Involving Others: Towards an Ethical Concept of Risk

Dr. Rehman-Sutter argues for a juridical concept of risk as it relates to an ethic of care. He also contrasts his view with traditional economic risk analysis

Würde am Lebensbeginn: Der Embryo als Grenzwesen

Zusammenfassung : Ethische Fragen in Bezug auf den Umgang mit menschlichen Embryonen in vitro stellen sich heute vor allem im Zusammenhang mit der Reproduktionsmedizin, der Präimplantationsdiagnostik und der Stammzellforschung. Aus biologischer, politischer und fortpflanzungsmedizinischer Sicht wird der Embryo in unterschiedlichen Diskursen thematisiert. Zur Perspektive der Patienten in fortpflanzungsmedizinischer Behandlung werden empirische Untersuchungen ausgewertet. Ausgehend von diesen unterschiedlichen Diskursen und Perspektiven, untersucht der vorliegende Beitrag, wie sich die ethische Verantwortung in Bezug auf Embryonen in vitro verstehen lässt. Der Beitrag betont den Aspekt der Beziehung. Im Zusammenhang mit der aktuellen Diskussion über den Status von Embryonen unterscheidet er 4 Bedeutungen von "Potenzialität" des Embryos: (a) die äußere Potenzialität, (b) die Tendenz für einen Entwicklungspfad, (c) die transitive Bestimmung durch ein Programm und (d) die Präformation. (a), (c) und (d) werden aus unterschiedlichen Gründen zurückgewiesen. Auf der Grundlage einer Potenzialität im Sinn von (b) wird der Embryo als ein sich entwickelndes Wesen beschrieben, das die Entwicklungsfähigkeit stetig weitergibt ("Selbst-Transzendenz") und auf dem Weg ist, ein Mensch zu werden. Dies wird als Grund dafür dargestellt, dass die Verantwortung für Embryonen in der Anerkennung einer wachsenden und mit der Nähe zur Geburt intensiver werdenden intrinsischen Würde lieg

Learning global solidarity in the Covid-19 pandemic?

In a letter published on March 30, 2021, 24 world leaders have called for global solidarity in the fight against the Covid-19 pandemic. This commitment to act in solidarity with low-income countries however was won under duress, and it was in part at least self-serving. Can this still be called solidarity? On the basis of a functional view on solidarity the paper argues that states can indeed act in solidarity, if they accept costs to assist others with whom they recognize similarity in a relevant respect. States can act in solidarity, or they can fail to act in solidarity, also in situations of duress and if solidary acts also serve their own interests. The paper concludes that if this is true for the Covid-19 pandemic it is also true for the climate crisis, where damage of even much bigger dimensions are to be prevented. Also in regard to anthropogenic global heating, nobody is safe until everyone is safe

Patients' and professionals' views related to ethical issues in precision medicine: a mixed research synthesis

Results Many patients and professionals expect high benefits from precision medicine and have a positive attitude towards it. However, patients and professionals also perceive some risks. Commonly perceived risks include: lack of evidence for accuracy of tests and efficacy of treatments; limited knowledge of patients, which makes informed consent more difficult; possible unavailability of access to precision medicine for underprivileged people and ethnic minorities; misuse of data by insurance companies and employers, potential of racial stigmatization due to genetic information; unwanted communication of incidental findings; changes in doctor-patient-relationship through focusing on data; and the problem that patients could feel under pressure to optimize their health. Conclusions National legislation and guidelines already minimize many risks associated with precision medicine. However, from our perspective some problems require more attention. Should hopes for precision medicine's benefits be fulfilled, then the ethical principle of justice would require an unlimited access to precision medicine for all people. The potential for autonomous patients' decisions must be greatly enhanced by improvements in patient education. Harm from test results must be avoided in any case by the highest possible data security level and communication guidelines. Changes in the doctor-patient relationship and the impact of precision medicine on the quality of life should be further investigated. Additionally, the cost-effectiveness of precision medicine should be further examined, in order to avoid malinvestment

Clinicians' and Researchers' Views on Precision Medicine in Chronic Inflammation: Practices, Benefits and Challenges

(1) Background: Due to the high burden of diseases with chronic inflammation as an underlying condition, great expectations are placed in the development of precision medicine (PM). Our research explores the benefits and possible risks of this development from the perspective of clinicians and researchers in the field. We have asked these professionals about the current state of their research and their expectations, concerns, values and attitudes regarding PM. (2) Methods: Following a grounded theory approach, we conducted qualitative interviews with 17 clinicians and researchers. For respondent validation, we discussed the findings with the participants in a validation workshop. (3) Results: Professionals expect multiple benefits from PM in chronic inflammation. They provided their concepts of professionals' and patients' work in the development of PM in chronic inflammatory diseases. Ethical, process-related and economic challenges were raised regarding the lack of integration of data from minority groups, the risk of data misuse and discrimination, the potential risk of no therapy being available for small strata, the lack of professional support and political measures in developing a healthy lifestyle, the problem of difficult access to the inflammation clinic for some populations and the difficulty of financing PM for all. (4) Conclusions: In the further research, development and implementation of PM, these ethical challenges need to be adequately addressed

Views on disability and prenatal testing among families with Down syndrome and disability activists: a comparative analysis of interviews from Germany and Israel

The prenatal genetic testing arena has witnessed great changes over the past decades and has been the focus of extensive discussion of its ethical, legal, and social implications. Germany and Israel were previously known for strongly contrasting regulations and attitudes of both professionals and laypeople towards genetic testing. Based on qualitative analysis of 37 semi-structured interviews, this study compares German and Israeli family members of individuals with Down syndrome and disability activists, thereby examining the interplay between lived experience and cultural scripts and their impact on the formation of personal views toward disability and prenatal testing. We have found that the differences between Germany and Israel remain, despite the emergence of new technologies, and that family members and disability activists reflect the norms of their socio-cultural environments, thereby emphasising the role society plays in shaping the views of those with direct experience of disability

What does prenatal testing mean for women who have tested?

We have conducted and analysed 49 qualitative interviews with women in Germany and Israel who had actually taken a prenatal test. The analysis was focussed on the meanings attributed to testing, i.e. their reasons and aims of testing. Seven typical meaning patterns have been found. They range from seeking empowerment from the knowledge gained, avoiding suffering, being prepared for a child with special needs to satisfying the social environment, or fulfilling the physician's recommendation. The findings give insight into the hermeneutics of testing from the point of view of those who have tested