processes are challenged by the rise of so-called artificial intelligence-driven decision support systems (AI-DSS). In a first step, this article analyses how the rise of AI-DSS will affect and transform the modes of interaction between different agents in the clinic. In a second step, we point out how these changing modes of interaction also imply shifts in the conditions of trustworthiness, epistemic challenges regarding transparency, the underlying normative concepts of agency and its embedding into concrete contexts of deployment and, finally, the consequences for (possible) ascriptions of responsibility. Third, we draw first conclusions for further steps regarding a 'meaningful human control' of clinical AI-DSS

Transparent human – (non-) transparent technology? The Janus-faced call for transparency in AI-based health care technologies

The use of Artificial Intelligence and Big Data in health care opens up new opportunities for the measurement of the human. Their application aims not only at gathering more and better data points but also at doing it less invasive. With this change in health care towards its extension to almost all areas of life and its increasing invisibility and opacity, new questions of transparency arise. While the complex human-machine interactions involved in deploying and using AI tend to become non-transparent, the use of these technologies makes the patient seemingly transparent. Papers on the ethical implementation of AI plead for transparency but neglect the factor of the “transparent patient” as intertwined with AI. Transparency in this regard appears to be Janus-faced: The precondition for receiving help - e.g., treatment advice regarding the own health - is to become transparent for the digitized health care system. That is, for instance, to donate data and become visible to the AI and its operators. The paper reflects on this entanglement of transparent patients and (non-) transparent technology. It argues that transparency regarding both AI and humans is not an ethical principle per se but an infraethical concept. Further, it is no sufficient basis for avoiding harm and human dignity violations. Rather, transparency must be enriched by intelligibility following Judith Butler’s use of the term. Intelligibility is understood as an epistemological presupposition for recognition and the ensuing humane treatment. Finally, the paper highlights ways to testify intelligibility in dealing with AI in health care ex ante, ex post, and continuously

Towards a smart glasses society? Ethical perspectives on extended realities and augmenting technologies

The release of Apple Vision Pro in early February and the subsequent media coverage have pushed Mixed Reality (MR) and augmenting technologies into public consciousness, raising the question of whether we are moving towards a “smart glasses society” where wearing MR-devices in public becomes commonplace, and regularly engaging with extended realities will be part of our everyday experience. This paper delves into the ethical implications of this potential development, scrutinizing the effects smart glasses may have on our humanity, our relation to the world, and our shared-life world. It calls for a nuanced approach that earnestly engages with these concerns while maintaining a composed outlook, recognizing that many of these issues discussed in the context of immersive technologies, although they seem new, have been with us for quite some time

Own Data? Ethical Reflections on Data Ownership

Abstract In discourses on digitization and the data economy, it is often claimed that data subjects shall be owners of their data. In this paper, we provide a problem diagnosis for such calls for data ownership: a large variety of demands are discussed under this heading. It thus becomes challenging to specify what—if anything—unites them. We identify four conceptual dimensions of calls for data ownership and argue that these help to systematize and to compare different positions. In view of this pluralism of data ownership claims, we introduce, spell out and defend a constructive interpretative proposal: claims for data ownership are charitably understood as attempts to call for the redistribution of material resources and the socio-cultural recognition of data subjects. We argue that as one consequence of this reading, it misses the point to reject claims for data ownership on the grounds that property in data does not exist. Instead, data ownership brings to attention a claim to renegotiate such aspects of the status quo

Data sovereignty: A review

New data-driven technologies yield benefits and potentials, but also confront different agents and stakeholders with challenges in retaining control over their data. Our goal in this study is to arrive at a clear picture of what is meant by data sovereignty in such problem settings. To this end, we review 341 publications and analyze the frequency of different notions such as data sovereignty, digital sovereignty, and cyber sovereignty. We go on to map agents they concern, in which context they appear, and which values they allude to. While our sample reveals a considerable degree of divergence and an occasional lack of clarity about intended meanings of data sovereignty, we propose a conceptual grid to systematize different dimensions and connotations. Each of them relates in some way to meaningful control, ownership, and other claims to data articulated by a variety of agents ranging from individuals to countries. Data sovereignty alludes to a nuanced mixture of normative concepts such as inclusive deliberation and recognition of the fundamental rights of data subjects

Playing God? Synthetic biology as a theological and ethical challenge

In the ethical debate over synthetic biology the formula “playing god” is widely used in order to attack this new branch of biotechnology. The article analyses, contextualizes and criticises this usage with respect to the theological concepts of creation, sin and humans as created in the image of God. Against the background of these theological understandings an ethical corridor of how to responsibly cope with the societal challenges of synthetic biology is presented

Risikoadaptierte Prävention: Governance Perspective für Leistungsansprüche bei genetischen (Brustkrebs-)Risiken

Risikoadaptierte Prävention; Governance Perspective; Gesundheitspolitik; deutsches Gesundheitswesen; Systemmedizin; Big Data; bioinformatischer Innovationsschub; genetische Brustkrebsrisiken; Hereditärer Brustkrebs; Prophylaktische Operationen; BRCA; Leistungsanspruch; Medizinrech

Risikoadaptierte Prävention: Governance Perspective für Leistungsansprüche bei genetischen (Brustkrebs-)Risiken

Die vorliegende Studie empfiehlt, Leistungsansprüche für Personen mit interventionsfordernden (Brustkrebs-)Risiken anhand einer neuen Rechtskategorie, der ‚risikoadaptieren Prävention‘, abzubilden. Spätestens seit dem bioinformatischen Innovationsschub (Big Data) kann eine risikoadaptierte Anwendung von prophylaktischen Maßnahmen umfassend gewährleistet werden. Jedoch können die gegebenen Rechtskategorien (primäre Prävention, Vorsorge, Krankenbehandlung) das medizinische Anwendungsfeld nicht adäquat steuern