Alter Patient - (k)ein Grund zur Sorge?: Ethische Fragen im Lichte empirischer Daten

Zusammenfassung: Hintergrund: Die vorliegende Arbeit befasst sich mit der Frage, ob und inwiefern das Alter des Patienten bei Therapieentscheidungen eine Rolle spielt. Material und Methoden: Als empirische Grundlage werden aktuelle Daten aus 2Interviewstudien zu ethischen Fragen in der Rettungs- und Intensivmedizin bzw. der Geriatrie herangezogen sowie eine Fragebogenstudie bei Allgemeinärzten und Internisten (ambulant und stationär tätig) in 4 europäischen Ländern. Ergebnisse: Demnach besteht Evidenz, dass das Alter des Patienten faktisch durchaus ein wirksamer Faktor bei der Therapieentscheidung bis hin zum Vorenthalten adäquater Maßnahmen ist. Zu unterscheiden ist dabei zwischen einer Wirksamkeit des Faktors Alter einerseits und der Legitimation, Therapie nach dem Alter des Patienten zuzuteilen oder vorzuenthalten. Ob eine solche Unterscheidung nach Alter ethisch akzeptabel ist, wird international kontrovers beurteilt. Die Daten der Studien werden im Lichte ethischer Argumente diskutiert. Schlussfolgerung: Nach einer Übersicht über das Für und Wider der Altersrationierung wird die Schlussfolgerung vertreten, dass die Argumente gegen eine Diskriminierung nach Alter überwiegen. Die Arbeit schließt mit (ethischen) Empfehlungen für die Praxi

Ethische Kompetenz im Rettungsdienst: Ausbildung professioneller Helfer - Ergebnisse einer Interviewstudie in Basel

Zusammenfassung: Fragestellung: Ziel der Studie war es, die ethischen Dimensionen von Reanimationsentscheidungen im Rettungsdienst zu untersuchen. Methode: Ein qualitatives Studiendesign wurde entwickelt, um ethische Entscheidungskriterien, persönliche Wertvorstellungen und Bedarf an Aus- und Weiterbildung zu erfragen. Mit Rettungsdienstmitarbeitern in Basel wurden 30 strukturierte Interviews geführt und nach der qualitativen Inhaltsanalyse ausgewertet. Ergebnisse: Notärzte und Rettungssanitäter beziehen eine Vielzahl ethischer Überlegungen in ihre Entscheidungen mit ein. Die Mehrheit äußerte Interesse an ethischer Schulung oder forderte sogar eine stärkere Verankerung ethischer Inhalte in Aus- und Weiterbildung. Schlussfolgerung: Konzepte für die Vermittlung medizinischer Ethik sollten den Bedürfnissen professioneller Helfer und den besonderen Gegebenheiten des Rettungsdienstes Rechnung trage

The role of patients in European Clinical Ethics Consultation

Clinical ethics committees and consultation services have existed in many European countries for over two decades. Many different modes of operation have emerged, each reflecting a particular health and socio-political context. As additional clinical ethics services become established, the role of patients and their relatives is attracting increased attention. In North America, patient involvement has been theoretically lauded and recommended by policy, but nevertheless is often neglected in practice.1 In Europe, this issue has not yet received a great deal of attention, although the importance of listening to the patient's voice has been recognized for some time.2 Despite this, patients have diverse involvement in European clinical ethics support. Patients or their relatives can, for example: be members of a clinical ethics committee; be notified when an ethics consultation is requested; or be involved in ethical deliberation to the same extent as clinicians. At the 4th International Conference on Clinical Ethics and Consultation,3 Professor Stella Reiter-Theil convened an expert panel to discuss: ‘Whether and how to involve patients and relatives in clinical ethics support’. Panellists from across Europe4 used a case study to engage in a lively and interactive discussion on the different approaches to patient involvement in clinical ethics consultation.This article was written by Dr Ainsley Newson during the time of her employment with the University of Bristol, UK (2006-2012). Self-archived in the Sydney eScholarship Repository with permission of Bristol University, Sept 2014

The role of patients in European Clinical Ethics Consultation

editorialClinical ethics committees and consultation services have existed in many European countries for over two decades. Many different modes of operation have emerged, each reflecting a particular health and socio-political context. As additional clinical ethics services become established, the role of patients and their relatives is attracting increased attention. In North America, patient involvement has been theoretically lauded and recommended by policy, but nevertheless is often neglected in practice.1 In Europe, this issue has not yet received a great deal of attention, although the importance of listening to the patient's voice has been recognized for some time.2 Despite this, patients have diverse involvement in European clinical ethics support. Patients or their relatives can, for example: be members of a clinical ethics committee; be notified when an ethics consultation is requested; or be involved in ethical deliberation to the same extent as clinicians. At the 4th International Conference on Clinical Ethics and Consultation,3 Professor Stella Reiter-Theil convened an expert panel to discuss: ‘Whether and how to involve patients and relatives in clinical ethics support’. Panellists from across Europe4 used a case study to engage in a lively and interactive discussion on the different approaches to patient involvement in clinical ethics consultation.This article was written by Dr Ainsley Newson during the time of her employment with the University of Bristol, UK (2006-2012). Self-archived in the Sydney eScholarship Repository with permission of Bristol University, Sept 2014

Dynamic rotor mode in antiferromagnetic nanoparticles

We present experimental, numerical, and theoretical evidence for a new mode of antiferromagnetic dynamics in nanoparticles. Elastic neutron scattering experiments on 8 nm particles of hematite display a loss of diffraction intensity with temperature, the intensity vanishing around 150 K. However, the signal from inelastic neutron scattering remains above that temperature, indicating a magnetic system in constant motion. In addition, the precession frequency of the inelastic magnetic signal shows an increase above 100 K. Numerical Langevin simulations of spin dynamics reproduce all measured neutron data and reveal that thermally activated spin canting gives rise to a new type of coherent magnetic precession mode. This "rotor" mode can be seen as a high-temperature version of superparamagnetism and is driven by exchange interactions between the two magnetic sublattices. The frequency of the rotor mode behaves in fair agreement with a simple analytical model, based on a high temperature approximation of the generally accepted Hamiltonian of the system. The extracted model parameters, as the magnetic interaction and the axial anisotropy, are in excellent agreement with results from Mossbauer spectroscopy

Is the ‘Living Instrument’ Approach of the European Court of Human Rights Compatible with the ECHR and International Law?

The article offers a rebuttal of prominent criticisms directed against the ‘living instrument’ interpretative approach of the European Court of Human Rights. The paper initially introduces the basic application of the interpretative approach as adopted by the Court and then considers whether it is compatible with the Convention and broader international law. The paper argues that the Preamble, subsequent State practice and preparatory work offer inconclusive evidence to both critics and supporters of the ‘living instrument’. However, the interpretative approach can claim democratic endorsement through States, while arguments based on the necessity to consider domestic interpretation of the ECHR cannot support a restrictive interpretation as a matter of international law. The ‘living instrument’ further appears compatible in the context of state sovereignty in international law, and the broader institutional concerns with the role of judges in the adjudication of rights. Ultimately, the ‘living instrument’ interpretative approach therefore appears legal under the Convention and relevant International Law

Ethical difficulties in clinical practice : experiences of European doctors

Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services. Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent ethically difficult case and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK. Results: Survey respondents (n = 656, response rate 43%) ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority (17.6%) reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decisionmaking capacity (94.8%), disagreement among caregivers (81.2%) and limitation of treatment at the end of life (79.3%). The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct (47.5%), someone capable of providing specific advice (41.1%), help in weighing outcomes (36%) and clarification of the issues (35.9%). Few of the types of help expected to be useful varied among countries. Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries

Futility: ein Begriff im chirurgischen Alltag?

Zusammenfassung: Ethisch anspruchsvolle Indikationsstellungen bei Patienten, die ihren Willen nicht selbst äußern können, wie beispielsweise schwer demenzkranke Patienten, konfrontieren uns häufig. Es stellt sich hierbei die Frage, ob wir mit operativen Eingriffen eine Übertherapie vollziehen. Der Begriff "futility" der Medizinethik beschreibt Übertherapie, ist allerdings für eine konkrete Anwendung problematisch, da eine exakte Definition fehlt. In der klinischen Situation von schwer demenzkranken, hochbetagten Patienten muss in chirurgischen Abteilungen eine Aufarbeitung von medizinischem Hintergrund, Lebensumständen des Patienten und belegtem oder mutmaßlichem Patientenwillen erfolgen mit dem Ziel, Indikationen individualisiert zu stellen. Nur so können diese Patienten optimal versorgt werden, eine klare Kommunikation über Behandlungsziele mit Angehörigen stattfinden sowie eine Vermeidung eines "burn out" bei den Behandelnden erreicht werden. Von großem Nutzen ist hierbei eine enge Zusammenarbeit mit Medizinethiker

Complete genomic sequence of Raphanus sativus cryptic virus 4 (RsCV4), a novel alphapartitivirus from radish

The present work reports the discovery and complete genome sequencing of a virus from symptomless radish seedlings, classifiable as a novel member of the genus Alphapartitivirus, family Partitiviridae. Total RNA extracted from germinating seedlings was sequenced using Illumina technology. Bioinformatic analysis of the RNA-seq data revealed two contigs representing the near full-length genomic sequences of two genomic RNAs representing a new virus. Analysis of the genome sequence (excluding the polyA tail, RNA1: 1976 nt and RNA2: 1751 nt, respectively) showed a genomic organization typical of viruses classed within the Partitiviridae, with each genomic RNA encoding a single open reading frame (ORF). Phylogenetic analysis of the RNA dependent RNA polymerase (RNA1 ORF) and of the capsid protein (RNA2 ORF) clearly showed the new virus can be classified within the genus Alphapartitivirus, but sequence divergence establishes it as a new species, for which the name “Raphanus sativus cryptic virus 4” is proposed